By Dhammika Herath –

Dear Minister. As you know very well, Sri Lanka has been and still hailed as a middle income country with an impressive heath system which has produced remarkable achievements in our human development indicators.  Nonetheless, I wish to bring to your notice my personal experience in two government hospitals in Kurunegala to argue that our health system is now increasing failing and leaves much room for improvement. My father’s brother, now aged around 75, was admitted to Kurunegala Central and he remains paralyzed. For some strange reason which I do not understand, the relatives were asked by the hospital to stay near his bed and look after (I call it patient sitting). So, we in our extended family, took turns and did patient sitting day and night sitting on a plastic chair but we were not alone. There were many people doing the same. Dear Minister, isn’t there something fundamentally wrong here? Why does the hospital requires a relative or someone from the family to stay near the patient to look after him? Where are the Nurses, the attendants who are paid by public tax money? Why can’t they look after the patients? Where are all those people who are paid by tax money?

Maithripala Sirisena - the Minister of Health

Of course it is our culture that we look after our relatives and friends who are sick. But we can do that at home. Can we, the working citizens, afford to stay away from our employments and spend days and nights in hospitals while we also pay taxes so that the government has appointed ATTENDENTS to do that job? What are they there for?

In Kurunegala Central hospital I was there once doing the patient sitting for my Lokuappachchi (father’s elder brother). During the course of the day, I can confirm, no attendant came to see him. Two or three times a nurse came. Since the patient is paralyzed, liquid food was given to him through a tube inserted through the nose. A nurse came to me and handed over a tablet and asked me to dissolve it in a cup so that he could put the medicine through the tube. Isn’t that the job of the nurse to prepare medicine? I had to use a normal tea cup. But is there no possibility of contamination?

In the morning two doctors came and looked at the patient. One was a young doctor responsible for the ward and the other seemed a more experienced doctor. None of them touched the body but looked at the records for about 3 minutes. None spoke to me. I asked’ ‘Doctor is the condition improving?’ The doctor replied ‘yes but it will happen gradually’ (all together 7 words) without looking at my face and then left. I want to ask a question? These doctors were educated using people’s tax money. My Lokuappachci worked in a cooperative for about 35 years and how much tax he must have paid? How much did he contribute to train this doctor? How much did other people, famers, labourers, teachers, carpenters, masons, employees in government and private sectors contribute to train this doctor? How much do people contribute to his salary by paying taxes when they buy a loaf of bread, a kilo of sugar and by incomes taxes etc…Probably the Doctor thinks the GOVERNMENT pays his salary. Where does the GOVERNMENT take money from? It is WE who work who gives money to the government and in turn government pays Doctors, nurses, attendants, hospital labourers etc.

I have another question for the Doctor. You must have been trained in a Western Country. You have now acquired all Western cultural traditions…dress, English Language, nice car etc…did you not learn that in Western Countries patients have something called PATIENTS RIGHTS? Yes of course I know the response. The doctor patient ratio is so poor here and hence doctors have no time. I DO agree. A doctors has to handle so many patients that often they cannot afford to spend lot of time with patients. But does it prevent you from spending a few more minutes with patients? I never mean to say that ALL doctors are like this. There are genuine doctors, nurses, attendants who do their job honestly even under extreme resources constraints.

I want to ask the Minister? Why can’t you increase the number of doctors? Yes the Government cannot do it because it does not have resources. But of course you do have the resources to spend for airports for birds, harbours for nothing, expensive cars and extravagant life styles of ministers, a jumbo cabinet, night races and all of that. It is a question of development priorities.

A little later in the day, the nurse in charge of the ward came. I had put a wet towel on something. She shouted at me ‘who put this here. Go and put that to dry out’. I agree with her advise but why can’t she be a little more kind and tell me the same thing a little bit more politely? Where is the Nightingale in who was once lost? Where is she hiding? Dear Minister we must look out for lost Nightingale BEAUSE those farmers, labourers, teachers, clerks, and all of us who end up in government hospital need not just tablets and injections….but kindness. Have your ever heard people say…I don’t need medicine. It is enough if the doctor listens to me’.

During the course of the day, I had to measure the amount of urine exist from the body by taking urine into a measurement bottle and then emptying the bottle to the toilet. I was not alone….other people looking after their relatives did the same. As of today, we continue to do it for our Lokuappachchi in the hospital. I have no bad feeling about doing it because it is for a loved one. But if an attendant were to do it, he would have the gloves to do that. I was unprepared. Who on earth would take gloves when you go to hospital?

My Lokuappachchi was later transferred to a regional hospital close to the village since his condition now did not require the central hospital. This was a smaller hospital. Yesterday, I went there again to do a second round of ‘patient sitting’ for a day. The patient was still paralyzed and during 6 hours I stayed he defecated about five times. I was alone and did not know how to manage. I was ready to touch feces (stool) but requested an attended to help me turn the patient’s body around so that I could do the cleaning. An attendant said he would come but never came. So I managed.

Later a nurse came and asked me ‘do you have any medicine with you’ I had no clue. I wanted to say ‘you should be having medicine not me but instead said as politely as I could, ‘I came for afternoon patient sitting and I don’t know’. The nurse said, ‘you should know’. Wait till the doctor come. She will recommend a drug. Bring that from a pharmacy’. Mind you I am in a government hospital looking after a patient who is paralysed.

Later I went out and brought the medicine. The Nurse ordered me to dissolve the medicine. Then she came to administer it through the tube inserted through the nose of the patient. All the while she asked me to help her…do this and do that…wash this and wash that…go to the tap and wash this again….I wanted to shout back but controlled by emotions. The nurse went on to distribute medicine to other people most of them were very old people presumably poor by their appearance. For some who could not get out of the bed she went and handed down medicine but some who could walk were asked to come and take medicine. I can assure you, she had no kind words to any of the patients.

Time passed by and I was doing the patient sitting. The ward was however clean and every bed had a mosquito net. I also saw a sign board that the ward had been renovated by Lions club and I would assume they had given the nets irrespective of all anti-NGO slogans of the government. Then came the rain with the winds. The ward had only half walls with a toll roof. Majority of the patients who were very old men with ailing health, were now half wet. To me this was painful to watch. The ward had a LCD TV. Right at that movement, there was news….one prominent UNP MP had made a cross over. Wonderful news for the patients who were now half wet. I could overhear two old men talking to each other…..’Ara XX kiyana Ekage light bila vitharak ek laksha ganaklu…balanna apita wena deval… (That XX man’s (a minister) electricity bill is over one hundred thousand…see what is happening to us). With suppressed emotions in me, this was probably the best solace. At least, people now seem to understand what’s going on in this country….that something is terribly wrong.

Dear Minister I would not stop with a negative note for I am a social scientist with several times more experience in rural villages in Sri Lanka than ministers probably have. Following are some simple recommendations.

• When you recruit all kinds of health workers, test their attitudes towards work
• Have a monitoring mechanism and code of conduct
• Have a complaint mechanism in hospitals so that people can complain
• Have CCTV cameras installed so that any lapse on the part of the workers can be investigated if and when things go wrong.
• Retrain all medical professional with right attitudes
• Increase financial resources for health sector so that there are more doctors, and more health professionals.

Thank you for reading this letter.

Yours sincerely

Dr Dhammika Herath (the writer is a social scientist with a PhD, not a medical professional).

PS: I wish to reiterate that this letter does not intend to paint a negative picture of our health services as there are many honest hard working people in it but hope this exercise would shed some light on where things have to improve. The government has a responsibility to provide sufficient resources to the health sector and put a stop to increasing privatization of our health service.