On Doctors and Kings

An authoritarian wind is sweeping across Sri Lanka

"Oh weep for the free man That is broken here." Seamus Heaney 
(The Cure at Troy)

Tisaranee Gunasekara-August 11, 2018, 

The current yearning for the heavy hand of a strong leader is in tune with the Zeitgeist. Across the globe, people, disillusioned with democracy, are opening their ears to the siren song of authoritarianism. As Barrack Obama pointed out in his Mandela Centenary Lecture, "We now stand at a crossroads – a moment in time at which two very different versions of humanity’s future compete for the hearts and minds of citizens around the world."

In Sri Lanka, the less immoderate, less illiberal government is in a state of semi-paralysis. The extremist and anti-democratic opposition is surging ahead. The myth that democracy is part of ‘The Problem’ (or even ‘The Problem’) rather than the least bad form of governance is ascendant. If democracy is the problem, then the solution, by definition has to be anti-democratic. This is the dangerous place to which Sri Lanka is careening.

It is shocking when a senior monk publicly expresses a yearning for a Lankan Hitler, and most other senior monks either stay silent or try to explain away such an aberrant desire. Shocking but perhaps not very surprising; most monks know little of world history and Sinhala-Buddhist extremists have a soft corner for fellow extremists, up to and including Herr Hitler.

But when the president of the Government Medical Officers Association (more infamous in its acronym, the GMOA) threatens journalists and gets away with it, it is a sign that society itself is sickening from the twin contagions of extremism and intolerance.

Playing with words like traitors and patriots is something one expects from politicians, or religious leaders, not from respected professionals, especially doctors. That makes doubly shocking the words of Dr. Anuruddha Padeniya, the head of the GMOA. "We have created a point scheme," Dr. Padeniya reportedly told a Lake House journalist. "In psychiatry there is a method to identify people who betray the country. We are going to launch this list and keep it online with the materials you publish. So we can display that you are carrying out a contract."

What occasioned Dr. Padeniya’s outburst? According to The Sunday Observer, he was angry about having to admit that "only about half the private practitioners had participated in the token strike." Incidentally Dr. Padeniya knew that his words were being recorded and will be made public. "I know you must be recording this. That is good. Let others in your newspaper also listen to this."ii

So what was the gist of Dr. Padeniya’s outburst?

* The GMOA will make a list of journalists it considers to be traitors.

* The list will be published online for the edification of cyber-bullies, cyber-criminals and potential mobs.

* The list will be made according to abusive psychiatric methods used by authoritarian rulers to confine their opponents in psychiatric facilities by sticking the mentally sick label on them.

In 1977, the World Congress of Psychiatry adopted the Declaration of Hawaii. The purpose of the Declaration is to take a firm stand against the abusive use of psychiatry for political and personal ends: As the Declaration states, "The psychiatrist must never use his professional possibilities to violate the dignity or human rights of any individual or group and should never let inappropriate personal desires, feelings, prejudices or beliefs interfere with the treatment... If a patient or some third party demands actions contrary to scientific knowledge or ethical principles the psychiatrist must refuse to cooperate."iii

According to Dr. Padeniya, the GMOA intends to use the abusive psychiatric practices condemned by the Hawaii Declaration to silence its critics. He is not trying to hide the fact. He is not ashamed of it. He doesn’t think making such a statement will lead to any adverse consequences. He just says it, as if it is the most normal thing in the world.

That is the clearest possible indication of the deadly place we are in today, as a country and as a society.

Children of Mammon

When the news broke out that parliamentarians and ministers are to get a massive pay hike, there was outrage, but little surprise. That is the kind of conduct we, Lankans, have come to expect from our legislators.

Surprisingly, it seems as if most of our legislators are not totally deaf and blind to public anger. Mangala Samaraweera, in his capacity as the Minister of Finance, opposed the pay hike publicly. As condemnation poured from all sides, the UNP, the JVP and the JO distanced themselves from the proposal. Eventually, the President and the PM said that a pay hike will not be permitted. Only three ministers have been so tone-deaf as to speak in favour of a pay hike: Lakshman Kiriella (directly), Champika Ranawaka and Sarath Fonseka (obliquely). For now, the proposal had been placed on the backburner.

There’s little doubt that the pay hike would have gone through, sans public condemnation. But there was public condemnation; and an absolute majority of legislators curbed their cupidity and backed down.

Not so the GMOA.

The GMOA launched a yet another token strike on August 4. A continuous strike is on the cards. Some of the demands demonstrate that the guiding spirit of the GMOA is not Hippocrates of Kos (or even physician-king Buddhadasa of Lanka) but Mammon. Having become doctors at public expense, the GMOA is holding the public as hostage to gain yet more perks and privileges for its members.

For instance, the GMOA demands that all government doctors be paid a monthly transport allowance of Rs. 100,000. The GMOA reportedly has 18,000+ members.

Work the maths.

Another GMOA demand is a monthly allowance of Rs. 30,000 each for all medical administrators.

Then there is the demand that children of GMOA members be guaranteed entrance to top level national schools.

