Will Rambukwella’s inveterate attitude spell doom for the incumbent government?

The health sector in the country, once a proud emblem of Sri Lanka’s dominance in social advancement in the region is now in a shambles. The government, it appears, couldn’t care less.

It was just a few years ago that the Sri Lankan state health system was the envy of other countries in the region. Healthcare was free, reasonably readily available and was manned by health professionals who commanded the respect of the rest of the world. All that has changed since the country descended into political and economic turmoil last year.

Even prior to that, there were tell-tale signs that the sector was being mismanaged. The manner in which the Covid pandemic was handled left a lot to be desired. The Minister of Health at the time, Pavithra Wanniarachchi was seen throwing pots of water into rivers to ward off the evil of Covid and later publicly endorsed a concoction made by a charlatan as being a cure for the deadly disease, becoming the laughing stock of the rest of the world.

Wanniarachchi was removed from the Cabinet by then President Gotabaya Rajapaksa in one of the many reshuffles last year. Though she has made a return since then under President Ranil Wickremesinghe, it is not as Minister of Health. This vital portfolio passed on, first to Channa Jayasumana and then to the current incumbent, Keheliya Rambukwella. Wickremesinghe has left Rambukwella with the job so far.

In the meantime, the health of the health sector has deteriorated remarkably. The first sign was the unavailability of essential medications in state hospitals. This was attributed to the foreign exchange crisis in the country at the time. Medical professionals rallied around, made frantic appeals for donations of both funds and medications from overseas colleagues. A major crisis was averted.

The next problem that the sector was confronted with was the migration of health professionals, mostly doctors and among them, mostly specialists. To be fair, it would be unreasonable to blame Rambukwella for this as professionals in many sectors are leaving Sri Lanka by the thousands and skilled migration in search of greener pastures is at a peak. It is a symptom of a greater malady that afflicts the country and is not confined to doctors alone.

What was even more alarming is the news we hear from the country’s medical schools. Newly graduated doctors are sitting overseas qualifying examinations and leaving the country in droves, mostly to the United Kingdom and Australia without even completing their ‘internship’, a period of practice that is mandatory if they ever wish to work as a doctor in Sri Lanka. Clearly, they have no intention to do so.

Then, adding insult to injury, the retirement age for all doctors, including specialists, was lowered to 60 years at the end of last year, depriving the country of dozens of specialists in one fell swoop. Perhaps realising the folly of this, it has since been restored to 63 years but the damage had already been done: many who were forced to retire at the end of last year have opted not to return.

Where Rambukwella and his colleagues in government can be blamed though is for not taking any measures to arrest these trends. They have been passive spectators while this highly specialised manpower required to run the state health sector is slowly dwindling. No incentives are offered to retain medical or other health professionals. Hence the reports of specialised units closing down in certain hospitals and surgeries and procedures being postponed. Slowly but surely, the system is shutting down.

The recent reports of deaths following the administration of medicines of questionable quality are not simply the problem. Instead, this is an indication of a wider malaise that has crippled the health sector- of ignorance, poor administration and corruption.

All medicines used in the country are supposed to be given the greenlight by the National Medicines Regulatory Agency (NMRA). It is an open secret in medical circles that the NMRA has not been functioning properly for some time now. Medicines were being imported under ‘emergency’ measures, bypassing stringent quality control tests but these ‘emergency’ measures have been ongoing for a few years now. Some of the medications which resulted in adverse consequences have been used even after those events were reported and gained wide publicity in the media.

At least one death following the administration of a drug at the Peradeniya Hospital has been dismissed by Minister Rambukwella as being an isolated allergic reaction. In doing so, Rambukwella displayed his attitude to all this in no small measure when he said that ‘not all people who enter hospitals return alive, some die, that is why funeral parlours are located near hospitals’.

Coming from Rambukwella, these comments are hardly surprising. This is a man who once threatened the Principal of Royal College for punishing his son, this is man who ‘fell’ under mysterious circumstances while in Australia and had the President’s Fund foot the bill for his treatment there. More than his inaction and incompetence, his attitude and arrogance will damage the government.

The parliamentary opposition is planning a Motion of No Confidence (NCM) against Rambukwella. It is spearheaded by the Samagi Jana Balavegaya (SJB). This is a double-edged sword: if it fails because the ruling party does still enjoy a parliamentary majority, the opposition could then claim that, by extension, the government is responsible for Rambukwella’s lapses.

On the other hand, if the NCM succeeds because ruling party MPs refrain from endorsing Rambukwella, the SJB’s own Rajitha Senaratne could possibly cross-over to the government if the Health portfolio is offered to him. He has made it quite clear that he dearly covets that position.

Through all this, the silence of President Ranil Wickremesinghe has been deafening. He who waxes eloquent about the Kurundi Viharaya or about not being ‘Ranil Rajapaksa’ hasn’t uttered a single word regarding the crisis in the health sector- nor has he acted to remove Rambukwella and save himself, Rambukwella and the government from embarrassment by shifting him to another portfolio.

Wickremesinghe will not be able to remain silent for long. If more incidents are reported in the health sector, Rambukwella will have to go- or Wickremesinghe’s government will also have to go with him.