24 March, 2023


Are Doctors & Hospitals In Sri Lanka Ethical Or Compassionate?

By Lasantha Pethiyagoda

Prof (Emeritus) Lasantha Pethiyagoda

Almost everyone in Sri Lanka knows that very often, public hospital wards have patients sleeping on the floor under other patients’ beds or in corridors even at the best of times. Wards wallowing in squalor and disrepair, with flies, cockroaches and mice, with rusting iron bed frames, narrow beds with torn and frayed Rexene covered mattresses, cracked floors and broken ceilings, creaking and rusty fans with thick layers of dust, perpetually leaking toilet taps and wet floors with dark greenish algae and brownish splashed feces stains adorning walls with cracked and peeling tiles are still not uncommon.

Public hospitals largely serve the needs of the general population, mostly rural, and often urban. Major towns have large hospitals, often designated as “teaching” hospitals. Wards are administered by senior doctors who have passed a doctor of medicine or doctor of surgery post-graduate exam, having served as registrars after becoming fully qualified medical practitioners.

Major towns also have sizeable populations who are able to cobble together large sums of money from fixed deposits, sale of property or jewellery etc if desperately ill and requiring expensive interventions urgently. Rural populations do not qualify in large enough numbers for “consultants” to set up shop as “private practices” outside their duty hours in public hospitals.

Most businesses operate in the evenings, with hordes of desperate patients milling around “channeling” centres in order to try and save their relatives from an untimely death from treatable conditions for which demand far outweighs supply in the public health system, or timely intervention is not assured due to systemic logistical inadequacies or lack of funding.

State of the art modern hospitals have sprung up in major towns and the national capital to cater to people who can afford to spend a few thousand rupees to see a specialist for a few minutes or stay in a private room for a hundred thousand rupees for a few days. It is fairly common to be billed a few hundred thousand rupees for a range of “services” during a few days’ stay. The “consultants” who see around fifty patients an evening, earn around a hundred thousand rupees income a day on top of their government salaries and perquisites like duty free motor vehicles.

These same consultants, unless they have retired from public service, are usually in charge of the overall administration of a male and female ward in their specialization at their respective major regional public hospital. With all due respect to the few honorable individuals who maintain their wards in a good state of repair and hygiene, the far larger majority of these multi-millionaires prefer to keep their government public hospital wards in the appalling state described above.

I have a question for the reader: If public hospitals are clean, well maintained with courteous staff and comfortable accommodations and toilets like in the private sector, will the private sector (of which these consultants are partners) still have thumping profits? Therefore, to an unethical and greedy individual who imagines that their qualifications are an open permit to profiteer from an ever increasing trade, would it not be in their own best interest to ensure that the status quo remains one of stark contrasts between private and public?

Sri Lanka has been sliding down deep and fast into an economic quagmire over several decades. Thus, most citizens (ie 99.9% of them) do not eat balanced and nutritious meals; they are stressed in their underpaid jobs; (real incomes are insufficient to counter price increases in basic essentials) they have various issues with injustices, unfairness and a duplicitous society. Many have taken to alcohol or other addictions with substance abuse to try and suppress their woes. With galloping inflation and shortages of essential consumer goods, these people have a far higher propensity to become ill or dependent on maintenance drugs and regular medical interventions to keep themselves alive.

It is in this context that demand for health services is at an all-time high (even regardless of covid). Medical practitioners know these basic realities only too well. Politicians have ensured that those who are unethical are rewarded. From corruption at the highest levels of government, to cronyism and nepotism, grossly unfair, unethical and unjust practices are tolerated or encouraged. Manufacturers and producers use unethical and often illegal means to gain more profits, jeopardizing the health of consumers. This is true for packaged shelf food, restaurant meals, dry groceries, vegetables and fruit, farmed meat animals to various agricultural produce.

Medicine is a noble profession. It used to be a calling that gained immediate respect and admiration, not so much for how many high marks one scores in order to be selected for medical studies but in the knowledge that practitioners genuinely strive to heal, with compassion and genuine caring for the welfare of the patient being uppermost. Quite contrarily to not doing harm, and doing good, choosing the best outcome for patient health and wellbeing, balancing options that favour patient interests (ie good health), most doctors would seem to be no different from the other business people mentioned above.

One could argue that medical officers work under much stress, with inadequate infrastructure, shortages in equipment and limited facilities with various woes themselves. Choosing medicine as a career entails the hardships argued about; it is chosen not as a lucrative business venture with the investment part forming the education and training in medical school, but essentially for the desire to serve people and be part of their well-being. The exalted status that is conferred to smartly clad men and women, twirling their stethoscopes along busy hospital corridors with poor desperate peasants looking up to them to be their saviours does not mean they should be regarded as demigods.

Any respect from the public must be gained. How often does one encounter an apologetic doctor meeting grieving relatives of deceased patients admitting to a fault that led to their demise? Instead, don’t the medical team cover for each other and close ranks, so that medical negligence is never an issue that relatives get to know about, regardless of prospects for litigation? The only explanation given to relatives is that they tried their best, but could not save the patient. Is that always a true and accurate depiction of reality? It could be ethical to comfort a terminally ill person saying that they would somehow make it, while removal of life-support in cases where the prospect of life is deemed almost nil, for the larger good (ie to save other critically ill patients with available limited resources) is acceptable and just.

