Doctorsí strikes

The right of expression, and especially the right to air grievances, is a fundamental article of a functioning democracy. A democracy must also be equipped with mechanisms or structures which can receive and respond to these voicings. Without such safeguards, democracies naturally tend towards anarchy and often even total collapse.

The past few weeks have been particularly tense for the health sector, first with the doctors going on strike and after their salary issue was resolved the "minor" employees taking to the streets. Actually, there are no "minor" employees or "major" employees, in the eyes of the state, all these persons are "employees". Period. They may be different in terms of grievance and demand, but they are all public servants and we need not elaborate on the meaning of that term. This is something everyone should take cognisance of, especially the government.

The "minor" employees, like the doctors, are complaining about salaries. These demands cannot be dismissed as unreasonable. If the way these demands are presented is objectionable, part of the blame must lie with authorities who have lacked the capacity to arrest discontent at the proper moment. Interestingly, whereas the demands of the GMOA were granted with minimum fuss, the Health Ministry has decided that the "minor" employees be treated with a different stick. A union leader has been arrested and a circular has been put out threatening striking workers with dismissal.

What is so special about doctors? Theirs is a noble profession, of that there is no argument. There may be grave faults about their salary structure, vis a vis the assistant and registered medical practitioners, but the fact remains that they have privileges that far surpass anything other public servants enjoy. Their history of union action has been mostly about having the cake and eating it.

In the good old days, when ethics might have counted, the GMOA agitated for the abolishing of private practice. "Common sense" or pocket sense might have prevailed for later they agitated for its restoration. The Administrative Reforms Committee recommended that those who engaged in private practice be allowed to continue while new recruits or those who gave up the perk be paid higher salaries but not allowed private practice. Everybody got the higher salaries and were also allowed the right to practice their profession privately.

It has always been a case of medical officers using whatever means necessary to look after their pockets. Apart from a few isolated individuals, we have never had doctors agitating en masse against the pharmaceutical mafia, i.e. the real drug lords, for example.

When the idea of setting up a private medical college was mooted, medical students and doctors protested vehemently on the grounds that the children of the privileged were being favoured. And strangely, they also objected to the children of the less privileged, who obtained their medical degrees through scholarships offered by the Soviet Union, from returning to practice in Sri Lanka. Though some of them do, various barriers were thrown in their way for good reasons and bad.

Compared with other professions, doctors, whose education the people of this country pay for, have the most opportunities to secure post graduate qualification. Sure, the average "take-home salary" (with private practice thrown in), is nothing compared with the average salary of a test cricketer, but they are well above the "middle-income earning" bracket.

There is no data about the number and percentage of doctors who engage in private practice. All we know is that even the poorest of the poor are forced to go to channelling services that are mushrooming all over the country when they require medical advice. When doctors strike, the private health care facilities make big bucks. The point is, only big-buck-earners can afford to purchase these services. The vast majority of the people in this country just cannot afford it, however deep they dig into their pockets.

Sadly, the bottom line, as far as the doctors are concerned, seems to have been encapsulated in an ill-timed statement made by an administrative officer in the sixties: "people die, it canít be helped".

How does one balance the right of doctors to protest perceived injustice with the right of any citizen to proper medical treatment? Perhaps a lesson can be learnt from post-war Japan where there was a general agreement not to indulge in strikes while the country was being rebuilt. Our country needs rebuilding. The fact of rebuilding does not and should not forbid protest. Workers have grievances and they need to be expressed and listened to. In Japan, doctors agreed not to strike but instead made the government understand that it has to consider a protest in the form of a black arm band is as serious as a strike action.

We have not had responsible or responsive governments, and therefore we cannot say how effective such a strategy might be. Nevertheless, a solution to such action has to be found, if we are to prevent unnecessary deaths, irresponsible trade union action, and high-handed counter measures on the part of the Health Ministry, the police or other arms of the state. We have had ad hoc committees for administrative reform, salary reform among other kinds of "reform". They donít seem to have worked.

We cannot suggest grand solutions that can deal with all manner of trade union action. Such solutions are best arrived at through collective effort where all stakeholders are allowed to have their say. However, we canít afford to have, say, the armed forces going on strike. We canít have the doctors abandoning patients, upping the ante ad lib in order to win demands. We cannot have random individuals playing god in situations beyond their capacity to comprehend. We cannot have armed forces being pulled back from areas that are clearly in need of defence and thrust into the job of running hospitals or bashing the heads of those whose complaints are not illegitimate. No, we need well-thought out mechanisms within the democratic framework that are sufficiently innovative and inclusive, so that grievance, expression of grievance and the rectifying of grievance can all take place without even one patient having to suffer unnecessary punishment.

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