By Emil van der Poorten –

Emil van der Poorten

Not so long ago, a gentleman who appeared to have significant academic credentials and bearing a last name that has generated respect in this country for a long time – “Pethiyagoda” to be exact – wrote a scathing critique of conditions at the Peradeniya Teaching Hospital. For whatever reason and despite its incendiary content the article did not receive the attention that it deserved in the medium in which it was published.

I had occasion to visit the Peradeniya Teaching Hospital not so long ago and was not surprised by the fact that it seemed to personify a Sri Lankan edition of Bedlam caused by the usual – simple lack of funds to provide the elementary facilities for the people of this country who are accused (and I use the term deliberately) of using allegedly “free” health care. Among other things I was directed to change from the trousers and underwear I wore into the (white) sarong I needed to be clad in for the procedure I was to undergo. I was directed to the toilet located on that particular floor which I was told to use as a changing room. Unfortunately, that facility was barred, literally, because it was undergoing extensive renovation. Since, I did not need to use the facility for its avowed purpose, I crept past the barriers, effected the required change in clothing and returned to the theatre where I was to undergo the procedure concerned. Fortunately, I was not observed breaking this, hopefully, temporary “house rule” by any of the Security personnel on the premises. What also crossed my mind at the time was the hope that this “temporary closure” would not have been encountered by a patient who was awaiting treatment for incontinence or an associated malady!

If I thought that horror story could not be replicated elsewhere in the Central Province, I was in for a very rude surprise.

I expected that the Kandy General (Teaching) Hospital would be an improvement over its Peradeniya equivalent because to achieve that plane of excellence would not have taken much.

Before, the incident I am about to relate, I did have occasion to visit the OPD and then the Dermatology Clinic of this hospital a few months ago. While the over-crowding on the premises would have driven anyone with even a mild case of claustrophobia over the edge, what impressed me was the ability of the medical and support staff, at least in the unit that I had occasion to visit, to work efficiently and effectively in conditions that, at first glance, appeared to be confusion confounded. Not only did they appear to do their work with a minimum of fuss and bother where the facilities were, to put it mildly, primitive, they did so while consistently displaying good humour and care and concern for their patients at all times. To describe the open space in which they had to work, with a couple of curtained cubicles, as very basic would be to overstate the case. The fact that medical procedures of any description could be carried on in such circumstances was something that simply blew me away. In short, I was most impressed by how well and how humanely doctors and support staff were performing.

More recently, I had occasion to visit an employee of ours who was sent to the same hospital with severe abdominal pain that the District Hospital at Galagedera had deemed to be of a nature serious enough to merit investigation at a better-equipped facility.

Making it through the teeming hordes at visiting time without such an elementary device as a lift (elevator) to move from one floor to the other if one was subject to any ambulatory difficulty had to be endured. However, when we got to the ward in question, we found “our” patient seated on a bed obviously occupied by another who’d already been in occupancy when “ours” had arrived. Remember that the person whom we were seeing was still suffering acute abdominal pain and you’d find it easier to visualise what we were observing.

We were told that in a ward with thirty-odd beds there were in excess of fifty patients. And our patient had been just moved out of the emergency unit. Get the picture? However, just in case, let me complete it by offering the information that the patient already occupying a bed had been kind enough to permit “our” patient to sit at the foot of it.

If you think that scenario is unacceptable, please consider the fact that there were patients lying on the ground without so much as a sleeping mat in some of the STAIRWELLS through which we walked. The practical difficulty that medical and nursing staff must encounter in even examining patients in these conditions can only be imagined.

That the hospital staff who serve under such abominable conditions are deserving of more than simple praise goes without saying though I expect that, from time to time, they must reach the end of their tether and exhibit some ill temper! However, that they are able to provide even a part of the care that might be expected of them in more “civilised” circumstances speaks volumes for them as caring human beings.

How have we reached this state of affairs and why is there no real attempt to address the collapse of a system of free medical care that was established at independence in 1948?

Overall, it has been the bandit capitalism that has overtaken this country where there are very real attempts to develop “medical tourism” for the rich of other countries in Sri Lanka, not to mention the availability of such treatment to the new class of oligarchs in The Pearl of the Orient. The other side of that coin is the gross under-funding of the public health system which is supposed to serve the vast majority of our population who, make no mistake, do, in fact, generate the very resources that are being channelled to the rich and famous while they do without basic services.

“Inequitable” did you say?

In the case of the Kandy General Hospital I have distinct recollections of being requested to join at least one parade through Kandy town in a much-publicised fund-raiser to construct a new cancer ward in that hospital the foundation stone for which was laid by our recently-deposed Emperor who would, I am sure, have performed the ceremonial opening of the new edifice which would have, doubtless with loud hurrahs from the Kandy Sycophancy, been named after him. The “movers and shakers” in that enterprise who were, patently, seeking “brownie points” from the Big Man are, I am sure, still around though I haven’t been solicited for my support in such endeavours ever since I was identified as one critical of what was being visited on this country! In fact, I have a distinct recollection of one of those poobahs who shared an alma mater with me avoiding making eye contact with me throughout a book launch a while ago, an endeavour in which I refused to assist by looking at him every chance I got!

I really would appreciate a response from those, some of whom served the Rajapaksas most assiduously in so many fields in addition to the medical one, so that all I’ve had to say doesn’t pass without qualification, leave alone contradiction, and readers are given the opportunity to view the other side of this story. If there is such a creature!

What should gall anyone with a sense of proportion, nay basic decency, is that billions of dollars and hundreds of billions of rupees were spent on projects like airports and harbours which simply pandered to the vanity of our Emperor and his family, not to mention fatten bank accounts in offshore locations, while the sick of this country have had inflicted on them a level of health (and other public) services that can only be accurately described as “primitive.” Let’s get this straight also: every one of those who played along with this scheme of things is guilty as sin of the crimes that have been perpetrated while they were gathering brownie points for identification as “pandankarayas.”

A final word: I do not, and I don’t think ANYONE should accept the hoary myth that “we can’t afford free medical care.” That is simply unadulterated horse-feathers and, if you notice, is spouted by those euphemistically referred to as belonging to the “upper income bracket” with money to splurge on the luxuries of life available in parts of the world other than just the Wonder of Asia!