Private hospitals are known to be ruthless in extracting their full fees from dying patients or relatives of deceased patients. Senior doctors, being partners in these businesses are complicit in these unethical practices. Thus, they cannot be adhering to the Hippocrates oath or indeed any pillars of medical ethics. It would be interesting to see how these medical business people deal with their own conscience.

Public hospital wards have very prominently displayed Buddhist symbols (ie images of the Buddha) for desperate patients and their relatives to pray or ask for mercy from the Buddha, not being aware that the Buddha had never promised to save people, unlike gods of theistic religions. One could argue that the psychological effect of relief has health benefits in such circumstances.

Here I would like to add in conclusion, that a false sense of reassurance from vainly praying to people’s respective deities and assuming that fate eventually deprived them of their loved ones seems to be the only relief when doctors and hospitals seem to be no different to any opportunistic vendor flogging their goods on the dusty streets of Sri Lanka.

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Latest comments

  • 3

    In SL there is no profession that are ethical compassionate or honest. It thus includes Doctors as well. I doubt that most of them honestly declare their real income to the Inland Revenue. Business men too do not pay their fair share taxes. Most of the ruling parties that have governed the country have been corrupt. Most of the current politicians are uneducated thuggish people who are protected by defence forces.

  • 3

    This is the punch line of the essayist,given below.

    …………..when doctors and hospitals seem to be no different to any opportunistic vendor flogging their goods on the dusty streets of Srilanka…………..

    Most of them[The majority] had abandoned the Hippocratic oath many moons ago………..
    I would strongly recommend that they purchase the book — The Hippocratic oath and the Ethics of Medicine. Available @ Amazon $ 35.95. Hard Cover.
    The channeled consultation fees milked from 3 or 4 patients within 3 or 4 minutes……….

    • 3

      Plate, Doctors and hospitals are part of this society. If you cannot afford, why go to private hospitals. I spent a month in National hospital after an operation and had the best care and did not pay a cent. Cant buy medical care attitude is good as not milking is otherwise.’ Dont forget that doctors spend 40 years studying and on poor pay and transferred far away from family until when old are able to be financially stable enough to marry off their children

  • 4

    Sadly the medical professionals in Sri-Lanka are neither ethical nor compassionate is the true answer. They are a money making machine who would see around 100 patients in a matter of hours.. There should be limit on them doing private work
    The authorities should ensure cleanliness in the hospital premises. and fine the CEO personally
    In certain areas especially in the plantation sector, they have not built new hospitals or added any additional facilities since the times of the British.
    The hospitals stinks adding more misery to the patients and visitors
    We must thank the writer for this timely article

    • 1

      Thanks, my friend, Nada, for these comments which stem from a variety of experiences over the years.
      Lasantha made a few important comments here, in this article on Ukraine which is about to go into Archives.
      That article led to some interesting comments which amounts to a discussion of sorts.
      Panini Edirisinhe

  • 1

    The Private Health Sector in SL need to kept in CHECK by a Government Office. It should keep an eye
    1) on the QUALITY of the care they provide
    2) on how their patients are charged
    3) on any medical negligence
    It’s a shame that the GoSL hasn’t got the finances to have efficient Government Hospitals
    It’s sad that we spent lots of valuable foreign currency in conducting an internal civil war for ages. Lot of young SRILANKAN were sacrificed during JVP and LTTE uprisings.
    This could have been completely avoided if we had Politicians /STATESMAN that had put the COUNTRY first and them last.

  • 8

    The doctors are also from this society, breath the same air, believe the same things.

    They study free at public expense and in the case of the doctors much more money of the public is spent on producing them. ( the cost is several millions) After that many Western countries offer then free scholarships to further study

    From the example of chaps like Paddaniya and also from the fact that majority of our doctors vote for him and his low quality crew , we can see that little education has become dangerous for them. Deeply Eastern characters doing Western medicine . But the mind-set is not in line with what they practice. If they did Ayurveda everything would have been in harmony, character and practice.As Ayurveda practitioners they can oppose anything outside of this country and promote a totally local based life for everyone, including thatched roofs for their little huts.

    Just because they have crammed up medicine they think they know everything.

    Now these village boys feel guilty that they are exploiting their sick fellow beings to amass wealth.

    So they promote the canard that they are doing the job of the gods, ( yes nothing else ) curing the sick ! ( Wow, just check the wealth the medical practice accumulates)

  • 1

    Opportunism play key role in corruption and you cannot expect anything different from doctors only. Ethical and compassionate life in Sri Lanka is dead whether it is in Politics or Healthcare or Security or Rule of law or in public life. It is not only doctors get free education in Sri Lanka but also all others also get free education, free scholarships and free trips. For example our President Gotabaya used the opportunity to attend UN sessions to meet his family in USA. Prime Minister made a trip to Thirupathy in a free donation. All ministers use the government vehicle for family use. If you give Rs.500 police will allow you without checking. If you pay Rs. 100 to a security guard you can visit any time in hospital. The whole system is powered with corruption and you cannot blame any profession separately.

  • 2

    Lasantha, thoughtful and well articulated. Thanks.

  • 0

    Don’t forget we live in a capitalist society where dog eats the dog policy is the norm. People, that includes Doctors, compete with each other for success in a cruel and selfish way. In the Western countries, half the doctors have their own private practice, the other half work for the government. Health service is almost free. Government doctors cannot work in private hospitals. In government hospitals, all patients are treated the same. No influence, special treatment or queue jumping.

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