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SLMC in crisis

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The recent release of the report of a panel of inquiry that probed the affairs of the Sri Lanka Medical Council (SLMC) and the subsequent removal of its President and four members by the Minister of Health has brought to the surface many problems concerning this important statutory body. It is well known that the inquiry was initiated by a complaint made by the office-bearers of a powerful trade union who happen to be members of the council.

Many deficiencies, shortcomings and irregularities in the report itself have been exposed. The impartiality of the inquiring panel has also come into question. It appears that the inquiry, meant to be of a fact-finding nature, had erroneously recommended punitive action.

The confusion in the minds of many regarding the difference between the Sri Lanka Medical Council (SLMC) and the Sri Lanka Medical Association (SLMA) should be clarified at the outset.

The SLMC is a statutory body established, in 1924, on the Medical Ordinance based on the same format as the General Medical Council (GMC) of Great Britain. It is tasked primarily with ensuring the safety of the general public seeking medical treatment from doctors registered by the council. It does so by maintaining the standards of medical education and by supervision and disciplinary control of medical practitioners of all categories. The public are encouraged to bring any complaints, supported by affidavits, regarding the actions of the practitioners to the SLMC. It is illegal to practise allopathic medicine in the country without first getting registered with the SLMC.

The SLMA, on the other hand, is an association of doctors of all categories dealing with academic matters, and bringing doctors updated with advances in medicine for Continued Professional Development (CPD). Its membership is voluntary, not compulsory, and is open to all graduate medical practitioners registered with the SLMC. It plays an advocacy role in various health issues affecting the people, as well as assisting the government in matters of health policy. At present, it is actively involved with the health authorities in attempts to control the Covid pandemic. It promotes ethical practice of medicine.

As already mentioned, the SLMC is based on a Medical Ordinance 96 years old. Naturally, much amendment is necessary to suit the current requirements. Such changes have been formulated and proposed to the Ministers of Health, the ultimate authority, by the SLMC at various times during the past two decades. Unfortunately, no action has been taken in implementing them. This has led to the various allegations levelled against the Council, often for no fault of theirs.

At present, the SLMC is composed of 25 members: the Director General of Health Services (ex-officio), the Deans or their representatives of the nine medical faculties in the country, eight graduate doctors registered in the main section 67 of the Ordinance, elected by vote, one representative each of the dental practitioners and registered medical practitioners and the President and four members nominated by the Minister of Health.

Many controversies have arisen due to this composition. Much criticism has been raised about the way the elections are conducted to select the eight graduate members. The trade unions like the GMOA with a large membership have a near monopoly of getting their members elected to fill these posts. They conduct their campaigns like in national elections, spending vast resources at their disposal, in bringing bus loads of doctors to Colombo for voting and even intimidating opposing contestants. At present, the GMOA President is an elected member of the SLMC along with three other office-bearers of his union. Being a vociferous trade union, the GMOA does its utmost to impose its will on council decisions. On several occasions, they have been reprimanded by the President of the SLMC for disrupting the council proceedings.

The current controversy concerns the five members, including the President nominated by the Minister of Health. Although the Minister is the nominating authority, the Ordinance does not allow her to remove them until five years have lapsed since their appointments. (This situation is similar to that which empowers the President of the country to appoint judges of the apex courts, but he has no authority to remove them.) The recent dismissal of the President and four members is therefore considered illegal.

Reasons given for such action based on an adverse report of the panel of inquiry referred to the above are worth further analysis. As mentioned already, allegations were brought in mainly by the GMOA:

1. Improper conduct of disciplinary inquiries. As a significant number of the accused naturally happen to be GMOA members purely because of their vast membership, there is a conflict of interest if GMOA members in the council are to sit on disciplinary committees. Thus, barring them from sitting on such committees has caused much dissatisfaction among the union members.

