Restoration of medical services need of the hour

by Dr. T. G. D. Chandra Perera

Sri Lanka enjoyed a great reputation for her free medical services and for the raising of the standard of health of her people, specially those of the rural sector. Every health plan of the country laid greater emphasis on the provision of medical services to the poor masses, who totally depended on free medical services provided by the Government.

That emphasis was so much that even the prescription sheet provided by the Health Department for use at Out Patients Departments, carried the rider "open for the relief of those who are unable to pay for medical advice or medicine".

This amply illustrates the fact that free medical services were solely meant for those who could not afford to pay for it.

Today there is a vast and expensive machinery to manage the country's health services, including the Ministry of Health at the national level and the eight Provincial Ministries of health at the provincial levels. However, it is a pity that the emphasis is increasing placed on the sophistication of health services, thereby neglecting the poor man's medical services, who hardly has access to those sophisticated services.

Nothing is more important to a physician or other health worker that delivering safe medical care of a high standard to a poor patient, who is helpless.

Millions and millions of such helpless people will breathe a sigh of relief if the free medical service that they have been enjoying traditionally is restored to them.

At the time when there were sufficient private medical institutions in the country for the affluent classes, the government medical institutions such as district hospitals, maternity homes, central dispensaries, branch dispensaries, visiting stations, etc., were established for the benefit of the poor.

When a serious epidemic of malaria and parangi began devastating the helpless poor people in the rural areas of Sri Lanka in the 1930s. These medical institutions successfully faced the situation.

To carry out the free medical services the Colombo Medical School/College was established and two grades of medical practitioners were trained. The senior grade qualified as licentiates in medicine and surgery after three years of training and the junior grade followed a two year training course and were appointed as apothecaries.

The lecturers for both these grades were the same. These two grades comprised the team that took western medicine to the rural sector.

The senior grade medical practitioners were appointed in charge of district hospitals with two or more junior grade medical practitioners to assist them at ward work with patients' section, dispensing section and other areas of hospital management.

The central dispensaries with two or more branch dispensaries and visiting stations were placed in charge of the junior grade doctors.

It was to the Out Patients Department (OPD) that a patient seeking western medical treatment had to come first. Government quarters were provided in close proximity to these institutions so that doctors' services were available 24 hours of the day.

According to the terms laid down in the letter of appointment, they were prohibited from engaging in private practice except in areas where there was no private practitioner within a radius of ten miles and that too required the permission of the head of the department. Any violation of this rule by an officer, meant dismissal from service.

According to general orders prevailing at the time, the salaries of government servants were based on the presumption that their whole time was utilised for the services expected of them.

The majority of the doctors of the time hailed from elite families and they came to do a meritorious service and these regulations restricting private earning did not worry them at all.

An illustrious member at this tribe that I had the fortune to encounter was Dr. B. S. Jayawardana of Ja-Ela who was District Medical Officer of the Aranayake hospital. In his office room, there were bags of dhal, green gram and other nutritious grains placed in a row.

Whenever he sees a malnourished patient he gets his office orderly to dole out these varieties of grains, a measure from each, to him. Drawers of his office table were full of clothes cut to different sizes, sarongs, etc. for issue to ill-clad patients.

As a young medical officer, my association with this generation of medical giants helped me to retire from the public service as a reputed doctor and remain so as even a general practitioner for half a century thereafter.

A special mention has to be made of the junior grade of doctors who mainly covered the rural sectors were the most popular and respected public servants of the era.

The villagers in their own way looked upon them with great respect and love. When they left their stations on routine transfers or retirement they were invited to farewell functions organised by the people of the area, at which they were garlanded, served with refreshments honoured with speeches of appreciation of their services, and valuable presents and souvenirs were gifted.

At most of these events group photographs where taken, in the late 1930s, when Dr. Harry Silva left Katugastota Central Dispensary on transfer, the farewell function was organised by Mr. Nugawela, who was then the Diyawadana Nilame of the Dalada Maligawa of Kandy.

When I left Hiniduma hospital on transfer in the year 1952 the farewell function was organised by R. Wijewantha, the father of I. Wijewantha, the present Chairman of the Southern Provincial Council.

It is by observing the enviable respect enjoyed by the junior grade doctors serving at central dispensaries of rural areas that the children of well-to-do families were attracted to State medical services.

It was when some doctors turned to illegal private practices, that the health services of the country began to deteriorate to a very unsatisfactory level. At this stage our late leader S. W. R. D. Bandaranaike by a legislative enactment banned the illegal practices of the doctors and once again restored the service to a satisfactory standard thereby restoring the poor man's free health services.

However, the President J. R. Jayewardene by an ordinary circular granted the right of private practice to all government doctors including medical officers of health.

As a result of this short-sighted action almost all the government doctors have now established private medical institutions, at every nook and corner of the country and the State medical institutions have virtually become channelling centers for their private dispensaries.

The personal attention given by doctors and their staff, and the eye catching packets of costly medical products issued at these dispensaries have toughed to create a feeling in the minds of the people that it is only at these places that good medicines are available to cure diseases.

It is heart-breaking to observe the hectic rush of poor patients for consultation of their doctors at channelling centres and private clinics, towards the evenings of everyday. This is a sure sign of the deterioration of our traditional medical services.

As a doctor who has been serving with love and dedication the down trodden people in remote areas in all parts of the country such as Kokilai, Hingurakgoda, Minipe (Morayaya), Hiniduma, Tittapajjala, Negampaha, Dewalapola, etc. since 1940, I feel extremely sorry to see the suffering of the poor people when a family member falls ill.

It is a pity that so far no one has collected statistical data to ascertain how many millions of poor people have to wait at their channelling centres at great in convenience and how many millions of such people have mortgaged their jewellery and other hard-earned savings to save the lives of their family members.

It is on their behalf that I am making this appeal to your Excellency for early relief to those who are deprived of free health services. I also wish to mention here that the withdrawal of this right enjoyed by the poor people of Sri Lanka since the colonial era is a violation of their right to health.