Challenge before Sri Lanka Medical Association

By Dr Upul Wijayawardhana

In this time of moral bankruptcy, on top of an enormous economic crisis, Sri Lanka Medical Association (SLMA) is facing a huge challenge; it has had to restore the honour of and respect for the medical profession. It is obvious that corruption has affected all professions, my long-cherished profession being no exception. The SLMA is the premier medical association in the country and the umbrella organisation that encompasses all medical men and women, whether they be specialists or general practitioners, government servants, employees of other organisations or independent practitioners.

The SLMA, which was established in 1887, as the Ceylon branch of the British Medical Association (BMA), severed connections with the BMA in 1956 as the BMA functions mostly as a trade union. Being a professional body with no trade union functions or affiliations, gives a distinct advantage to the SLMA.

I am confident that SLMA can face this challenge, and I say so for two good reasons. First, this is not the first time the SLMA faced what seemed insurmountable challenges but overcame difficulties by adapting and embracing change. Second reason is the induction of Dr Ananda Wijewickrama as its President. Although Ananda is saddled with another important responsibility as the Chairman of the National Medicines Regulatory Authority and his time as President, SLMA is limited to a year, I am sure Ananda can! I say this with confidence as I can testify, not only to his many abilities but also to his honesty and integrity, having had a very close association with him for two years in Grantham Hospital, during his overseas postgraduate training in the UK.

Perhaps, I have the dubious distinction of being the only president-elect of SLMA not to be inducted to that high office in 1989, as I left Sri Lanka in 1988 having chosen family over SLMA but am left with no guilt as I contributed my fair share for the advancement of SLMA. My close association with the SLMA began in 1974, during another period of great difficulty, perhaps, only marginally second to the present.

In spite of the first JVP insurrection happening during my PG training in the UK, I returned to Sri Lanka in January 1972 and was appointed a Consultant Physician, Badulla Hospital. In June 1973, I accepted the post of Registrar to Dr N J Wallooppillai in the Cardiology Unit, GHC. In appreciation of my contribution to setting up a postgraduate centre at the Badulla Hospital with the support of the Ceylon College of Physicians, Dr E H Mirando proposed my entry to the council of the SLMA.

In 1975, I agreed to be Hony. Assistant Secretary without realising that the post carried the additional responsibility of being the business manager of the Ceylon Medical Journal (CMJ), the oldest surviving medical journal in Australasia, which started life as “the Journal of the Ceylon Branch of the British Medical Association” in 1897. Except for a break from 1893 to 1904, it had been in continuous publication and was the only internationally recognised journal in Sri Lanka.

However, there was a major problem; it was on the verge of collapse due to the vastly reduced revenue caused by the non-availability of advertisements due to restrictions imposed on pharmaceutical companies. To prevent its closure, I made a proposal to the council that we have non-pharmaceutical advertisements; it was carried through, not unanimously though! I rang round my patients and friends and was able to collect sufficient advertisements to tide over. For the first time, CMJ carried advertisements on Datsun cars, etc. but that ensured its survival!

During my period as Assistant Secretary for three years and the Hony. Secretary for another three years, under the stewardship of six Presidents, we faced many more difficulties including dwindling finances. An American company, oraganising tours for American doctors in India, approached me for similar tours in Sri Lanka. They were making use of the liberal tax laws in the US, which allowed the cost of the entire holiday being tax-deductible if doctors took part in a scientific session. Having got council approval, I arranged an evening session of lectures for each group and am thankful to other members of SLMA for voluntary participation. Obviously, they each had to pay a registration fee which, if my memory serves right, was 100USD, which was a very large amount then, which helped the SLMA’s depleted coffers!!

