Economics, Welfare Systems, Balance of Payments and other Bovine Excreta – an Open Letter to the People of the Resplendent Isle.
Posted on April 2nd, 2020

Sakuntala Seneviratne MBBS MD FSLCOG Consultant Gynaecologist and Obstetrician

When the WHO says spend 6% of your GDP on health you said we are doing just fine on 3%” and gave yourselves a pat on the back didn’t you? You didn’t hear us when we said the curative arm lags far behind a 75-year-old preventative system. We said that blood and sweat and tears can only get you so far. What will you do with your awards now? Shall we place them next to the monuments of the dead?

When we said that health care is crucial to the state and needs to be centralised you laughed and waved a constitution at us. An amendment imposed at gunpoint and widely rejected. And as per that amendment health is on the reserved list. So doctor’s appointments are controlled by the central government and everything else” by the Provincial government. So we have no equity of distribution of resources and of all non-medical staff. And poorer people are just going to die now. But perhaps not the people they voted for.

Scientists and Doctors have told you countless times that smoking kills. That Alcohol destroys lives. But you needed the money these businesses bring in. Well. You had your money. Look where it got you. How many people need to die because of the vulnerability brought on by substance abuse before you recognise it for what it is? Did you really need the link of Covid 19 deaths to smoking as the icing on your cake to prove the point?

So when we thought that new buildings were needed for new hospitals you barely listened. You built Hotels instead because the country needed revenue. And industry would generate income and later – someday – with that revenue maybe you would build. And we are not economists so we backed away.

When you were reluctantly persuaded to design and build: you didn’t put in lifts. You put in narrow corridors; you put in tiny cubicles without showers as changing rooms; you had unacceptable spaces as scrub rooms. So now when we have to have a one-way system with negative pressure, a donning room, a scrub room, the operating and resuscitating space, a doffing room and a clean room we don’t. We just make do. As we have always done. We catch an infection. That if it doesn’t kill us, at best makes us too ill to work, to save you and your families lives.

You hired the best architects in the world and created aesthetically appealing spaces for the hotels and the exhibition centres and the malls didn’t you?

When we told you that the textbooks from 30 years ago say cotton scrubs cover your nakedness only” you laughed and said again this is the third world and just give them some extra antibiotics”. So now our population has generalised resistance. And the healthcare staff have no appropriate protective equipment. No supply chains to get these. No local manufacture. And no organised system for the disposal of hazardous waste.

When we thought the measly buildings you did put up should have sensor activated taps, sensor activated doors hand wash, hand rub, disposable hand wipes you laughed and told us again this is the third world Doctor this is Sri Lanka!” And now we touch the door handles, the taps, the top of the soap dispensers, and the little sliver of soap in the dish. We dry our hands on oft-used pieces of cotton cloth. Our hands are cracked and dry and microbes grow on our broken skin.

But the Hotels needed all these thing; the malls needed all these things because it’s economically sound. And well, we were told we are just doctors, and we should just learn to work with what we have. Until later maybe you would consider improving facilities in the health care system. Some of us who didn’t think what you were doing was right walked away to other places where they did prioritise these.

You watched while they walked. You watched while the handpicked few, for qualities like hard work, intelligence and resilience, who you trained in a highly specialised technical, academic and professional sphere walked away to places where working 56 hours a week would pay you enough to buy a home, a car. Where the tax that was paid would ensure a lifetime of reliable healthcare. Of decent schooling and university education for kids  – even if they weren’t the top 1%. We didn’t walk away for luxuries. We walked away because we wanted to not do two jobs. We wanted time for our loved ones; time to sleep, to laugh. We wanted balance and yet to achieve these basics. And so you lost some of the cream of your crop. You lost those who didn’t inherit wealth. You lost some of your hardworking dreamers.

And you, the patriotic” ones, who stayed, changed the countries wealth into foreign currency to pay for those same things for your children. It was easier than developing it internally. And frankly do you even know how?

Because you also failed to bring down a system that ensured our qualifications, our training, is recognised and appreciated on four continents across the globe. You failed to destroy a training system, where we mandatorily were exposed to the way, smarter countries prioritised spending on health. So we know how it should be. But having done that, you handed over the conditions that we work in at home, to administrators who have no comparable skills. No training beyond the local. Who are blinkered by the politicians who they have to stooge to. You allowed the systems to be run according to the whims of corrupt, unqualified, heartless, self serving, shameless men and women who used politics as the shortest route to material wealth.

So now we are a nation that’s mortgaged it’s future. Having spent on vulnerable industries that cannot reliably generate income. We have insufficient home grown food. So here we are in debt. Poor. Hungry. And soon we are going to be sick. Or dead.

Next time, people of the Resplendent Isle – can you get your priorities right?

I’m not angry. I’m not saying I told you so. I’m just sad. Even if I survive I may have to watch you die.

Sakuntala Seneviratne MBBS MD FSLCOG

Consultant Gynaecologist and Obstetrician

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