27 October, 2020

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What Is Being “Taught” At The Kandy General Hospital?

By Emil van der Poorten

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!

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Latest comments

  • 9
    0

    Emil
    Thanks for restoring my faith in humanity. A person of your high social class and privileged upbringing (your subtle clue as to your “elite” alma mater does work) showing empathy for the suffering of the peasant masses of Kandy moved me to tears. It convinces me not everything is lost, that no human is totally wicked – devoid of all compassion, when I read your passionate account of the plight of the “teeming hordes” (your words) who can only afford government hospitals. Anyway, jokes aside, I do really appreciate your highlighting the harrowing experience people have to go through because of the appalling conditions in our hospitals. I hope something good comes out of your effort. Meanwhile I hope you have fully recovered from whatever mysterious condition you were suffering from.

    • 5
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      Off the wall:
      In case you haven’t noticed, I happen to share in what happens to the “peasant masses” of Kandy. If I didn’t I wouldn’t be using a general hospital would I? In case I can afford one, though, do you think you could recommend one of the private facilities with which I am sure you are familiar?
      As for “elite schools” etc. I am neither proud nor ashamed of where I had my education. I consider myself fortunate to have been at Trinity when it did live up to the philosophy of its founders. However, it has, over the years, produced its share of bad eggs and its standards have fluctuated quite dramatically. Much of its recent travails were the result of the dishonest and unethical behaviour of several Rajapaksa pandankarayas, in case you aren’t aware of that reality.
      P.S.
      Thank you for your good wishes for recovery from what you have diagnosed as my “mysterious condition.”

  • 2
    0

    Another timely post about a most serious matter that demands attention from the GOSL. However, it appears that the solution with regard to the proper accommodation facilities, not to mention maintenance of the existing ones, as well as all the other inadequacies that demand attention, would be extremely difficult given the budgetary considerations. And the fact that hardly anyone who is responsible for these matters really cares, is another kettle of fish!

    The President, more that anyone else, should be most qualified to understand the prevailing and past inadequacies of the Medical ‘System’, having been the Minister in charge for, what seems like, ages. So hopefully he can influence the current Minister in charge to get that ball rolling!

  • 1
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    Whilst I absolutely agree with you that the condition of public hospitals need to improve, we should bear in mind why the hospitals are in this situation. Thought the past few decades the hospital system has worked on a policy that all patients who present to hospital, be treated and none turned away. This has allowed equitable access to all patients, importantly for he poor, as they do not need to bribe or pay their way into a hospital bed. To improve the situation more funding is needed, which unfortunately means increased taxes – but that’s not very popular with the public is it? We should not operate hospitals on loans, as this is not sustainable (unlike for infrastructure development). Of course, reducing wastage would also be helpful. We also need to appreciate the colossal size of our health system – Sri Lanka has one of the highest admissions per capita in the world!

    • 3
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      Minal:
      All I can say is that Sri Lanka does not have to reinvent the (public health services) wheel.
      There are many examples of very successful systems in which your right to life and good health is NOT predicated on your ability to pay for services.It wouldn’t hurt to look at those and use or adapt what suits us best. However, as long as we cling to the belief that our civilization and culture is somehow superior to anyone else’s and we can’t learn anything from anyone else we will fight this (losing) battle.

      • 2
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        [Edited out]

  • 1
    4

    Surely Mr Poorten could have got his problem fixed at Navaloka with all private comforts like reverse cycle A/C and A La cart meals..

    Mr Poorten perhaps purposely elected a Dalit hospital to experience what our poor masses go through when they are in desperate situations like illnesses of themselves , or their beloved family members.

    Has Yahaplana President who was the Minister of Health for 10 years said anything about this pathetic level of services?.

    Unlike Mr Poorten ,perhaps Sira never went to Government Hospitals.

    May be lack of Democracy, and Human Rights, Soldiers guarding us against Terrorists and Police killing IRCs and Drug Mafiosa.and even brutal Rapists are more unhealthy than their Health.

    I mean for the Dalits.

  • 2
    1

    Emil.

    The Kandyan Peasantry have had a raw deal,for a very long time.The last King of Ceylon had his seat at Kandy.In fact it was the Kandyans who articulated the need for a Federal setup,in the early days,long before anyone else.

    Interestingly,in a recent survey conducted in the UK,the first concern[56%] was Immigration,followed by the National Health Service[NHS]!

  • 1
    0

    Emil,
    Just a mild criticism:
    “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.”

    I get the message , but I am sure there are people who don’t . If you would leave out phrases like “ambulatory difficulty” I am sure more people would get your message, especially in these days of TOEFL and IELTS.
    That apart, excellent article.However, I think a completely free service is impractical. Why not levy a nominal charge of Rs.100 per visit?

  • 1
    0

    The author’s words of appreciation for the ward staff labouring under such trying circumstances is noteworthy. The infrastructure is however another matter having suffered from lack of financing for the duration of the war. As pointed out above the present President of the country was the Minister of Health for 10 long years during which little if anything positive happened in the health service. True that the Harbour project and the little used airport are white elephants, BUT where those funds should have been used is open to debate.
    I have to disagree that Sri Lanka could afford a viable universal ‘free’ health service of the calibre that the author envisages with the funds available. In fact Britain, a richer country by far is struggling to fund the NHS, and demanding considerably more hours for lower pay from it’s junior doctors who are paid a pittance more above the unemployed benefits. Unless we are blessed with some kind of sudden windfall, things will unfortunately continue much as they are today.

