GMOA: Look back, re-think

Despite 70 years of independence, as a developing country, Sri Lanka remains poor, lagging far behind countries that were on par with us such as Singapore, and Malaysia. As a trade union representing an elite section of this nation, the Government Medical Officers’ Association (GMOA), should shoulder a significant social responsibility to ensure that our country is travelling in the right direction towards economic and social development. In recent times, unfortunately, the actions of the GMOA do not seem to be much nation friendly. Instead, it has propagated a downhill drive towards poverty, chaos, inequality and corruption.

Developed countries first established social norms that form the basis of development. The civil society takes politically unbiased planned action to resolve issues that erode their standards of living and strive to innovate for their well-being. Health care, Education, Law and Order (discipline), and Research and Innovation, and Peace are the fundamental pillars of development they strive to uphold. The national administrative structure is organised to assist, adore and reward contributions and contributors to the above norms. After a half a century of trade unionism, the GMOA is yet to at least complement its own members who contributed nationally.

Just think for a moment. The luxurious items that you consider essential for your lifestyle today, the trains, planes and cars, electricity, smart phones, computers, air conditioners, refrigerators, television, radio etc. These are all innovations made elsewhere that we purchase from the innovators to sustain our comfortable lifestyles, and often at the expense of the poor. At the same time, it is unfair that we block all avenues available and fundamental for education and innovation, and promote further suffering of the innocent. Stable government means stability in the above fundamental needs of a nation. If there is no stability on the above, I am afraid our future is bleak. That is why, this appeal to the GOMA and to its membership.

Provision of health care is a priority and education is a must for development. There is no country in the world that has developed without this. London and Paris are extravagant cities in the world that people adore to live or visit. These cities together constitute a population of 20 million, similar to ours in Sri Lanka. Yet, we have startling differences in living standards. The secret is the skill set of their citizens acquired via constant training. We too need skills and education to compete and achieve such living standards for all, at least for our next generation.

Politicians have different views, muffled by their personal agendas, and exploited for their personal gain. But, an elite organization such as the GMOA should be above this level of mediocre thinking. Unfortunately, despite your daily media justifications, current politicisation of the GMOA as an organisation is too obvious. This is because your actions neither serve the interests of the public nor that of your members.

Just look back and reflect upon the contributions the GMOA has made as an organisation over the last few decades, for national development. This is not about the GMOA’s individual members’ national achievements that are based mostly on voluntary contributions and personal perseverance. I can only recall criticisms and obstructions mounted by the GMOA as an organisation against many of the constructive projects, sometimes initiated and supported by its own members. Instead of helping their members to strive and install necessary changes, the GMOA has often harassed and obstructed them. Although its members contribute to exemplary teaching at various levels in the country, as an organization, the GMOA has not been education friendly. The GMOA protested against the establishment of the Post Graduate Institute of Medicine (PGIM) in 1980’s and even issued death threats to students who participated in its early MD examinations. Today, the PGIM is the temple of postgraduate medical education in this country. It opposed Assistant Medical Practitioner (AMP) education and brought it to a grinding halt at a time when we are grossly short of doctors, and even to date the situation has not changed. Careful planning and installation of service protocols could have easily utilized AMP services, without opening avenues for ‘quacks’ to practice unorthodox medicine in rural and sometimes less affluent parts of the city. The GMOA opposition to the beginning of the lifesaving renal transplant program in Kandy and Peradeniya hospitals in early 2000 is not forgotten. The background of competence created for transplantation then has today led to a new era of heart transplantation in the same hospital. The GMOA vehemently opposed the inauguration of BSc education programs for nurses and allied health professionals in 2006. It’s the Supreme Court that allowed those talented students any breathing space to continue their education in 2007. These graduates are now a great asset to the National Health Service. The GMOA also opposed a competence based critical care education program designed by the PGIM for its very own junior doctors in 2010. As a result, we are yet to install a fully-fledged, competence based critical care specialist education program in this country. Just imagine the number of lives we could have saved on dengue alone if we had such professionals who received competency based training in this country today, who can lead advanced critical care services. Lately, the GMOA via its links to ‘anthare’ has now intimidated medical students and kept them away from education for over 6 months using the same tactics of fear of reprisals, intimidation and withdrawal of teacher support. The same prongs were used against the AHS students in 2006 delaying their education. A sad covert purpose seems to be to mastermind a new heath care crisis in a few months, as there will be no newly qualifying doctors to take over internship service positions in our hospitals. Sadly, the cost of this will eventually have to be borne by the nation, and the medical students and patients themselves, and not by the GMOA.