The other major problem we faced was dwindling attendances at the Annual Scientific Sessions and the falling numbers as well as the quality of papers presented. The SLMA has been having these sessions since 1937, but this too seemed to be grinding to a halt. After a few brain-storming sessions with friends and fellow councillors, especially Dr. Dennis Aloysius and Prof. W. A. S. de Silva, I presented three proposals to the council for energising the Annual Academic Sessions:

1.  The establishment of an oration titled SLMA oration and making it the most prestigious oration to be delivered at the inauguration of the sessions and for the lecturer to inaugurate the session, obviating the need for ‘imported’ chief guests.

2.  Award of prizes for best presentations in different categories.

3.  Charging a registration fee.

Although most council members supported the establishment of the SLMA oration, there were strong objections to the registration fee and doubts expressed about the feasibility of selection for awards. I offered to draw up the procedure of selection for awards and pointed out to the council that human nature being such, if one pays one will attend. With great difficulty, I persuaded the council to introduce the registration fee, on a trial basis. Although I cannot be sure of the year registration fee was introduced, maybe it was 1978, but I am sure the first registration fee was Rs10. Contrary to the views of the majority of the council, but to my great relief, it was a tremendous success, all sessions being well-attended as never before!

The number of awards has increased since and continues to this day. In fact, just before I left Sri Lanka, I set up a fund to award a cardiology prize but I was informed that it could not be named Wijayawardhana Cardiology Prize as I am not dead but it would be awarded as the cardiology prize set up by me but on the few occasions I attended the Anniversary Sessions, when it was awarded no such mention was made. I requested the SLMA council to name it in memory of my parents, two years ago, but have had no response so far. It looks as if SLMA has grown so rapidly since our time and things have got unwieldy.

The inaugural SLMA oration was delivered by the pioneer neurosurgeon Dr Shelton Cabraal in 1979 and I followed next year, detailing how I was able to set up the Permanent Pacing programme in Sri Lanka with the support of Dr N J Wallooppillai.

1982 was a significant year when my great friend Dr Dennis Aloysius was the President and I was handling public relations. Rupavahini has just started broadcasting and M J Perera, Chairman of Rupavahini, requested me to do health education programmes. When I forwadeded this to the council there were objections, initially, but commonsense prevailed a couple of months later and I was able to conduct panel discussions on behalf of SLMA on Rupavahini’s flagship programme Neth Sera produced by Sanath Liyanage.

Manufacturers of Panadol offered to sponsor a radio programme and I was able to conduct Sri Lanka Vaidya Handa, monthly, on SLBC. The reward I got was one of my colleagues reporting to the Sri Lanka Medical Council that I was indulging in advertising! Fortunately, the SLMC accepted my defence that I was doing these programmes on behalf of SLMA.

It was also in 1982, one of our beloved seniors, Prof N D W Lionel, much-respected professor of pharmacology, died suddenly, very prematurely. The outpouring of sympathy of the pharmaceutical trade, which was doing very well by then due to the liberal policies of the JRJ government, was channelled to build an auditorium, which we were badly in need of, in his name. The medical officer of Ceylon Tobacco, who was a council member, offered to get Ceylon Tobacco to fund the auditorium but that offer could not be accepted for obvious reasons!

I have gone into details to show that we can come out of difficult times. I do hope the present council of the SLMA would take steps to re-establish the honour of the profession and that the SLMA would lead the way for other professions to follow, as unless corruption is reduced significantly Sri Lanka has no future.

Going by press reports and communications to the press, most dissatisfaction towards our profession seem to stem from irregularities in private practice, like overprescribing, which is of great importance at this time of severe economic stress. Perhaps, the SLMA can set up an expert committee to look into this as well as other aspects. I am well aware that the SLMA already has a number of committees but this should be a very high-powered committee to produce a rapid response. If a voluntary code of practice is followed, the public is likely to be reassured.

In fact, SLMA should go a step further. With the concurrence of private hospitals, guidelines could be drawn which could avoid many of the malpractices common at present. Irrespective of what the government does, which many do not care for in any case, the SLMA accreditation may be way forward and it is high time SLMA asserted authority.