Prof. Colvin Gunaratne called the GMOA a trade union. That is doing injustice to absolute majority of trade unions. A mafia would be a closer analogy.

Sri Lanka is one of the very few countries in the world where medical education is free. Doctors are created at public expense. The public also pay their salaries and benefits. Now the GMOA wants the public to pay even more. That would mean having to impose more taxes on an already overburdened populace.

A key structural anomaly in the Lankan economy is the complete imbalance between direct and indirect taxes – the ratio is 80:20. This grossly disproportionate reliance on indirect taxes works against the poor and most of the middles classes by pushing up prices and living costs. The Sirisena-Wickremesinghe administration promised to redress this imbalance, a promise observed in the breach until Mangala Samaraweera tried his tax reform.

The pluses and minuses of the new tax proposals are open to debate. But the need for a tax system which reduces the burden on poor and middle classes by correcting, even marginally, the gross imbalance between direct and indirect taxes is obvious. That was why the PAYE rate for those earning more than 350,000 a month was increased to 24%.

The people who have the least right to oppose such an increase are those who benefit most from the tax monies, such as doctors, many of whom would have been denied access to medical education had it not been free. Therefore, there’s something particularly noxious about the demand that doctors be exempted from this increase. This and other GMOA demands turn doctors into greater adherents of Mammon than even our politicians – and that is saying a lot.

The fact the GMOA uses the suffering of the poorest of the poor, those who cannot afford to seek private treatment even in a life-and-death situation, as a bargaining chip places it beyond the pale.

It is highly likely that a majority of doctors are not happy about breaking the Hippocratic Oath for private gain. It is highly likely that a majority of doctors go along with the GMOA out of fear. Given Dr. Padeniya’s threat to journalists, it is not hard to imagine what he and fellow GMOA bosses would do to any dissenting doctor.

But the silence of the silent majority is enabling the GMOA to bring disrepute and shame on a venerable profession. When the good play Chinese monkey, the bad can become super villains. The fear of the silent majority is understandable, given the GMOA’s thuggish conduct. But by staying silent, the good and decent doctors are placing in danger the lives of people they have pledged to protect.

Ending Impunity

The day the GMOA launched its latest strike, Prof. Colvin Gunaratne resigned from his post at the head of the Sri Lanka Medical Council (SLMC). Addressing a media briefing, Prof. Gunaratne pointed out the need to change the composition of the SLMC. Of the 25 members of the SLMC, a majority are from two trade unions representing doctors. It is this doctor dominated SLMC which acts as the sole arbiter in public complaints about medical malpractices.

Monk Galagoda-Atte Gnanasara has been sentenced to prison. Ravi Karunanayake lost his ministerial post. Arjuna Mahendran is on the run while his son-in-law is in remand. But not a single doctor has been found guilty of medical malpractices by the SLMC. Prof. Gunaratne pointed out that during the five and a half years he served as a member and chairman of the SLMC, there was at least three complaints of medical malpractices per month; not a single doctor was found guilty by the SLMC; not a single patient received the justice he/she was seeking.

A similar point was made by Dr. Avanti Perera in a book published in 2016 – Medical Negligence Claims in Sri Lanka. As part of her research, Dr. Perera interviewed 40 complainants about medical malpractices. Not a single one received any justice from the SLMC.

Dr. Gunaratne wants the composition of the SLMC changed, to make the institution less biased towards doctors and more able to deliver justice to the public. The GMOA is totally opposed to any such change, understandably. It has reportedly approached the Association of Medical Specialists (AMS) about launching yet another strike in protest. According to media reports, the AMS has refused to engage in strike action. In an even more heartening development, the President of the Sri Lanka Medical Association (SLMA – the umbrella organisation of all doctors) has "asserted that a change of composition of the SLMC was of pivotal importance to ensure the rights of the public."iv

The GMOA may or may not be playing a political game. In the end, it doesn’t matter. What is clear is that the GMOA is marching to the authoritarian drumbeat. The wildcat strike by railway trade unions was a despicable action in the midst of the AL examination. But the constant strikes by the GMOA are even more despicable. No civilised society can approve of poor patients being held hostage by a mafia. No government worthy of the name should permit such outrage.

When it comes to the patriotism of politicians, Ambrose Bierce’s The Devil’s Dictionary is the go to reference. Bierce defines patriotism as ‘as fierce as a fever, pitiless as the grave, blind as a stone and irrational as a headless hen." That perfectly describes the movers and shakers of the GMOA; their greed is as fierce as a fever, they are as pitiless as the grave when it comes to denying treatment to suffering men, women and children and they are as blind as a stone to the pain and harm they are causing. Irrational as a headless hen too, because they are losing the respect of society and bringing into irreparable disrepute a great profession.

i http://www.sundayobserver.lk/2018/08/05/news/gmoa-president-threatens-journalists-%E2%80%98traitors%E2%80%99-list

ii Ibid

iii http://www.codex.vr.se/texts/hawaii.html

iv http://www.island.lk/index.php?page_cat*article-details&page*article-details&code_title*189290