It took only a few of months for doctors, who constitute a major part of the healthcare professionals’ community that came to be known and revered as “suwa wiruwo” (translates as ‘health heroes’) during the peak of the Covid-19 pandemic, to be perceived as a group that decided to betray the country for money and comfort.
This is due to the continuing migration of doctors for high-paying foreign jobs in a context where their role and contribution in keeping afloat the struggling health sector is now a national-level concern. While service-seekers are suffering due to the lack of doctors, medicines, medical equipment, and overall medical services, doctors are also struggling with increased responsibilities, wages commensurate with their experience and knowledge, and most importantly, a lack of hope of Sri Lanka’s situation improving. Now, the country is dealing with a doctors’ exodus, which is likely to increase.
Tax-funded free education
“Doctors who received higher education through public schools and universities should not just leave the country in this manner. What of the moral responsibility to repay the debt that they owe to the country and the taxpayers who funded their education? Benefiting from the free education system and abandoning the country as soon as the difficult time (a reference to the prevailing economic crisis) came sets a bad precedent. We must learn a lesson from this and take necessary actions, so that we would not henceforth spend tax money on people that selfishly kick the ladder that helped them. It is high time to introduce a system to require doctors, who want to leave the country without serving it, to repay the tax money that was spent on their education.”
The above is a Facebook post about the much talked about moral responsibility on the part of the doctors who are contemplating leaving the country.
Concerningly, these days, many share the idea relayed in the above Facebook post, or similar ideas concerning the said moral responsibility. Their main argument is that doctors should serve within the country to compensate for the tax money that was spent on their education (through the free education system), or, they should pay a certain amount to the Government if they want to leave the country.
Their argument is clear and blunt, and seems to be a concern arising from the dire state in which the health sector remains today. However, at the same time, it is ill informed, and does not show any potential to lead to tangible, positive changes.
One obvious reality that those who hold this argument have conveniently overlooked is that those who became doctors thanks to the free education system and their families were also taxpayers, whose tax money also contributed to maintain the free-education system. Therefore, they too have paid for the education that they have received. The social discourse based on taxpayers and the free education system is flawed in many other ways, one of the main ones being how practical it is to calculate how much one owes to their country for the free education that they received. This becomes more complicated when we try to place in this equation how much taxes a school or university student or their families have paid directly and indirectly to maintain the free education system. How fair this argument is, is another concern, because nobody asks those who obtained free education for years only to drop out midway through to pay for the free education that they received.
The moral responsibility that the above-mentioned parties keep pointing out is questionable, because it is up to each person to decide where they want to work and live. When we do not ask the same from other professionals who have left the country for foreign jobs after obtaining free education and are most likely to outnumber migrating doctors, how fair is it to expect a moral responsibility selectively from doctors?
An act of survival
The humanitarian aspect of this situation should receive greater attention. Even though the aforementioned parties are trying to portray doctors as a community that has turned into some form of traitors, that is an extremely questionable opinion, because their decision to leave the country is not aimed at further inconveniencing the country but finding a better place for themselves and their families to live in.
We all agree that the country is in a dire situation where procuring even the most basic of services and goods has become challenging for many. We all agree that when looking at the present political situation, which is not very different from the one that contributed to creating the economic crisis in the first place, there are not a lot of promising signs of the country’s situation changing for the better in the foreseeable future. We all yearn for better living and working conditions, if not here, abroad. Why then are we trying to demonise doctors for their decision to use their qualifications, which, as was stated above, was attained through the free education for which they also contributed, to find a better environment for themselves?
If we could, would we not have done the same?
What is more, the doctors’ exodus entails an inevitable phenomenon in human civilisation and world history. That is migration, without which many civilisations would not have come into existence or excelled. Among other reasons, migration for survival, which many Sri Lankan doctors are seeking, is not new at all. It should be noted that it was not only doctors that sought to migrate seeking better living and working conditions. Many other professionals who immensely support the country’s economy have also left and are leaving. Among them are information technology professionals, university teachers, engineers, various forms of mechanics, those working in the hotel industry, and also labourers skilled in various fields. Although the exact figures in this regard are not available, anecdotal data suggests that such professionals’ exodus is as serious as the doctors’ exodus. While the serious nature of the services provided by doctors cannot be ignored, at some point in the near future, we will have to acknowledge the reality that these professionals leaving the country for better working and living conditions is but an act of survival.
Health-sector crisis is real
This is not to say that doctors’ exodus is not a real issue, or that it does not affect the country. For a country that is struggling with an economic crisis, this is a situation that requires urgent and genuine attention. Our take on this situation however is somewhat questionable, for we have chosen to overlook many important aspects of this situation.
We need to be more pragmatic and fairer when it comes to finding solutions, because, on the one hand, doctors leaving the country in search of greener pastures is their response to the humanitarian crisis that the country is facing, and on the other hand, as world history has proven countless times, restricting freedom only leads to a bigger demand for freedom. Recently, a leading medical professionals’ trade union claimed that approximately 5,000 doctors who are qualified to work abroad are likely to follow in the footsteps of the doctors who have already left the country. Even if that statement was an exaggerated one, the doctors’ exodus is only just beginning, because the health authorities appear to be focusing more on imposing restrictions on doctors that are planning to leave the country, instead of addressing the issues, including minor ones such as facilities related issues in rural hospitals, that have led to the doctors’ exodus.
Our approach is already wrong. We demonise doctors for their decision to prioritise the wellbeing of their families, despite the fact that we would have done the same, and we try to force them to remain in the country, knowing fully-well that the situation of the country is hardly ideal. In such a context, while retaining more doctors in the country and thereby keeping the health sector up and running for the benefit of the general public is a pressing concern, whether we would be able to achieve it with the ill-informed and highly-biased understanding that we have of the situation is questionable.
The truth is, if Sri Lanka is to stop the doctors’ exodus someday, it can be done not through restricting freedom, but through making available better living and working conditions within the country. When that happens, not only doctors, other professionals will also choose to remain and serve the country.