Published On:Saturday, July 2, 2011
Posted by Sri Lanka Guardian
by Gaja Lakshmi Paramasivam
(July 02, Melbourne, Sri Lanka Guardian) I write in response to the article ‘Intensivists: Why do we need them now? ’ by Professor Chula Goonasekera of Peradeniya University (Sri Lanka Guardian 30 June).Professor Goonasekera says ‘Sadly, we do not have such specialists in Sri Lanka. Yet, it is very important that we do. This is because we do not have an unlimited capacity to provide intensive care to all who need them. For example, it is recommended that 15% of bed capacity in a hospital should be allocated for intensive care, but in Sri Lanka this number barely reaches 1%. This will give you an estimated understanding of how lucky one should be to be admitted to an intensive care unit when the need arises in Sri Lanka.’
The question is whether patients in countries that satisfy the 15% benchmark feel 15 times more satisfied than Sri Lankan patients. Those with Western education often tend to indiscriminately use statistics when they seek to ‘show’ outcomes. To me the first valuation is based on the feelings of the patients. This depends on belief/faith that the patient feels in the doctor and the medical system s/he is in. In Sri Lanka, this is known through the respect shown by the patients to those of the medical profession. In the West, with its greater investment in Democracy, this aspect is suppressed to ‘show’ commonly achievable results.
In Sri Lanka, majority depend on the blessings of Higher Powers and this leads to doctors being treated as manifestations of those Higher Powers. To the extent the patient believes, the powers of the person through whom the ‘blessings’ / ‘cures’ are expected, work naturally for the patient to cure her/himself. That is Divine Power that all of us have the ability to feel. This is the key reason for investing in independence of the individual. But believing is not easy – especially where there are other distractions - including calculated attention by specially allocated doctors. Many Indian doctors are using such avenues to lure patients away from the Sri Lankan Public Health system. Moves towards Western systems would make Sri Lanka more attractive to foreign doctors.
In his article ‘A conspiracy to kill Sri Lankan Universities?’ (Sri Lanka Guardian 24 May) Professor Goonasekera says ‘Thus, 97% of our younger population, irrespective of their good performance at the GCE (Advanced Level) Examination may not enter a university. This is despite all of us, big and small paying taxes through our noses for the government to ensure equity in the educational sector for our children. University teachers emerge from the aforesaid 3%. In some areas of study, more than 50% of the graduates leave Sri Lanka for good, due to many reasons, economic and non-economic. Some do remain in Sri Lanka, not merely because they cannot find foreign placements in greener pastures, but out of choice. They just cannot do way with their duty to serve the motherland despite many difficulties and deficiencies. University teachers are ultimately the best lot out of our own graduates who have chosen to live in Sri Lanka due to their love for the country’
Professor Goonasekera has the responsibility to use the same yardstick as above in measuring doctors and their practices. Exporting teachers has similar effects as importing foreign medical systems. We need to ‘feel’ as insiders and then add to it the ‘foreign’ component that influences our environment. Within Sri Lanka this ‘foreign’ component would be higher in Colombo than in other parts of Sri Lanka – including Jaffna as it is today. The total needs to be then compared with the outcomes of the Western systems.
The parallel of this is the caste system – which is being actively analyzed by the Tamil Community. To the extent a person exercises caste based authority on the basis of belief – this would stand up to genuine scrutiny by any good system of Administration and Management. Those of us who come ‘outside’ those local circles of belief – largely due to higher education – need to then add our status as per the new system to assess ourselves for the purpose of our self confidence. The results we need to show are those measurable by independent experts. The foundation is our belief.
The Sri Lankan Government claimed Sovereignty as a Country to deal with what it claimed to be terrorism. To the extent the Government believed that it was terrorism, it had the moral authority to deal with the issue confidentially. The recent revelations including through the UN Report – have confirmed that they went outside their belief and therefore their Sovereign powers. To that extent they owed it to the world to be transparent and are accountable to the world they seek to be a part of.
Professor Goonasekera says ‘The ICU's roots can be traced back to the Monitoring Unit of critical patients through nurse Florence Nightingale. The Crimean War began in 1853 when Britain, France, and Turkey declared war on Russia. Because of the lack of critical care and the high rate of infection, there was a high mortality rate of hospitalized soldiers, reaching as high as 40% of the deaths recorded during the war. Nightingale and 38 other volunteers had to leave for the Fields of Scurati, and took their "critical care protocol" with them. Upon arriving, and practicing, the mortality rate fell to 2%. Nightingale's work, paved the way for intensive care medicine to be established.’
Given that Florence Nightingale was a Nurse and NOT a doctor, I take it that Madam Nightingale felt for the patients as if she had the problem. It was common faith that brought the mortality rate down in an area where there was a freeze on available resources. Belief produces exponential value. Many service providers in war torn areas of Sri Lanka rely heavily on this belief to help the victims of war. This was also the reason why the Tamil Tigers were far more powerful than the Government’s armed forces until they started relying on ‘external’ powers. Once they weakened their internal powers, it was easy for the Government also to use external forces to defeat them – external to Northern Sri Lanka as well as Sri Lanka itself.
Similarly, if the Sri Lankan medical profession weakens its belief in itself, it would be easily defeated to become second class to money rich Western Countries. Belief needs to be the foundation on which objectively measurable merit needs to be assessed.
Professor Goonasekera says ‘A training program for an intensivist, starting after qualification from medical school is expected to last 6-8 years. If Sri Lanka embarks on this program now, we could hope for a better chance for survival in intensive care in the year 2016. Intensivists reduce cost and help more patients to survive. Hon Minister of Health, isn't it time we embarked on this training without delay? We do need a ‘Nightingale’ now to make this change’
The parallel that comes to my mind is the grab by various groups to take over the status of the LTTE. Where was the call for Sri Lankan Nightingale during the recent war when it was most needed? There were many in the camps and outside with the families of victims. But they are not recognized by the Government nor the medical profession. Hence all those who have the power to elect Government – through majority vote are disqualified from entering the Sacred Area of Florence Nightingale. It is amazing as to how any Sri Lankan including Tamil Sri Lankan could so easily forget what happened to those of low status in both sides of the war in Sri Lanka and think of quick economic progress before the wounds have healed.