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| Sunday, 22 June 2003 |
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Doctors' strike Government Commission deems salary difference a non-anomaly by Shanika Sriyananda and Jayanthi Liyanage Despite the blatant infringement of chiefly the non-tax paying common man's right to health and their very lives, the strike of the graduate medicos has brought to the surface a few hard truths. \ What are the medical ethics of floating a literally "give or die" type of ruthless trade union action, to seek redress for a salary difference between professionals at recruitment level and those of lower cadres with more years of work experience? The Government-appointed Commission has already deemed the salary difference a non-anomaly. As a senior public official rightly put it: "A public servant with a grievance can go to the Ombudsman or Courts to ask for a redress. If a doctor refuses to treat a patient, where can this sick person go to get his health back?" In the absence of this fundamental humanitarian mechanism, how can one prevent the protectionist policy of trade unionism abusing civil welfare? Although it is natural that deep-seated feelings of resentment over different structures of pay in somewhat parallel cadres would bring forth a clamour for revision, one is also reminded of what a senior professor of the Colombo Medical Faculty has stated about the curriculum change of 1995, including a Behavioural Sciences stream among other changes, for MBBS undergraduates. "In this faculty, we believe that strikes are not weapons to be used by doctors and students to settle issues and they have to be dealt with through discussion and dialogue." The C'3 doctor (competent, compassionate and caring) the professor envisaged seemed to have got submerged in the much narrower goal of "reward for trade" and not its "worth to the citizen." The views expressed by a cross-section of the public the Sunday Observer met reflect this thinking. A patient at the OPD of the National Hospital, Colombo: "My infant son was operated on both knees four weeks ago to correct a knee deformity. I came carrying him last Thursday and the Thursday before that to get his stitches removed, but had to go back as there was no doctor to attend to it. They say that the emergency services and a skeleton OPD service is there but minor things like this must wait until the strike is over and my son will have to wait with his bandages." A senior official in the Nursing profession. "I personally do not agree with strikes of doctors or nurses as, despite the difference in the nature of work, our objectives are the same - which is to heal the sick. The other most crucial reason why I do not like doctors and nurses striking is that those who come to us in the government hospitals are mostly the very poor patients who have no other manner of obtaining medical treatment. Those who can afford, go to private channelling services and private hospitals. Rather than striking, I believe we should resolve their problems through discussion. I also feel that the Ministry should take steps to speedily resolve such issues through discussion." A junior doctor who passed out a year ago and has not taken his oaths yet. "I feel that the demands of the doctors are 100 per cent justified. I am a staunch UNPer but in this issue I support the Trade Union action. The salary anomalies between AMPs and MBBS doctors are very unjust as I feel that the AMPs are useless and even a nurse can do their job. AMPs are not graduates and can't do surgery or transfer patients from one ward to another and MBBS doctors certainly deserve more rewarding salaries. What's more, quite a few of the AMPs have politicians behind them. What the media says about doctors neglecting patients and some patients dying is wrong because only the routine work is affected by the strike. The emergency service, the OPD and the paediatric unit is operating. I stayed up the whole of last night attending to patients." A senior doctor who brought in a critically ill woman on the pretext that she was related to the doctor, in order to more easily obtain emergency medical facilities. "It's really a minor employee's mother but if I, as a doctor, did not intervene during the strike she would not have got all the attention she could have obtained with my intervention. "I am totally against the strike. Doctors, teachers and para medics should never be on strike because their work directly builds or destroys human lives. When your work has a direct impact on the progress of human lives, you should never play games with it. I didn't tell anyone but I worked during the strike because in my mind I know I would be utterly wrong if I kept away from my work as a doctor. "I passed out as a doctor in the early eighties and I belong to that dedicated, committed generation of doctors. We see our work for the healing of humans as a noble cause worthy of whole-hearted devotion. I am totally dissatisfied with today's younger generation of doctors who are often after higher salaries, perks and other benefits. "But this demand for regularising the salary anomalies between AMPS and MBBS doctors too is justifiable in some aspects. When you look at the root cause of this grudge, the disparities are not only between AMPS and MBBS. There are long-brewing dissatisfied feelings