    • 2
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      I do not buy the “we can’t afford it” argument. It is the lack of attention to priorities and organization and a gross lack of COMMITMENT TO PRINCIPLE that are at the root of our present mess. As I write this at 7 a.m. the same patient has left by three-wheeler for Kandy at 4 a.m. to attend the “clinic” with no guarantee that she will be among those fortunate enough to get a number today.
      We can’t afford not to afford a free health system with appropriate checks and balances.
      Despite all the squawking about “abuse by patients” etc. etc. there are many countries that have maintained their universal not-for-profit healthcare systems despite the drug companies and (some) medical practitioners arrayed against them. We can and must do so even if we have in addition, the very lucrative private hospitals run by “medical mudalalis.”

      • 0
        0

        I had included a link below (deleted by CT) which would have made things a lot clearer.

        Comparable figures for 2012 Sri Lanka UK Canada US
        % of GDP spent on Health Care 2.9 9.6 11.3 17.9
        Private spending as % of total 55 16.1 29.5 46.9
        Per Capita total spend in US$ 148 3480 4404 8362
        Per capita Gov. spend in US$ 66 2919 3104 4437

        The inadequacies in the US in spite of the large spend are well known. Canada is better. In the UK the services are considered inadequate by the people, but they would rather not spend more. That Sri Lanka could not provide a comparable service with a mere US$ 66 per head does not need explaining. Now that the war is over, let us hope that a bigger % of the GDP will be earmarked for health in the national budget. We have wasted 30 long years killing each other for a bigger piece of a rather minuscule cake.

  • 3
    0

    [Edited out]

  • 2
    0

    The General Practitioner,served to screen out the really serious cases particularly at village and small-town level. They have been made virtually extinct by the “channel” system. This no doubt contributes to the excessive numbers who seek treatment at General Hospitals.

  • 1
    0

    Emil van der Poorten chronicles another important facet of our daily lives. The concept of a National Health Service is one where the medical care is at least as good as that of private health care. After all, in most instances, the doctors in both public and private are likely to be the same. Private treatment will ensure that you will see a doctor quickly, and when you go into a private hospital you will probably enjoy your own private room (with bath, of course!) We produce good doctors and capable supporting staff, then we expect them to provide wonders in the shitty conditions under which they are expected to perform. .

    What happens now is that our MP’s including government ministers will get their treatment privately or overseas. The majority of our elected send their children to ‘selected’ government schools or private schools or even overseas. I do not know of any who use our public transport services.

    This then is the Sri Lankan condition; ‘I’m alright Jack, and stuff the rest’.

    WE still have a very, very, long way to go.

  • 4
    2

    I am glad that Mr Emil van der Poorten has re-established awareness of the continuing horrors of public hospitals in Sri Lanka with his above article.

    My reference was to the horrors of Ward 30 at the Kandy “Teaching” hospital and not to the other major facility at Peradeniya, a town near Kandy.

    I am in full agreement that excuses about a lack of public funding has no credibility nor public sympathy when colossal amounts have been squandered on projects which have almost zero public utility, and as the writer correctly observes, merely pandered to tyrannical egos.

    A rather submerged fact in this state of affairs is that medical professionals seem to want the present status quo to be maintained, as many do private practice outside the public health system, and earn exponentially greater amounts than their austere government salaries.

    If the public sector facilities were world class or in line with WHO guidelines in basic care which is the right of every citizen, they would lose the lucrative private practices and consultations at private hospitals.

    Therefore, together with major shareholders of private facilities, the government practitioners benefit from keeping a healthy number of citizens perpetually dependent on the pharmaceutical, pathology laboratory, electronic diagnostic and surgical facilities turning over at a brisk pace.

    If one considers the numbers of sick people in Sri Lanka, they would be at an all-time high level in proportion to population growth, with record profits in the medical insurance industry and pharmaceutical industry, with a presumably major contribution from poor public health.

    The pathetic conditions in public hospitals helps to keep the private facilities running very profitably as they fleece the vulnerable with impunity. If conditions changed in favour of the people, the aforesaid business profits would surely fall, as a much larger section of the general population would stay with the public system.

    Think about it.

  • 3
    1

    Lasantha Pethiyagoda:
    I couldn’t agree more with the sentiments expressed!
    While government policy is to be identified as the culprit for all of this, I certainly agree with your list of the other contributors to this woeful state of affairs.
    The first doctor I spoke to shortly after my return to Sri Lanka,someone of my vintage said, “Emil, there are no doctors in our country now, only mudalalis.” That might have been an overstatement but it certainly identified a part of the broader problem!

  • 0
    2

    The debate here has been on how to provide healthcare to the population, whether it should be left to the individual as and when he needs it or for the state to have a larger say by funding more of the needs. Sri Lankans had never been dependent solely on the government provided service, and general practitioners and consultants in the private sector have been in constant demand from as long as I can remember. Today some Sri Lankans fly off to Singapore/Malaysia to seek medical care even when they are available at home. It is certainly their right to do so.

    As I have pointed out the TOTAL health spend in Sri Lanka is a mere US $ 150 per head, compared to US $ 3500 in the UK, US $ 4400 in Canada and US $ 8400 in the US (2012 figures). The government spend is less than half of the total in Sri Lanka. It would be insane to believe that a service comparable to those in the countries mentioned is possible with the tiny sum available. The grossly underfunded government facilities are creaking under the demands placed on them, both in Sri Lanka and in the vastly better funded UK. Health care funding is a BLACKHOLE with no bottom.

    The criticism here comes from two individuals who abandoned Sri Lanka, after their education, to seek their fortunes, and the all important right to happiness abroad, in two different CAPITALIST economies. Were they wrong to do so. No, in fact they owed it to themselves to better their lot. They sold their own skills in the said markets at the MARKET RATE. One, it seems has returned for good, for whatever reason, and the other visits. However, when they crow about the merits and the virtues Stalinism could endow on the system in Sri Lanka we must call a halt. They sound fraudulent.

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