2. Delay in conducting the ERPM examination for foreign qualified doctors. This is an ongoing problem. The examination schedule has been disrupted this year due to the Covid related restrictions. Matters have been made worse over the years by different groups of candidates getting court injunctions preventing the holding of examinations for various reasons. The examination branch of the SLMC has been working round the clock, headed by a respected emeritus professor of the Colombo Medical Faculty, with long term experience in conducting medical examinations. The high rate of failure at this examination is due to many reasons. It cannot be blamed on the examination process. The format of the examination has been improved on several occasions over the years. No doubt an ever-increasing number of candidates and a paucity of available examiners cause several logistical problems. Unreasonable calls from the politicians and others to do away with the examination altogether have been resisted effectively so far. In one instance, when the Minister indicated that a crisis situation had arisen due to the high rate of failures, the SLMC pointed out that a graver crisis would arise if poorly trained doctors are allowed to practise medicine!

3. Inability to maintain minimum standards for entry into foreign medical colleges. It was realized way back in 2011 that some students had gone abroad for medical education without even passing the GCE advanced level examination. These students have returned with their medical degrees. The SLMC could not disqualify them from sitting the ERPM exam, as such retrospective action was deemed illegal. However, corrective action has been taken to establish minimum standards for entry to medical schools. Up to now the courts have rejected applying such criteria without being passed by an Act of Parliament. Various proposals for such action have been ignored or delayed by the political authorities. The provisions were at last passed by an Act of Parliament a few weeks ago. Thus, it is unjustifiable to blame the SLMC for such deficiencies and delays.

The political authorities, over the years, have attempted to interfere with the vital functions performed by the SLMC. Requests for lowering the pass marks at qualifying exams, register foreign medical specialists with substandard qualifications, and recognition of local and foreign private medical colleges with many deficiencies were successfully resisted by the SLMC. In one instance, the lady president was forced to resign when she did not comply, as there was no provision in the ordinance for her removal. So far, the SLMC has been able act honourably due to the non interference by those in authority, guaranteed by the Ordinance.

The present situation where the Minister single-handedly and illegally removed five members, including its President, is bound to have serious repercussions for the future. It is not a question of the suitability or otherwise of the personalities who were removed or those who replaced them. It is the illegal violation of the independence and autonomy of a statutory body. Hence it is essential that this decision is reversed and status quo restored.

Once that is done the amendments to the Medical Ordinance should be framed and implemented without any further delay. Changing the composition of the SLMC, the way the members are selected or elected, and the inclusion of respected non-medical professionals are among the priorities to enable the SLMC to discharge its duties to the general public at large. If the current situation prevails, the SLMC will be a toothless tiger serving the selfish interests of politicians. Ensuring that the medical profession is well regulated maintaining high ethical standards, thus safeguarding the interests of the general public will be the least of their concerns.

 

A Former Member of the SLMC



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Opinion

A Cabinet reshuffle needed

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By Dr Upul Wijayawardhana

It looks as if the government did not realise the need to take drastic action to stem the tide of public disapproval. Even the most optimistic, who were overjoyed at the election of a non-politician President, followed by that of a government with an unexpected thumping majority, are sighing in despair! Although part of it is due to avoidable own-goals, there seems to be an extremely effective anti-government campaign directed by an unseen hand. Even when toxins are detected in imported coconut oil, rather than laying the blame on errant importers, attempts are made to tarnish the image of the government. All this is possible because the government seems to lack an effective communication strategy. One wonders whether the government has a lax attitude because the Opposition is blundering.

The fracas in the Parliament on the issue of Ranjan Ramanayaka losing his seat was the best illustration of a misguided Opposition not fit for purpose. Critics may argue that RR was given an unfairly harsh punishment but their criticism lacks moral authority because they opted to be silent when a Buddhist priest was given a much harsher punishment for the same offence: in fact, they were delighted! RR stated publicly that most judges were corrupt and defended his stance at every possible turn. He also refused all opportunities afforded for clarification. In spite of the Attorney General informing a while ago that RR’s seat should be declared vacant, to his credit the Speaker waited till RR’s petition for appeal was dealt with. Even though the facts were obvious, the Leader of the Opposition accused the Speaker of removing RR on the basis of non-attendance for three months, which he had to correct the following day! Those who blamed the SLPP for staging unruly protests in Parliament in October 2018, did the same on behalf of RR. Is this not laughable?

