The last year has not been kind to Sri Lankans, with many struggling to get by while their dreams and plans have been dashed. A silver lining amidst the doom and gloom created by poor governance and bureaucracy, was the public health system which a great many Sri Lankans depend on. However, medicine shortages, questionable quality of medicines available, gaps in capacity and an increasing brain drain of medical professionals have dented the reputation of the national health service, which was once held high. However, hidden amidst the newer crisis, remains a bitter topic which has often gone unaddressed over the decades. The accountability factor of the health system has always been lacking, and today has come to the forefront again.  

The news that a child who went through a kidney surgery at the Lady Ridgeway Hospital (LRH) died due to the complications of the surgery, which includes the suspected accidental removal of both the kidneys instead of one that needed to be removed due to medical reasons, sent shockwaves through the country. However, such incidents have been reported in the past. Nevertheless, this incident has instilled concern and fear into the minds of the public seeking health services. 

While the magnitude, nature and the consequences of this so-called ‘mishap’ are disturbing, they are not the first of such accidents. This is merely the latest incident that attracted nationwide attention. Before this, during the past few years and months, the country witnessed a number of cases in which irresponsible behaviour on the part of doctors, nurses and overall hospital administrations allegedly caused unjustifiable health complications and even deaths of which the victims were the public who had sought services from hospitals. Even though substandard medicines and medical equipment were also a part of this discussion, with the LRH incident, the public now see lack of responsibility, accountability, and transparency on the part of the medical profession.

Calls for solutions have already emerged, and they are growing. Solutions that should be taken by the Government and the relevant health authorities, need to be, not just swift but also effective. Because, after all, this is a matter of life and death for many who rely on the public health sector. There is much to fix, firstly, the government must restore transparency and accountability to the Ministry of Health and other key state agencies which have been seen as lacking. While what Sri Lanka can do as a debt-ridden country in order to improve its health sector is a complicated and delicate question, improving the sector’s quality is not entirely reliant on financial resources. However, there are potential policy, ethical and regulatory steps that require only genuine efforts and a well-thought-out plan. The complexity of accountability in the medical profession means, there can be no short-cut or knee jerk solutions, but well-debated, and scientific based ideas which can be forged into a robust compliance, disciplinary and accountability structure. For long term change to effect, a significant change in the culture of how medicine is practised and administered may be needed.

Sri Lanka has in place certain procedures that provide for disciplinary actions, including punishment, against medical professionals that have failed to fulfil their responsibilities diligently. However, how effective they are and how well they act as a deterrent, remains a question. One problem is, mainly because these are not pre-emptive measures, but reactive measures which can only be taken once something questionable has occurred and caused damage. While the importance of such measures cannot be underestimated, measures aimed at preventing such tragedies are more important and beneficial as long term solutions. As a start, perhaps Sri Lanka should pay attention to introducing a system to evaluate doctors’ overall performance, which can also investigate whether doctors are updated about new knowledge in their field and whether doctors are adequately mentally and physically fit to perform their duties. This evaluation could take place for example once a year, or once in a few years, and can be conducted either at the hospital or national level. Either way, such evaluation should certify that doctors are adequately fit to do their job.

Such evaluations are now more important than before, because many experienced doctors are migrating abroad leaving more inexperienced doctors back in homeland, and the prevailing crisis in the health sector is more than capable of affecting doctors mentally and physically which then affects the performance of their duties as well. Such regular evaluations are quite common in many fields, and having in place such a system for doctors, who literally deal with matters of life and death, is not unwarranted or excessive. Broadening of the support base offered to medical practitioners, clinical staff and caregivers may in the long term also lead to less tragedies and a robust system.

Such a system would not only save lives through assessing and improving the quality of services provided by doctors, but it would also restore faith in the country’s health sector. The bitter truth is, no amount of legal or disciplinary actions, apologies or compensations can completely reverse the damages caused by irresponsible conduct or even genuine mistakes on the part of medical professionals. The best approach therefore is prevention through regularly evaluating and reviewing doctors’ performance and suitability.