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?
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.
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.
Bustingchops / July 26, 2013
Dr. dhammika herath, You are asking a maggot to save the limb of a rotting carcass.
rotting carcass being the whole of the sri lanka, the limb being the health sector and the maggot being the politician, who is thriving on what’s left of the rotting carcass.
Don Stanley / July 26, 2013
The so-called minister of Health is utterly corrupt. He and bis brothers have stolen state and reservation land in Polonnaruwa and built luxury hotels. This Rajapassa crony and thug minister has NO Qualifications to hold the portfolio of Health.
The Rajapassa Cabinet of Clowns – including the so called minister of health and Bandualla and SB in education are an insult to educated Sri Lankan!
Gamini Wickramatilake / July 26, 2013
Very admirable letter to the Minister which basically explains what the reality in Sri Lanka is, right now. The work ethics, morality and the humanity is slowly slippimg away from the public servants, thanks to the corruption which has spread from the top to the bottom.
Taraki / July 26, 2013
I hope you don’t expect the Minister to actually DO anything about these matters. Surely you didn’t think he was appointed in order to be an efficient, incorruptible problem solver?
justice / July 26, 2013
Your relative has probably had a stroke. Had he been to a family doctor and screening tests done,he would have had medication which would have prevented the stroke.
Stroke patient management is very difficult and only dedicated staff will do it well.
This is why they try to get rid of stroke patients.
Our health system is more curative than preventive.
In other countries,there are Stroke Prevention Clinics where people are screened and preventive medication given.
Have you yourself been screened – if not,do so at once.Have your family too screened.Tell your friends too.Dont go to a quack.
The nurse and minor staff are lazy and this is their behaviour.
This will not improve.
The minister is helpless.
JULAMPITIYE AMARAYA / July 27, 2013
With our tax money they will send Kudu dealers/ killers to abroad for specialist’s treatment and
some will get western countries’ hospital treatment at the expense of our blood.
they can do \night races and have air ports to land in door steps.
It does not matter National carriers / Family Air loosing Billions of rupees and paying millions for inefficient family members appointed to manage them.
It doesn’t matter Take Billions of rupees on loan from foreign countries and
take ten percentages as commissions, prior to the completion of work, allowing two, three generations to pay for the lending country and pawning our natural resources.
Appointing a world’ biggest, A Jumbo ministerial Cabinet This governance become Laughing stock of the world.
We, all appointed Them,
and WE, The WORKING PEOPLE OF SRI LANKA,
WHO, SACRIFICED TO FINISHED THE CIVIL WAR, and They the our blood sucking governance, are claiming the Victory.
and On the WAR CICTORY PIGGY BACK,
Rajapassa Governance spending a Majestic life surrounding contract Killers and kudu dealers,
suppressing OPPOSISTION for that.
And we have opposition parties, who have taken bribes from Rajspassa governance and looking Like Buffoons.
And how we can expect a Fair governance from Morons, Ransom takers, Abductors, Thieves , kudu dealers and killers
WE ALL ARE FOOLS, WHO GAVE THEM POWER.
Peter Perera / July 27, 2013
Our country does not give real value for the life. That is why thousands of people die from motor vehicle accidents, dengue fever or at unsafe railway crossings. These can prevent with simple measures, no need of rocket science.
As a nation we does not have identified our priorities in any field.
Priorities are made by the uneducated politicians depends on the commissions they receive not due to national needs.
Educated administrative officers are not override this because they want to safe guard their positions.
Dr. Hearth, this behavior is not only seen at heath care workers. This is the mentality of any Sri Lankan government servant. Not even government servant any one has minimal power try to put pressure on other fellow citizens. That is what we experience in our day to day life from low level privet bus conductor to high level the medical doctor.
Our system need a overhaul.
Raja / July 27, 2013
He is your relative I cant understand why your complaint is that you have paid taxes and other people cud look after him .
I have spent hours beside sick relatives , and the nurses were kind .
Sometimes there was only two nurses for large wards . can they do everything.
Money is being wasted lots of corruption those are problems for social scientist to solve.
