Enough with Tinsel Kings of medicine

The mafia type GMOA leadership declared a week ago they would go on an indefinite strike, if Prof. Carlo Fonseka was not re-appointed as Chairman of the SLMC. 

They opposed any other appointment, including that of Prof. Colvin Gunaratne. They want the people to believe it is only they who know what’s right and what’s best and have the undisputed right to decide on everything that’s health.

The octogenarian that Prof. Carlo Fonseka is, he had told the GMOA leadership he couldn’t be a guiding force in the SLMC anymore with his feeble health. That sanity in him, made him reject the decision of the GMOA on his re-appointment. The GMOA leadership thus lost their battle to hold its grip tight over the SLMC as expected. 

They then opted for a “Waterloo”. Flanked by the Joint Opposition, the JVP, the FSP and ‘memberless’ TU leaders, the GMOA leadership told media if SAITM was not abolished, the Government would be toppled. 

Finally the Rajapaksa in them spoke openly.

The GMOA has now forgotten they opposed the appointment of Prof. Carlo Fonseka in 2012 January, on the basis that the SLMC should be devoid of politics. Then Additional Secretary of the GMOA Dr. Upul Gunasekera told media, they therefore wanted Prof. Lalitha Mendis re-appointed. He also told media the GMOA had sought a meeting with President Rajapaksa to sort out the issue.
Unfortunately for the GMOA leadership, that was not “Kurahan” for Rajapaksa. They thereafter meekly accepted Prof. Carlo Fonseka. 

Thirteen years later they met on the same political track after Rajapaksa was defeated in 2015 January and in August Parliamentary elections. Thereafter Prof. Carlo Fonseka saddled himself firm, on the donkey the GMOA brought on the track. That is the only reason the GMOA now wants Prof Carlo Fonseka for.

The GMOA believes unlike with Rajapaksa they now bray for, they can threaten this Government to have their decision implemented. 

The appointment of Prof. Colvin Gunaratne as Chairman, SLMC can be stopped by declaring an indefinite work stoppage. 

There is a marked difference though. Prof Colvin Gunaratna has proved he could not be influenced or coerced in anyway, to abandon his principled positions. That is precisely what the GMOA cannot live with

What is less in Prof. Colvin Gunaratna that Prof. Carlo Fonseka has? 
There is a marked difference though. Prof Colvin Gunaratna has proved he could not be influenced or coerced in anyway, to abandon his principled positions. That is precisely what the GMOA cannot live with.

This society is to be blamed for allowing this GMOA leadership’s underworld behaviour. They live that way by driving home the message the medical doctors are indispensable and the people tend to believe it. 

The implied message is that the entire health sector would grind to a halt without them. But that is not the truth. 

On their own they simply cannot manage even a hospital ward. The Out Patients can be handled even with Assistant Medical Officers (AMOs).

The truth is, it is without other supplementary staff like nurses, medical laboratory technicians, radiologists, pharmacists and also the attendants that a hospital cannot be managed. 
It is also a fact, these auxiliary staff can on their own, easily manage a hospital ward without a medical doctor and they have been doing so, every time these doctors go on wildcat strikes.

• Finally the Rajapaksa in them spoke openly.
• Time to look at AMOs and RMOs?
• Message is the entire health sector would grind to a halt without them. But that is not the truth. 
• On their own they simply cannot manage even a hospital ward.
• The Out Patients can be handled even with Assistant Medical Officers (AMOs).
• It is without other supplementary staff -like nurses, medical laboratory technicians, radiologists, and attendants -that a hospital cannot be managed. 
• It is also a fact, these auxiliary staff can on their own, easily manage a hospital ward without a medical doctor 
• A vast number of MBBS doctors don’t specialise 
• There are 18,345 registered medical doctors in Government service but only 1,739 specialists cover 49 specialist areas.
• In some specialisations like Paediatrics and Neurology there are only five in the public service, including GMOA boss Dr. Padeniya. Only four Thoracic Surgeons, 12 Neuro Surgeons, 19 Genito-Urinary Surgeons for the whole island. 

Role and competence of medical doctors are heavily amplified. That was aptly described by Medical Consultant and academic, Gynaecologist Dr. Pradeep de Silva in the Lankadeepa of July 4, 2017. 
I would quote him here for the benefit of English readers, who may have missed his well articulated, informed explanations contradicting all what the GMOA says about medical doctors.

“The MBBS doctor can be compared to a seasoned ball of clay. That’s not rough. If one wishes, a flower pot can be moulded out of it, or even a plate. It means, he or she with a good quality MBBS degree and with capability, can be trained and guided to perform many things at many levels. 
“That is the first argument. But that is not what the GMOA is saying. What they say is, an MBBS degree holder can perform anything. That is wrong. For example, we can train an MBBS doctor as an Anaesthetist. S/he can then anaesthetise. But cannot perform surgery,” wrote Dr. de Silva.

A vast number of MBBS doctors don’t specialise and thus remain ‘clay balls’. While there are 18,345 registered medical doctors in Government service, there are only 1,739 specialist doctors that cover 49 specialist areas. In some specialisations like Paediatric Neurology there are only five  in public service, including GMOA boss Dr. Padeniya. 