Once and for all, the question of the authority of the President was settled with the passage of the 20th Amendment and it is high time the President made use of his new powers. The most important thing he can and should do is a cabinet reshuffle, a mechanism often adopted by British Prime Ministers by way of a course correction. It need not be a major reshuffle but a minor one involving some ministers who are obviously underperforming. I have written in the past about the Minister of Health who demonstrated gross irresponsibility by partaking of an untested and unlicensed medicinal product. She is also responsible for not implementing the Jennifer Perera committee report on the disposal of bodies of unfortunate victims of Covid-19? Had this been implemented in December, much of the adverse publicity the country received could have been avoided. Perhaps, the voting during the UNHRC resolution also may have been very different. The Minister of Public Security talking of banning some face coverings did not help either. Pity he did not realize he was talking of this at the wrong time; during an epidemic when face coverings may be useful.

The Minister of Trade, who was an effective critic in the Opposition, has turned out to be totally ineffective. Even the government gazette has become a joke due to his actions. Perhaps, it is time for him to take a back-seat and allow someone else to have a go at the rice-mafia. etc. Perhaps, ex-president Sirisena may be given a chance to see whether brotherly love is more effective than the gazette in controlling the prices of rice.

The biggest failure of this government is on the diplomatic front. What most diplomats consider to be the most important diplomatic assignment, the post of High Commissioner to India remains unfilled for almost a year. Whether we like it or not, India is fast gaining the status of a world power, and not having our representative to deal with officials acknowledged to be of top calibre is a shame.

The way the UNHRC resolution was handled showed total incompetence of the highest order. We withdrew but the Ambassador decided to take part; we lost and claimed victory! To cap it all, the Foreign Minister announced in Parliament that the resolution was illegal. All the time sinister forces are at work, relentlessly, to undermine the country and force the separatist agenda on us and if we are not sharp, we may end up in disaster. For reasons best known to themselves, the government failed to utilize fully the good offices of Lord Naseby. Statements made by the Foreign Secretary no doubt irked the Indian and US governments.

For all these reasons, the need of the day is a complete overhaul of our Foreign Affairs set up, starting with the Minister. It is high time we made use of our career diplomats, who are well trained for the job and stop sending political ambassadors. The practice of utilizing ambassadorial posts as parking lots for retired service chiefs is abhorrent, as it gives the false impression that Sri Lanka has a military government in all but name.

There is still a chance for reversal of fortunes, if the President decides to act swiftly after returning from Sinhala and Tamil New Year celebrations. If not, unfortunately, there may not be much left to celebrate!

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Opinion

Alleviating poverty, the Chinese way

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China has released a white paper on poverty alleviation which outlines the success of policies implemented, the methods employed and her desire to share the unique social experiment with other developing countries. Sri Lanka being a friendly international partner of China should make use of this opportunity to study the programme and plan a scheme and send a team to China to learn the activities conducted under the scheme so that Sri Lanka will be able to handle the fight against poverty, successfully.

“China achieved the largest scale battle against extreme poverty, worldwide, as 98.99 million people had been lifted out of absolute poverty, creating a miracle in human history.” These people were living in 128 ,000 villages all over in China. China through a sustained program was able to achieve its poverty reduction targets set out in UN 2030 agenda, 10 years ahead of its schedule.

A quote from a report released by the BBC outlines the success achieved by China.

