A large number of medical professionals in the state health service, especially those in the Health Ministry, are drawn like moths to torchlight to opportunities of foreign travel under the veil of official work.There have been whispers that many Epidemiology Directors travelled overseas for conferences in the past.There was also an instance when certain top officials of the Health Department were sent on foreign trips for World Health Organization (WHO) meetings with the onset of Covid-19 in 2020, so that certain parties with ulterior motives would be able to manipulate the opportunities the disease itself presented in their favour.
Two years down the line, the situation has not changed much, as Filaria Specialists working in the Quarantine Unit of the Health Ministry fly overseas for discussions on Disaster and Preparedness with approval from the Director of that Unit.
While the officials of the Health Ministry engage in such escapade adventures abroad, one wonders as to whether it could be even marginally considered as ethical for those at the Health Ministry to draw the line preventing a sizable number of medical practitioners, not only acting consultants, but even those with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees to fly the coop in search of greener pastures.
“Sri Lankans known to donate blood, organs, and even their eyes are little known for donating qualified doctors. The country which educates them, sees them through medical college spending at least Rs 35 million on each, and another Rs 5 million for postgraduate education finally ends up donating them to the United Kingdom, the United States, Canada, Australia, and Singapore. From January 2022, till date at least 32 qualified consultant doctors have vacated their posts,”Health Ministry sources said.
At least 10 to 15 health professionals including doctors and nurses leave the country per month having received foreign job opportunities. In 2021 alone, a total of 400 doctors left the country, of whom half were for academic purposes, while the remaining of those who left, went for “academic purposes with job opportunities,”they said. During the last six months, a total of 350 doctors have gone overseas. 100 of those who left, went purely for academic purposes, while 250 left the island for academic purposes with job opportunities.
They said 75 per cent of those who leave the country travel with their families and don’t return to the country, having found schooling for their children and jobs for their spouses. They establish themselves and don’t return to the island.
Non-Clinical consultants such as Consultant Community Physicians, Medical Administrators, and Forensic Consultants are among those who don’t receive foreign jobs in the above-mentioned countries, their skin colour being a known deterrent.
However, Clinical Consultants receive job opportunities. Therefore, while they leave Sri Lanka as ‘Acting Consultants,’they receive foreign training to remain in that country.
Sources said although these Clinical Consultants required the Board Approval of the Sri Lanka Medical Council (SLMC)to be locally recognised as Consultants, those who leave the country either obtain that recognition from that particular country or merely returned to Sri Lanka and waited till such time that they were able to obtain SLMC Certification. “After which they fly the coop,” they said.
A large number of Clinical Consultant positions opened for doctor’s post Covid-19 waves, especially in countries like the USA and the UK, possibly offering better opportunities for medical practitioners.
Bonds and legal framework
The problem with Sri Lanka is that stricter legal action is not taken against those doctors who violate the bond they sign. The bond amounts to Rs 1 million to Rs 1.5 million, which has to be paid to the Health Ministry if the medical practitioner fails to return to the country as scheduled. Two guarantors are also needed to sign the bond.
Accordingly, if the training period lasts for two years, they are bound to serve in Sri Lanka for a period of eight years, while if the period of training lasts one year, they have to work in the island for a period of four years, according to the Establishment Code. Those who violate this agreement are expected to pay the bond fee which they signed prior to leaving the country.
At present, Sri Lanka has to pay a total of USD 36,000 per month for foreign training of 100 doctors who have gone for academic purposes. Each medical practitioner who travels abroad for academic purposes receives about USD 2,000 per month as an allowance during the training period, which is not paid for those who follow their consultancy training while working. This amount includes living and warm clothes allowances. The Health Ministry bears the cost for the visa and ticketing fares for each medical practitioner for all its foreign trainees. Trainees are paid their salary during the first 12 months of their training period while abroad. However, the country does not incur that expense for those following their consultancy training while working.
There are provisions in the Establishment Code, the Health Ministry, the Postgraduate Institute of Medicine (PGIM), and the Sri Lankan Constitution for any official going abroad. They need to inform their address to the Sri Lankan Embassy in that particular country during their training period.
Any officer overstaying also needs to inform the Embassy, the Health Ministry, and the PGIM.
Sources explained that those who do not return to the country to report for duty could be issued with vacation of post (VOP) letters by the Regional Authority, while they have to be blacklisted. But such strictures are not followed because they are professionals, and hold some respect even amongst the Immigration and Emigration Officers at the Airport, they said.
Does the Ministry or the doctors who leave really care?
Sources said, however, that it was unfortunate that those who left in this manner lack the responsibility and accountability that is required from those holding such professions. But what needs to be noted is that the Health Ministry and the Government also did not seem to mind. Despite the legal bond which is signed, there isn’t a proper human resource follow up system to get these doctors to pay back their bond fee at least. At least the guarantors are not held accountable for this gross omission.
What is more, there are local doctors who tell those abroad to stay where they are rather than return to Sri Lanka and fulfil their duty by the people who paid for the free education they enjoyed and screamed about whenever the opportunity presented itself.
Sources lamented that the Sri Lankan Government lost millions of rupees annually on the education of medical officers and their PGIM courses, but it was almost as though it encouraged doctors to run off, they lamented.
Crisis following temporary suspension of foreign training
Director General of Health Services (DGHS), Dr. Asela Gunawardena, in a letter to PGIM Director on 1 July 2022, requested him to “temporarily halt mandatory foreign training for postgraduate trainees owing to the limited foreign currency in the country.” He said, there would be no restrictions for the officers who had arranged foreign training as paid jobs, while the PGIM Director was also requested to assist in finding placements with paid job opportunities. Therefore, a big question arises as to whether the Health Ministry cares or whether considering their code of conduct with regard to foreign travel, they are able to impose strict laws on those doctors who vacate their posts.
Lack of data
With the bulk of the Health Ministry’s work being carried out manually, during which the passing of files from one clerk to another plays a major role, it is also doubtful as to whether even the Ministry and its officials know the exact number of doctors who have left the shores of the island for good.
As a result of the increasing number of specialist and MBBS qualified doctors jumping ship, the island’s health service would head into stormy seas due to the shortage of consultant doctors in the years to come.
By Dilanthi Jayamanne