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Hippocrates, Hypocrites and the Lucrative Medical Profession in Sri Lanka

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by Reggie Ponnampalam

At the outset, let me categorically state that I am not for SAITM. Then again, I must admit, I don’t have anything against them. Whether they are right in exercising their right is not something I want to write about. It’s just that I am allergic to doctors. I wonder if you remember “Doctor I’m Sick – Of Your Ilk” – Sunday Island 25/SEP/2016. A friend of mine sent me a quote – A doctor gave a man six months to live. The man couldn’t pay his bill, so he gave him another six months.

We can talk about health services, standards, quality. Around 50 years ago, my family doctor told my mother that I would die if I did not get my appendix operated on. My remedy was “Operation Escape”, a dose of two Disprins once in six months and, although my dad died at 62, with about 10 or 15 doctors as close friends, many of them ‘boozing pals’, I’ve passed his age.

I have a great many friends and classmates in the “Medical Profession”. In 1985, I was visiting my brother in Melbourne and he fell sick. We took him to a hospital and a very professional nurse checked his history, took urine and blood samples and 30 minutes later, we saw the doctor. Etched in my memory is the heated discussion between the nurse and the doctor and the only time the word “Sir” was used was when they addressed the patient (my brother). I must admit I don’t know my elbow from my backbone where medical terms are concerned, but I gauged the nurse presenting a case for ‘remedial’ and ‘precautionary’ when the doctor was angling towards ‘incision’. We ended up with an earful of advice, a bag full of medications and my brother is still ‘alive and ticking’.

I get a desperate call in 2011 from my sister that Michael (her husband) had suffered a stroke. With a son in Berkeley, a daughter at NYU and a workload from the office, she was finding it difficult to cope. I had just returned from a stint in Saudi Arabia and my ‘charitable soul’ found me taking wing to New York. My sister picked me up and drove me straight to the hospital where Michael was in ‘intensive care’. I rushed through the doors and corridors, running to see the patient when I was stopped by a matronly figure. Questions asked, answered, I was given a leaflet and directed to a washroom. I emerge fully washed, sanitized, robed, masked down to my shoe covers. Michael’s face lit up when he saw me, grinned (a sly smile was his trademark), and pointed out a seat at his bedside for me to sit while an Amazon of a woman (at least 6’2″ and 100 – 120kg) in uniform was attending to him. Know something? When I walked out, I was asked to throw the robe, mask, head cover, shoe cover et al into the Trash Bin. That was where I virtually lived over the next couple of weeks (sanitized in and trash out) and I learnt that this Amazonian was a Physiotherapist and, while she was not around, there was a Speech Therapist and an Occupational Therapist. Two weeks I was there and the doctor visited; the nurse, the therapist or even the person cleaning the toilet greeted him with “Hi Doc”. “Sir” was reserved for the patient.

A couple of years ago, we had something like a ‘reunion’; a lot of them expatriates. Somewhere down the line, one guy mentioned that this country had ‘gone to the dogs’. Another wit retorted, “That was sometime back. Even the dogs won’t take us now”. I love my country but I cannot deny fact. In the course of proceedings, one guy complained of a chest pain. Activities halted, we took him to a reputed (big) hospital. The doctor on duty ordered blood, urine tests and an ECG. One hour later, he summons us and tells my friend that he has to undergo urgent bypass surgery and that he could recommend a surgeon. My friend is an Aussie who left Sri Lanka in the late 60’s. Very realistic this guy asks the doctor “If I do the bypass surgery, how long will I live?” Doctor answers, “that depends”. “If I don’t do the surgery, what happens?” Again the response was “that depends”. My friend was not sure of how his insurance would cover these expenses and he opted to cut short his vacation and return to Aussie. A week later he calls me and I asked him how he was, he said his Aussie doctors diagnosed ‘strain, stress and emotional excitement after a long hiatus’. Bypass? “Don’t trouble trouble till trouble troubles you”!

A couple of months back, a friend of mine tried to lift a flower pot and he fell. With a back ache, he went to a doctor who prescribed a two-week course of pills. Two days later, the nagging pain persisted and he went to another doctor – same prescription. Finally, a fourth doctor recommended an X-Ray. A hairline fracture on a vertebra and the treatment took a different course. For two or more weeks my friend endured the pain and pills of three doctors who valued rupees more than sense!

Just yesterday (07/FEB), my sister-in-law calls and says she has a slight blur in one eye. A few calls are made and we get an appointment with a top class eye doctor (Opthalmologist or something like that). Doctor’s fee 1,000 + tax 150 + hospital charge 500 = Rs 1,650.00 for the consultation. We were number 14 and I counted up to number 37 – patients awaiting consultation. Consultation concluded; diagnosis cataract; remedy surgery. As luck (the consultant’s or ours) would have it, Tuesday was his surgery day and we could ‘avail’ of his services immediately. Checked in at the counter and they say an ECG (Rs 500) and two types of eye drops have to be procured (620 + 470 odd – almost 1,200). Surgery was tabbed at 27,060. I managed to creep into number three and I counted up to 14 surgeries listed for the day by the same consultant. Unlike the invoice for consultation fee, the bill for surgery didn’t have any breakdown – just plain heartbreak when I worked out some math – 37 consultations at 1,000 doctor’s fee of 1,000 = 37,000. ‘Shop Closed’ by 9:00am. On the ratio or percentage that the consultation fee is distributed (a little over 60% to the doctor), it’s a little over 16,000 per surgery for the ‘doctor’. I counted 14 and there could possibly be more. It was around 3:30/3:45 when I was downstairs waiting for a cab I had called to take my sister-in-law home. This consultant comes by, gets into his chauffeur-driven limousine and well over a quarter of a million pocketed for a day’s work! By the way, we were billed an additional 27,000 for a ‘lens’ that was to be inserted. With a quarter of a million already in your pocket, why work on a percentage of that?

Lawyers, Engineers, Accountants are also professionals who undergo the same five or more years, either in university or other preparatory institution. They hold their life in their hands. Apparently doctors hold our lives in their hands and they hold us to ransom. A few years back, we had nurses walking, striking, protesting at the drop of a hat or whatever else was waved at them. Today we have the stethoscope attempting to redefine the horoscope of our political landscape; abandoning patients for protection of patent. The tragedy is in cajoling students who should be studying medicine and not ways and means to break the law. When ‘educated’ professionals gauge success of a protest or demonstration by the defiance of law and order, and talk about the response to violence, there is a lot to be read. Between the lines.

“Jeevithiyang aniyathang maranayang niyathang”. The concept of death being the only certainty in life. Medicine can postpone this occurrence, but at what cost? Mothers sometimes find it difficult to give milk to their babies but doctors have made an art form of ‘squeeze’. Drive-by (or ride-by) shootings are so common a friend of mine tells me he could arrange one for 10 or 15 thousand. He was joking but I don’t believe it would cost much more. Lasantha, Kumar Ponnambalam and a whole lot more were shot dead – the assassin never missed. Never. The CEO of SAITM was shot at, not hit. Was the miss surgical?

I’ve read a great deal about Stalin – he makes good reading but I never was a follower. Sometimes however I wonder what it would feel like to be a Stalin today. I would open a kitchen and offer stir-fried testicles – MBBS qualified!

Courtesy:Sunday Island

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