on other disparities as well. For example, I came up as a doctor the hard way - that is, by hard study to be among the best results at A/Ls through stiff all island competition. Only about 250 students from the whole island were admitted to the Medical Faculties annually. There are others like me who were always the first or the second in the class. Those who were usually the 5th or 6th in our class are now employed as MLTs and Radiographers. But the amazing thing is that some who were near rock bottom in class are now doctors. How did that happen? Either they went to the private medical college or they went overseas and got a medical degree at an overseas university, or worse, at an unrecognised medical tutory and now both they and us are in the same category with similar salaries. "Such anomalies are at the base of the dissatisfaction and frustration among the MBBS cadre. "But to say that a nurse can do the same job as an AMPs is quite wrong because AMPs too come after about three years of study and they certainly are at a higher knowledge level than nurses." ********* Views of the senior Treasury officials "The four members appointed by the Cabinet Sub-Committee to look into the salary anomalies of Graduate Medical Officers and Registered/Assistant Medical Officers were drawn from the Management Services and Budget Departments of the Ministry of Finance, Health Ministry and the Public Administration Ministry. The four had divergent views, with some feeling that there was no anomaly and some, that there was a slight anomaly from 1988 onwards. None of the previous high-powered commissions such as the Wanasinghe Commission, B.C. Perera Commission and Tissa Devendra Commission recognized this as an anomaly. We asked the doctors why they didn't make representations to these commissions and were told that it was not held as an anomaly by the commissions. "The two categories Registered Medical practitioners and MBBS graduate doctors should not be compared because what you see in their salaries is not an anomaly, but a difference. Such differences are seen between trained teachers and graduate teachers and also between Technical Officers with many years of experience and Engineers at recruitment level. It is not fair to compare the salaries of RMPs of about 20 years of service with new recruits to the graduate MBBS cadre. The Committee issued its report saying that there is no salary anomaly between the two. Though the Cabinet Sub Committee considered this report, it felt there had been an anomaly and has recommended a pay hike of 40-44 percent as well as the paying of 50% salary arrears to the MBBS doctors. The RMPs have now gone to courts citing this as an infringement and a violation of their rights. "Funds for such salary increase have to come from the recurrent expenditure component of the budget and will not encroach on development or rehabilitation funds. But the Government will have to find the resources to meet the pay hike. We feel that a pay hike of the magnitude of 44 per cent is not really fair. Why did the MBBS doctors not raise this anomaly when it was created? Why, all of a sudden, this demand in 2003? We feel they should have come out with such action at a more appropriate time than now, and that their demand for Cabinet sanction on the circular, in order to cancel the strike, is really childish." ************ Anton Lodwyck, Secretary-General, National Workers Congress. "Being a service with the ordinary people of the country, they should not jeopardise the large population and should resort to exhausting all negotiations before using strike action. The strike weapon should always be the ultimate weapon of the trade unions. The doctors should accept the assurance of the Hon. Minister that the Cabinet has accepted the recommendations and therefore, they should report back to work without further inconveniencing the ordinary masses." *********** The Hippocratic Oath... "Whatsoever house I enter, I will go into for the benefit of the sick, refraining from all wrongdoing or corruption.......", was transformed to a 'Hypocritic' oath: " I will work for the benefit of the sick but only if my interests are placed above theirs," when doctors attached to 982 state-run-healthcare institutions continued with their trade union action demanding a 44 per cent increase in their salaries that would ostensibly rectify a salary anomaly. Hopes were raised on Tuesday that the doctors would call off their strike following a Cabinet decision to give into the doctor's demand. But, the GMOA claiming that the circular agreeing to the demand had come from the Ministry of health, the GMOA decided to continue with the strike, which is now on its ninth day (at the time of writing this on Friday the 20th.) Meanwhile, the Registered and Assistant Medical Officers who the GMOA claim are earning more than MBBS qualified doctors, filed a case in the Supreme Court against the Ministry of Health and the relevant authorities for discriminating against their professional status. " We are not against the MBBS doctors demanding that the salary anomaly be rectified", Dr. Mahinda Liyanage, Secretary, Society of Registered and Assistant Medical Officers Union (SRAMO) said condemning the indirect attempt by members of the Government Medical Officers' Union to devaluate their profession. Having gone through 3-year