Medical encounters of the political kind

Compared to my article of last week, ‘Medical encounters of the drugs kind’, this one is a bit trickier. ‘Political’ here not only refers to politicians of all ilk, grade, and background – from MPs to ministers –, but also those who are associated with them such as advisers, activists and agents, or those who use them either because they are close friends or to whom they are related – and on behalf of whom they feel they must show their influence or clout. All of the latter are as responsible or guilty for the irregularities which result, these being infringements of principles, procedures and regulations which in the first place have been established through due legislative-cum-legal process. Oftentimes the hangers-on of the politician act even more brazenly than their master, and to be fair, probably unbeknown to the latter.

Whether or not the politicians of the moment who transgress it actually participated themselves in this process is immaterial: the substantive point at issue is that, being the elected representatives of the people, they have to respect the laws of the land and demonstrate that they do so – which would send the right signal about what is and what is not permissible. The irony – to which they are totally indifferent – is that they not only tolerate but force these breaches on, usually, hospital staff, mainly doctors. However, had some of the latter, especially those who are seniors and are in positions of higher responsibility, responded on the basis of the same principles, etc., allied to medical ethics and professionalism, the perpetrators would not have had a field day, which can only happen in countries with this ‘third world’ mentality such as Mauritius.

Inappropriate pressurizing from politics

It goes without saying that resisting such pressures is more difficult for the junior doctor, especially in the Accident and Emergency Department – popularly known as Casualty – which, despite being the first point of contact in the hospital for a majority of patients, is an orphan of the system. That is, there is nobody truly in charge there, as should have been the case a long time ago, as it is not staffed like other departments with a formally trained Consultant as head, supported by a team of emergency physicians who would thus have someone at hand to turn to should there be attempts at inappropriate pressurizing from politics. As it is, the person who is nominally responsible is the Medical Superintendent of the hospital who is either a ‘generalist’ or a non-clinical specialist. S/he therefore cannot stand up for the junior.

As for the seniors, it soon becomes apparent to all and sundry – including the powers that be — who is the no-nonsense guy, and those who would wish to try any hanky-panky had better think twice. Sadly, there ought to have been more of them, which is not the case. For those who had the reputation, it was matter of their training, character and culture – both general and professional. Professional to a ‘t’, they did not suffer political fools gladly, and the way they handled the pressures that they were faced with was an abject lesson for those who they worked with. They kept away from the glare of the public space, and so were not the cheap ‘salebrities’ of the latter times with their supple spines. But in the medical profession, they were living exemplars and legends whom others needing help could turn to and be assured of unconditional and active support if the issue was a just one.

But similarly, so was the case with the politicians – hence my use of the term ‘ilk’. Among some of them too it was a matter of character and culture, and those who knew where the limits lay avoided crossing the Rubicon. And there was mutual respect as a result. The few examples that follow will give a flavour of some of the dimensions of this ugly face of our health system, and are drawn from my own experience and that of others as related to me or that I know of. They are genuine incidents that represent but the tip of an iceberg.

My own first encounter happened when I was a junior, recently returned doctor posted at the SSRN Hospital in the early 1970s, and Sir Harold Walter was the Minister of Health. About 8 o’clock one morning I got a call from the hospital – I was residing in the doctors’ quarters there – saying that Sir Harold wanted to speak to me. In perfect English, for which he was known, he referred to a case I had seen the previous night in Casualty, which I had diagnosed as mild appendicitis and sent home with the appropriate treatment with a review. Apparently Sid Harold had been contacted, which is the reason he was calling. Would I see the child again this morning and get a surgical opinion?

Then, as my friend Colin from Cape Town used to say when we were training in Dublin, ‘the penny dropped’. That is, I could put two and two together and figure out what had happened. Poor Sir Harold, I had occasion to reflect later, he did not realise he was being used, or fooled – by the surgeon. Like practically all the specialists of those days, he used to do his private practice in Plaines Wilhems. The child concerned was from one of the sugar estates in the north, whom he had seen privately, and sent for admission without, obviously, any note to that effect. And that explains why the mum had brought the child around 7 pm. And subsequently reported to the surgeon what had happened. Either she or her husband, or the surgeon, had contacted Sir Harold.

Humble pie

The child duly was brought back – and reached before 9 am, so that even if seen later he would still be referred to the surgeon on call till 9 am according to the rules. Afterwards I learned that he had in fact been admitted and operated upon – unnecessarily, because that was then and remains to this day my opinion. But then the surgeon was notorious for his devious ways and rudeness towards all colleagues. A couple of years later, shortly before I went for specialization, he triggered another incident involving me again, though this time without any political involvement. It was not long before he had to eat humble pie

There were some other episodes with Sir Walter and the profession in which I was an active participant, but we’ll pass on to something different. This concerned one of my seniors, who became my lifelong mentor. He was then also a recently recruited non-specialist doctor at Victoria Hospital, again on duty one night when a young lad was ‘brought in dead’ and following the rules duly referred the case to the Police Medical Officer of those days, Dr Tacoor.

Shortly afterwards, he got a call from the ‘Procureur General’ who first requested him to issue a medical certificate and release the body. When he mentioned that the matter had already been sent to the PMO, the reply he got was: ‘Avec mes 22 ans d’expérience de la loi, je peux vous affirmer que vous pouvez livrer le corps, docteur. Donc, faites ce que je vous dis.’ (‘With my 22 years of experience in law, I can affirm that you can release the body, doctor. So just do what I am telling you.’)

The response that he got, very politely, was classic. ‘Dans ce cas, Monsieur le Procureur, étant donné que je n’ai que six mois d’expérience dans le service, si vous m’envoyez une note à cet effet sur du papier à en-tête officiel et votre signature, certainement je vais conformer à votre requête’. (‘In this case, Sir, given that I have only 6 months of experience in the service, if you send me a note to this effect on paper bearing your official letterhead and your signature, I will certainly comply’).

You can guess that the letter never came!

The PM’s convenience

When Sir Seewoosagur Ramgoolam as Prime Minister had to pay a visit to a relative who had been operated at the SSRN Hospital, he personally talked to the Medical Superintendent and requested him to find out from the surgeon when it would be convenient for him to visit. The surgeon of course told the MS that as he is the Prime Minister he should see his convenience. And when he duly came, before proceeding to the ward, when the MS tried to contact the surgeon so that he would also accompany SSR, the latter advised him not to disturb him and let him attend to his patients.

This contrasts with another incident years later when a Minister of Health came unannounced at a hospital and perhaps expected a welcoming committee with garlands and all. The Hospital Administrator (HA) who had been informed as the minister’s car entered the hospital gate quickly rushed to meet him, as he had already crossed into the entrance hallway. He gave a totally unjustified dressing down to the HA, who was suspended. Not one to accept an affront to his dignity, the HA took his case to the Supreme Court, which determined in his favour, alas posthumously.

And so on and so forth! It would require volumes to detail the misdemeanours and abuse of privilege which the political class is capable of, but these few preceding examples should be enough to make citizens ask themselves questions and see what they want for the future of their children. Especially when culture and character are ever diminishing in premium. About putting the interests of patients first, and respecting the principles of equity and fairness in healthcare – politicians make the usual noises about them, but simply ignore them when they are personally concerned. So the public should be aware of the kinds of incidents involving politicians that take place and which go against established practice and ethical behaviour, and which we have a duty to make known if only for historical record. Time to say ‘Cry, My Beloved Country’?