Feudalism’s Last Refuge: Medical Sector?

Protesting trade unions demanded a hike in their allowances commensurate to the increase of the doctors

If you want to see the residual of feudalism alive and kicking in this country, look no further than the health sector. Deputy Director of the Colombo National Hospital, Rukshan Bellana became the unannointed spokesman of the condescendingly lowly status the doctors hold the support staff in the profession. This may not be the uniform stance where individual interactions are concerned. Still, it appears to be a de-facto official position if you are to survey the Government Medical Officers Association’s (GMOA) reaction towards nurses, midwives, paramedics and other support staff.  

Strangely for a band of professionals, whose elevated position owes so much to the public funded university education – without which many would not have achieved more than Paramedics or lab technicians whom they now look down from their pedestals – doctors’ unions in this country have regularly opposed the career development of other affiliated services, if they even remotely threaten the status of doctors.   

Dr Belllana put this innate condescension on public display last week when he disparaged the support staff in the health sector, which had launched a trade union action over the disparities in the pay scale after the government unilaterally increased the Disturbance, Availability & Transport allowance for doctors by 35,000 rupees.   
Protesting trade unions demanded a hike in their allowances commensurate to the increase of the doctors.   
Bellana unleashed a tirade at the support staff, describing them as those who push trolleys and clean toilets, and saying that ‘hospitals can carry on without their service’.   

Earlier, Bellana and other GMOA spokespersons sounded out the doctors’ special status. “Office assistants of companies cannot ask for the luxuries of the CEOs,” one quipped.  
This time around, Bellana struck a raw nerve. Support staff laid siege to his office. He was evacuated from a back door, but the trade unions demanded his removal from the Hospital. The Health Minister has promised an inquiry. Dr Bellana has retorted he would resign if he is removed.  
This is not an isolated incident. Earlier, a doctor at Kapapitiya hospital was charged with assaulting support staff. This is not a problem with individuals - ask how our doctors conduct themselves during their training in the UK or Australia.  
This is a problem with the structure. The system itself fosters that last residue of feudalism. 

How Did We Get Here?

The publicly funded healthcare system in Sri Lanka is a gem of its welfare state and is universally acclaimed for its cost-effective, superior performance. This free universal health care system was not exactly a Sri Lankan innovation; the colonial government founded it in line with the British welfare reforms introduced by the Labour government in 1945, which introduced a ‘cradle to grave welfare state’.  
(Similarly, C.W.W. Kannangara’s Free Education Act was enabled by a similar Free Secondary Education Act passed in the UK in 1944.)  

After independence from Britain, successive leaders adopted the welfare state, some out of conviction, some not so much. But for all, winning political office and survival in the office was conditioned on the continuation of the welfare state. However, over time, as populism and quasi-Marxism infested the system, the welfare state became an utmost state monopoly, which actively excluded private investment. State monopoly meant smaller intakes of the medical service to the universities, and anywhere else where the country’s youth aspire for upward mobility. This all-encompassing state monopoly is the primary cause of Sri Lanka’s sub-par economic performance.  

However, the world has changed since then, but in Sri Lanka, those who climbed up the ladder in this statist system have opposed every effort to open it up. Doctors and medical students have forced the government to shut down private medical colleges. Engineering students had fought street fights with their less fortunate peers in NDT courses when the latter was elevated to degree status.  

Public-funded university education is a case of the misallocation of limited tax money for the betterment of a few, at the expense of the vast majority. Worse still, in Sri Lanka, the system operates to the exclusion of others who could not attend a public university. It also dissuades private investment in higher education. Though I myself am a beneficiary of this system, in retrospect, the same system has cannibalized the future of around 80-90 per cent of students in my cohort. Things have improved since then, but visceral selfish interests to exclude most youth from achieving their dreams persist.  

As a result, the system produces a large standing army of three-wheel drivers, housemaids and unskilled labourers for the Middle East and Korea. That is a shame.  
Similarly, it has fostered a fortress of feudal entitlement, as seen in the professional classes. This results from unofficial supply caps enforced on higher professions in isolation from the market forces, which otherwise could have brought an equilibrium.  
Then, the good fellows threaten to migrate when their special privileges are not accorded. 

How to Dismantle the Vestige of Feudalism

Mao Zedong unleashed the cultural revolution, and red guards ‘smashed the old’, ostensibly to destroy the last vestige of feudalism. Gandhi preached non-violence. But if anyone, it was Deng Xiaoping who conclusively destroyed feudalism in China with his adoption of free market policies.  
Capitalism is the most potent weapon to destroy feudalism. Yet, for a country that had seen its competitive advantage slipping away under state monopoly, Sri Lankans are still fooled by the same old culprits, who have a habit of blaming the market forces for all the country’s shortcomings. In fact, it was the lack of economic liberalism that contributed to much of the country’s economic underperformance, and empowered a few at the expense of the vast majority of people.  

For Sri Lanka to break the remnant of feudalism in the medical sector, it should promote private medical schools and provide pathways for the career advancement of nurses and paramedics, just like in other countries, and let the market forces create an equilibrium of supply and demand.  
The same applies to tertiary education at large, where private-public investment should be the primary driver to provide higher education opportunities to 75 per cent of the students of each cohort who could not attend a public university.  

Expanded and modernized tertiary education, supported by tuition fee loans, should be the primary pillar of strength, if Sri Lankan youth are to achieve their full potential.  
Feudalism in the health sector is a symptom of a bigger malady that besets the country at large. The treatment for it is universally known, except that successive governments have suffered from a chronic deficit of political will. 

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