:” In 1990, there were more than 750 million people in China, living below the international poverty line – about two-thirds of the population. By 2012, that had fallen to fewer than 90 million, and by 2016 – the most recent year for which World Bank figures are available – it had fallen to 7.2 million people (0.5% of the population). So clearly, even in 2016 China was well on the way to reaching its target This suggests that overall, 745 million fewer people were living in extreme poverty in China than were 30 years ago. World Bank figures do not take us to the present day, but the trend is certainly in line with the Chinese government’s announcement. (“Another large country, India, had 22% of its population living below the international poverty line in 2011 (the most recent data available) …:”}

The people living in extreme poverty suffer from the lack of extremely basic amenities, such as food. safe drinking water, sanitation, health, shelter, and education. It is a fact that those who come under this category are trapped in a vicious circle and for generations they cannot escape the deprivations.

Some of the policies followed by China in achieving the enviable outcome are discussed in the White paper. The most important condition to be fulfilled is the acceptance of the fact that governance of a country starts with the needs of the people and their prosperity is the responsibility of the government. “To achieve success, it is of utmost importance that the leadership have devotion. strong will and determination. and the ruling party and the government assumes their responsibilities to the people. play a leading role, mobilize forces from all quarters and ensure policies are consistent and stable’.

China has provided the poor with the guidance, direction and tools while educating them to have the ambition to emerge from poverty, Through farmers’ night schools, workshops and technical schools create the improvement of skills. The government identifies the economic opportunities in consultation with the people, then provides finances, loans for the selected projects, and strengthens the infra-structure facilities, including the marketing outlets.

While the macro aspects for the poverty alleviation is planned centrally, the activities are executed provincially and locally.

Sri Lankans living under the national poverty line was 4.1% of the population in 2016 (World Data Atlas). The impact of Covid-19 in 2020-21 has dealt a severe blow to the living standards in Sri Lanka and it is assumed that the people living under the poverty line would have reached approximately 8% of the population by 2021.

President Gotabaya Rajapakasa has realised this gloomy truth in his interaction with the poor in the villages on his visits to the remote areas in Sri Lanka. I would request him to study the success story of China and to work out a similar NATIONAL programme in consultation with China. In the White Paper, China says that she is ready to share her experience with other countries who desire to reduce the poverty levels. The President should appoint a TASK FORCE of capable and nationalist-minded individuals to steer the program with given targets as PRIORITY VENTURE. If Sri Lanka can plan a comprehensive programme for poverty alleviation and implement with determination under the capable, dedicated and willing leadership of the President, nearly two million Sri Lankans who live below the poverty line will benefit and would start contributing to the growth of the nation productively.

RANJITH SOYSA

 

 

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Opinion

Need in New Year is to heal the divides

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By Jehan Perera

One of the definitions of reconciliation is to move from a divided past to a shared future.  The arrest of the Jaffna Mayor Visvalingam Manivannan came as a reminder that unhealed issues from the past continue to threaten peace in the present and the future.  According to people I spoke to in Jaffna, this arrest has revived memories that were no longer in the people’s consciousness.  Nearly 11 years after the end of the war, the people were no longer thinking of the LTTE police and the uniform they once wore. The bailing out of the mayor de-escalated the crisis that was brewing in Jaffna following his arrest.  There were reports that a hartal, or shutdown of the city, had been planned to protest against the arrest.

Jaffna Mayor Manivannan was taken into custody by the Jaffna police for allegedly promoting uniforms and iconography of the LTTE, according to the police.  They had found that the Mayor had recruited five individuals to perform traffic duties in Jaffna town in uniforms that resembled those worn by the LTTE’s police during the time when they ran a parallel administration in parts of the north and east. Photos published in the media show a similarity.  Promoting symbols associated with the LTTE, including uniforms is an offence under provisions of the Prevention of Terrorism Act (PTA).

However, the position of the Municipality was that the five individuals had been recruited to a Jaffna Municipal Council task force on a temporary basis to enforce penalties against environmental violations such as littering the streets.  According to Mayor Manivannan, the uniforms were, in fact, the same as those worn by a similar task force run by the Colombo Municipal Council (CMC). Media reported a striking resemblance between the task force uniform and the uniforms worn by the LTTE police but also that a parking meter initiative run by the Colombo Municipal Council has employed staffers who also wear a light blue shirt and pants of a darker shade, vaguely similar to the offending Jaffna outfit. 