Only four Thoracic Surgeons, 12 Neuro Surgeons, 19 Genito Urinary Surgeons for the whole island. 
There are many such specialist areas with less than a dozen Consultants for the entire island.
Of those 18,345 medical doctors, more than 3,000 are reported idling for years without completing their post graduate degrees, for which they have been released from service. 

Added are those thousands who sit as health administrators, numbers the Health Ministry officials (Medical Doctors themselves) don’t provide even on RTI requests. It is these medical doctors in administration the GMOA uses for its strength in intimidating Governments.

The present and the past prove society doesn’t have to produce these MBBS “clay balls” at a heavy cost, when their worth is nothing more than that of AMOs. Or that of Administrative Officers in Government Departments.

Sri Lanka’s high quality health standard was also not achieved with MBBS doctors. In 1869 the British colonial Governor Hercules Robinson introduced the AMO Service for which the head of the Civil Medical Department, Dr. W.R. Kynsey helped establish the Colombo Medical School in 1870. 
A research paper for the “Journal of Inter-professional Care” titled The Assistant Medical Officer in Sri Lanka; Mid level health worker in decline by Dr. Vijitha de Silva of the Medical Faculty of Ruhuna University, Dr. Mahinda Liyanage of Kadugannawa District Hospital with two academics from the Department of Community and Family Medicine, Duke University Medical Centre, Durham, NC, USA, published in May 2013 says:

“This AMO training program consisted of one year at the medical college followed by six months of clinical training. The curriculum included structure and function of the body (anatomy and physiology), nutrition, biochemistry, pharmacology and pharmacy, microbiology, parasitology, pathology, community medicine, medicine, surgery, paediatrics, gynaecology and obstetrics.”

“For almost 150 years, the services of AMOs were an integral part of Sri Lanka’s health sector. Throughout this period, most of the government central dispensaries and maternity homes (Approximately 380) distributed across the island were run by AMOs and RMOs. In addition some rural and peripheral hospitals were managed by them.” 

For 150 years the AMOs provided this care in remote areas and were the practitioners, who staffed the outlying hospitals and Out Patient clinics until in 1995 the Chandrika Kumaratunge Government abandoned AMO training

The paper also says, it was since 1960 the medical graduates (MBBS) outnumbered AMOs in service.
And then, a WHO report (Public Health Success in Sri Lanka) published in 2016 says:
“A highly trained workforce including Public Health Inspectors, midwives and local volunteers ran social mobilisation campaigns to ensure the success of the mass drug administration (MDA) campaigns in endemic areas”. 

All undisputed proof, we achieved our quality health standard in eliminating epidemics purely on committed work of the Public Health Sector with trained staff and not with medical doctors, who don’t ever sign an attendance register but collect overtime for hospital work and appear more in private practise and channel services.

It is also the national education system that helped develop a very literate society, which contributed for improved health indicators by 1960. 

And this literate society was educated on health and hygiene, was provided with drinking water and sanitation facilities, all outside hospital work.

“A highly trained workforce including Public Health Inspectors, midwives and local volunteers ran social mobilisation campaigns to ensure the success of the mass drug administration (MDA) campaigns in endemic areas”. 

The AMO model was no unique concept. It was what China developed as “Barefoot doctors”. In Spain they were “practicante” and adopted in their colonies too. By 1960 it was further developed as “Physician Assistants” in the USA, Canada, UK and Australia. The logic is, instead of incurring a heavy cost in producing MBBS degree holders to take care of primary health, the same can be achieved and efficiently too by AMOs at a much lower cost. 

The research paper quoted earlier establishes the fact: 
“For 150 years the AMOs provided this care in remote areas and were the practitioners, who staffed the outlying hospitals and Out Patient clinics until in 1995 the Chandrika Kumaratunge Government abandoned AMO training.”

It is with such elimination and restriction of supportive medical staff the MBBS doctors through their GMOA have come to monopolise the health sector with no added benefits, but a burden to society. 
This monopolising has robbed them of professional ethics and morals too and the society is left with a plethora of medical practitioners who are awfully selfish, greedy and arrogantly dumb.
It is therefore time, to raise two major issues that require answers for posterity. 

It is with such elimination and restriction of supportive medical staff the MBBS doctors through their GMOA have come to monopolise the health sector with no added benefits, but a burden to society. 

One is that of the SLMC. Policy making is the responsibility of the Government and it is for that a Government is elected. The SLMC is a regulatory body and has to be efficiently limited to that. Therefore the Health Minister should 

(01) Immediately appoint Prof. Gunaratne its Chairman with a mandate and a firm decision to re-design the SLMC with necessary amendments to the Act, which is now almost redundant. 
(02) Immediately establish a Medical Education Commission with other professionals and disciplines included to study the entirety of medical education including MBBS degree and to propose a rational, cost effective model for the future.

Wish the Minister will have that much far-sightedness for the sake of the people and the people would realise they have lived enough with these ‘Tinsel Kings’ in medicine.