I recall very well in the late 1990’s, the then presidet of the GMOA campaigning to curtail all advancement in health care services led by university medical staff. For example, a trauma high dependency care unit planned and built at Peradeniya was downgraded to general wards. As a result, the consulting rooms also had piped oxygen. What a waste of planning and resources. The Sirimavo Bandaranaike Children’s Hospital, funded and built by the people of the Central Province, was acquired and made a no-go area for any medical students, undergraduate or postgraduate, bringing it down to a non-specialist paediatric service amidst major allegations of corruption. Ironically, it’s the then president of the GMOA, who is now leading the SAITM as the Vice Chancellor. There appears to be one thing in common. Disagree to agree, promote indiscipline and inequality, and claim credit for the damage done.

Health is the wealth of the nation. Our national free health service was world renowned as it contributed significantly to our national health improvements, led by the GMOA’s own members and all other patriotic health care professionals of this country. In the last two decades, due to increased number of strike actions, the trust that the public has on our national health care system has diminished. As a direct consequence, the private health care has flourished and today, more than 50% health care expenditure of this country is now privately funded. The service rendered is increasingly trade-union centred, instead of being patient-centred. This is driving our health care towards a chaotic ill significant service, similar to that of our neighbouring India. Thus, medicine will become a true business rather than a service, where everyone will have to pay for advanced treatments, only offered in private health care institutions. As the name implies, your membership, the Government Medical Officers are fully funded by the public. With increasing mishaps in the health care service, it is unlikely that the public would want to continue funding a service that is haphazard, callous and unfriendly. If so, the employment prospects of your members in the National Health Service will also be in jeopardy in the future. We need to maintain the trust of the public, to ensure survival of our much loved free health care service.

Our free education is now in turmoil with students wasting their precious time on the roads protesting on various issues, not directly relevant to them. Very often the protesters do not understand why they are protesting. They are painted a future of doom and gloom, filled with intimidation and harassment in their university life, if they do not cooperate. The recent medical student boycott is also based on the same principle. Would sabotaging student learning help us achieve the highest standards of living? Medicine is advancing so fast with a 50% change in medical knowledge every 5 years. Thus, medical education cannot advance in a snail pace on and off. It is now a lifelong learning process. There is no time to pause.

Our national health service has a wealth of information for research and innovation, but sadly not used for national benefit. It is a wasted resource. The GMOA has offered little encouragement to its members to engage in research, unlike, for example, British Medical Association of doctors. Also, the GMOA, has offered little assistance to its members, for example, secure study leave, conference leave etc. Instead, it openly destroyed any new development; see the end result of the renal unit at Maligawatte, and the Toxicology Unit at Peradeniya.

The GMOA, it is too obvious that your actions are politically motivated and biased rather than professionally triggered. For example, the Sri Lanka Medical Council is the organisation that should maintain discipline of doctors and ensure their quality of training. Visiting its chairman openly, accompanied by the media, is a display of callous disregard to its fundamental purpose of establishment; i.e. governance of doctors to maintain professionalism.

Undergraduate medical education in the world has now been mostly transformed to that of a combined science graduate degree, recognising the need for a basic science background for the advancement of medical science. Today, the ‘graduate’ medical students, intercalated with B Sc programs are excelling themselves in the developed world to lead medical understanding and therapy to an extra-ordinarily high level. Yet, we are fighting tooth and nail, across the country, to block all other opportunities for competitive medical education in an environment of gross shortage of doctors. I can only imagine the protests that you would mount if a graduate medical student entry was proposed to medical schools?

Sri Lanka is struggling to keep up its ranks in the world of education, both in quality and quantity. In medicine, we are still short of the entire scope of health care workers. Thus, the Ministry of Health is limited in its capacity to provide quality health services to our citizens who deserve a return for the taxes they pay to fund it.

A country needs research and innovation in its forefront. We are getting extremely good at leading protest campaigns, designed to keep us out of ‘work’. We demand better standards of living, from the government, day and night, without realising that a government can only spend the money that we earn as a nation. If we do not work, there shall be no money for the government and there shan’t be any welfare coming our way, however much we protest. Sri Lanka has a long way to go, with only 5% (1 in 20) of its population entering university education, whereas in the developed world at least 40% (1 in 3) of the population has a university degree. It is not the degree that brings income, but the effective use of the skills gained through credible university education, which is now at stake. The need for constantly modernized, and competitive university study programs is paramount. This is not achievable without both educators and students being more accountable and responsible to the public for their duty and role. Thus, ‘free’ education cannot be free of obligation. Student democracy is not a ‘free ticket’ for relentless disruption and protest against the duly elected establishment.

More and more industrial action will only bring more misery to the public and their trust, and less willingness to fund the ‘free health’ as opposed to private health insurance. Similarly, as we have already seen, bringing education to a halt in universities will make these education programs less attractive and less worthy of public expenditure. This will lead to the end of free-education too. The GMOA may not foresee these to happen in the short-term, but certainly would witness it in retirement. It seems to me that the GMOA actions are premediated to lay the foundation for the demise of both free education and free health care in this country.