training and possessing 12 years of experience as medical officers, the RMOs and AMOs feel that it is unfair to discriminate against them. Unlike a MBBS doctor who is promoted to Grade II after two years of service at government hospitals, a Grade II RMO needs to put in 12 years of a service to become a Grade I RMO. The Grade I RMOs need to serve nearly 24 years to get promoted to the Special Class ", he said. " This is solely professional jealousy", Dr. Liyanage claimed, pointing out that the salary increments that they received were not from political influences but according to the recommendations of the Salaries Commissions. The 1,500 RMOs/AMOs attached to government hospitals are opposed to doctors receiving anything more than a 8.3 per cent increase in their salaries, and in another twist to the medical men that has throughly inconvienced the people, the RMOs/AMOs have also threatened legal action if their MBBS collegues are paid anything more. Hospital sources reveal that the GMOs strike had brought the daily routine activities of islandwide hospitals to a standstill. However, Colombo National Hospital souces said that the Accident Service had been functioning as usual with over 70 daily admissions. Around 30 to 40 emergency surgeries had also been performed daily at the Accident Service though more than 100 surgeries were cancelled. Dr. Hector Weerasinghe, Director, Colombo National Hospital said that only the daily routine work of the OPDs and clinics was crippled but that all other emergency services were carried out as usual. -The Cabinet Sub Committee (CSC) appointed by Prime Minister Ranil Wickremesinghe to probe disputes in the health sector will submit their report to the Cabinet soon. The Committee is headed by Ministers Karu Jayasuriya and comprises P. Dayaratne, Dr. Rajitha Senaratne, Vajira Abeywardena and Alick Aluvihare. " The draft prepared by the CSC was given to every trade union in the health sector and with their proposals the report was handed over to the Ministerial Review Committee. The final report, which is to be submitted to Parliament, had been completed now", Priyantha Kumara said. He believes that 60 percent of professional's disputes in the health sector would be solved with the new recommendations of the CSC. ************** Private practice on state time The doctors strike has also brought up the issue of medical ethics and moral obligations, especially in terms of private practice. The Ministry of Health received numerous complaints about government doctors carrying on with their private practice while on strike from public duty. S.L.A. Navaratne, Director Investigations and the Flying Squad Unit of the Ministry said that that Unit had received several complaints during the past week about doctors who treated patients in private hospitals during their duty hours. " A consultant and doctors attached to the CNH and Ragama Hospital were among the culprits", he said. According to him, disciplinary actions will be taken against them after the conclusion of the investigation. Dr. H.H.R. Samarasinghe, President, Sri Lanka Medical Council (SLMC) said that "ethically it is incorrect for doctors to engage in private practice while they are on strike". He said that the government should take legal action against doctors who do private practice during their office hours. " Such complaints should be directed to the SLMC alone with an affidavit, and we will investigate the allegation and take appropriate actions", Dr. Samarasinghe said. Lalith Wijetunge, Human Resources Manager in a private sector organisation said that it was unethical for professionals to win their rights by violating the rights of others. " Patients have the right to get treatment from doctors, especially from the government hospitals. But, if doctors purposely evade treating them, it is a gross human rights violation ", he said. Strongly condemning the frequent trade union actions by the doctors and nurses, he said that they were more previleged than other professionals and needed to maintain their dignity. According to him, doctors are the only professionals who are blessed with the chance to do private practice and no authority will count their earnings which run to lakhs of rupees per day. " The doctors have a weapon - the patients- to win their demands. There is no solution for the salary disparities in other professions, who are equal to doctors. They cannot stage a battle since they do not have human lives to use as shields", he added. Several top officials of the Ministry of Health express dissatisfaction at the way the authorities keep giving into trade union action. " Problems in the state health sector cannot be solved with temporary action. They need to be reviewed and solutions found for the particular problem. Ad hoc solutions would bring more disparities. Otherwise strikes in the health sector would be a vicious cycle, which would not ever stop", they pointed out. R.B. Priyantha Kumara, Director, Trade Unions, Ministry of Health said that most of the problems in the health sector had arisen after the Kodagoda Committee Report. He stressed the need to review its recommendations to settle disputes among health professionals. Medical officers as well as the minor staffers have to suffer under the Kodagoda recommendations, he said. |
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