INDRALATHA DE SILVA / July 27, 2013
In Srilanka medical ward, infact any ward has at least 50-60 patients at a time, some are on the beds and there will be few under and sharing as well. There will be maximum of three to four nurses in a shift. You can’t compare this with a ward in developed country with maximum of 20 -30 patients.
Nurse to pt ratio in developed country is less than 10. How can you expect a nurse in Srilanka do look after patients and give maximum care however much they want to? People should be pleased at least they are given medicine.
In a out patient clinic a doctor will see only 5-6 patients in developed country. In Srilanka at least there are 200 patients per clinic. A consultant and two to three junior doctors need to see all of them in 3 hours. In a admission day at least there will be 50 -60 admissions and they will be seen by two doctors. People should thank doctors at least they will be seen after few hours.
We are asking too much from doctors and nurses in Srilanka for a salary even a cleaner in Foriegn mission earns.
If you are expecting better service increase the number of nurses and doctors available in the hospitals. Attendants are paid minimum salary and they are waiting to leave the job with a better salary. How can you expect any better service from them.
If you pay them more you can get a better service. Better people with qualifications will be attendants.
If you do not want doctors to do private practice increase the salary and they will be happy to stay at home after working 8-5pm.
Wickramasiri / July 28, 2013
I think we need to look at the writer’s complaint a little more sympathetically.
The positive side of our medical service is that it is more or less free, but of late drugs are not freely dispensed and some have to be purchased outside. If doctors and nurses and drugs are in short supply it is up to the government to rectify instead of offering excuses. These excuses have been given for over 50 years and must not be accepted indefinitely. There is a great deal of funds expended on non urgent projects which can be diverted for health care. Health care must be considered a priority.
To get a family member to bed sit is unusual. If required, then he must be given the necessary facilities and some basic instructions as well.
The writer also hints at another aspect of healthcare which in fact touches on the Sri Lankan attitude to service. That is the lack of kindness and consideration, politeness and etiquette in addressing another, whether it is a patient, client or customer, a driver of a motor vehicle in traffic, or awaiting one’s turn in a queue. Consideration to another is often lacking despite the bombastic boasting of the inherent kindness in our culture! Doctors and nurses tend to be short and curt, sometimes rude and arrogant. Many a doctor does not take the trouble, or dislike to explain, the nature of the illness to the patient or the patient’s relatives. In fact because of the restriction in visiting hours the immediate relatives do not get an opportunity to meet the doctor. Another aspect in government hospitals that must be rectified is that a copy of the patient’s diagnosis card and treatment protocol is not released to the patient at discharge. As a result the patient is unable to follow up with another doctor or hospital and the tests have to be repeated multiple times at greater cost and inconvenience. These are not costly things to change.
Sri Lanka’s health service is sick not because of lack of funds, but lack of will.
Peter Perera / July 28, 2013
I agree 100%.
Health care workers need attitude change.
Heath administrators need to identify the priorities in scientific way.
Dr Wasantha Dissanayake / July 30, 2013
I do agree with some comments made by Dr Dammika.Stroke is paralysis f a part of a limb or limbs with some time inability to talk( dysaryhria).it is mainly occurs due to uncontroled hypertension .If the blood pressure is well controled its unlikly lead to this complication.
However the stroke patients should managed in a specialised stroke unit with all facilities available,unless patient will end up with disability or die with aspiration pneumonia.As Dr Dammikas comments stroke care for his patient has not given adequatlya,mainly due to lack of resiurses.Once you get stroke it is more nursing care than medical care,and you need multidiciplinary approch with physiotherapy,speech therapy,and occupational therapy.These three aspects of management in state hospitals are not adequatly provided.
I can understand when a person sudenly paralysed what mental trauma he or she will get.
All stroke patients should manage in specialised stroke units,at present this facility only awailable in national hospital.
All stroke patients should rehabilitate with with physiotherapy,speech therapy,and occupational therapy ,in hospital and at home .Once I tried to train volantiers with the help of red cross and send them to their ( patients) home and to rehabilitate them but unfortunatly it was not siccesfull due to unawailability of funds.
I think Dr Djammikas comments will open eyes on everybody to look into this matter in depth.