 

JAFFNA VISIT

Ironically, a few days prior to this incident, I visited Jaffna to take part in the last rites for Fr Nicholapillai Maria Saveri who had headed the Centre for Performing Arts, in Jaffna, for over four decades.  Under Fr Saveri’s leadership the centre produced an entire generation of artistes who reached out across all barriers of ethnicity and religion and touched the lives of people everywhere.  Through his artistic and cultural productions, Fr Saveri tried to show the interdependence of those who live in the country and need to share it bringing to the fore their different talents, connections and capacities.   He sought to turn the diversity and pluralism in the country away from being a source of conflict into one of strength and mutual enrichment. 

The normalcy I saw in Jaffna, during the short period I was there, made me feel that the ethnic conflict was a thing of the past.  At the hotel I stayed I saw young people come and enjoy a drink at the bar and talking with each other with animation and laughter as young people do.  When I went to the District Secretariat, I was struck by the fact that they played the national anthem at sharp 8.30 am and all work stopped while the anthem played all three verses in the Tamil language and all stood to attention, even inside their rooms.  The Lessons Learnt and Reconciliation Commission (LLRC) appointed by President Mahinda Rajapaksa, in 2011, had recommended that the national anthem be sung in both languages and I was happy to see that in Jaffna this was being implemented a decade later.

At the funeral service for Fr Saveri I met many people and none of them spoke of war and conflict but like people in other parts of the country they spoke of the economy and cost of living.  An administrator from the University of Jaffna spoke about his satisfaction at the large number of Sinhala students at the University and the mixing that was taking place as a result, between the communities.  He said that as the University did not have adequate hostel facilities many of the students from outside of Jaffna, including the Sinhala students, lived with local families.  He said that during the recent graduation ceremony, hundreds of their family members came from the southern parts of the country and joined their children in their places of accommodation which contributed to the inter community mixing.

 

UNIFYING THEME

The situation in Jaffna was so normal to my eyes as a visitor that one of the questions I had and to which I sought answers from those I met, was whether there was a common theme that bound the people together.  Despite my inquiries I could not discern such a common theme that was openly visible or explained to me as such.  It was much like the rest of the country.  At the last general election the people of the north voted for a multiplicity of parties including ones that are part of the present government.  The candidate who got the largest number of votes was one who was affiliated with the government.  At the same time nationalist parties got votes too that saw them enter Parliament and the more moderate parties emerged the largest. 

The arrest of Mayor Visvalingam Manivannan has now supplied a common unifying theme to the politics of the north.  There is distress that the popularly elected Mayor has been treated in such a manner.  If the uniforms that the Municipal workers were wearing too closely resembled those of the LTTE, he could have been informed that this was not appropriate.  It would have been possible to ensure that the uniforms were immediately removed and replaced with ones that were more appropriate while taking into consideration the sensitivities that three decades of war would bring.  As the Mayor is most closely associated with government Minister Douglas Devananda such a request would most certainly have been complied with.  As leader of the EPDP, Minister Devananda was at the forefront of militarily fighting against the LTTE.

The government’s determination to thwart any possible attempt to revive the LTTE can be understood.  The war with the LTTE cost the country enormously in terms of human suffering and economic devastation.  The government won the last election on the promise that it would give priority to national security and also develop the country on that basis.  However, sections of the Tamil Diaspora continue to be openly pro-LTTE and espouse a separatist agenda.  The loss of the vote at the UN Human Rights Council, in which the Tamil Diaspora played a role, would make the government more determined to suppress any attempt to revive the LTTE.  Now that the immediate crisis has been defused due to the release of the Mayor on bail, it would be timely for the government to mitigate the political damage by a multiplicity of means, including by reaching out to the Jaffna Municipal Council about its Municipal law enforcement mechanism.

 

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