‘From higher up’

‘From higher up’ pressures will never cease but there are robust exit strategies that preserve both dignity of office and defence of the public interest

Food for Thought

By Dr R Neerunjun Gopee

There is no country in the world where pressure ‘from higher up’ is not brought to bear on those lower down. This takes place at the State level, in government in the public or civil service, in private sector organizations of all kinds including businesses, corporates and companies, societies, in religions – in fact across the board in society at large. In governments there are formal bureaucracies, and in the private spheres there are hierarchies of one sort or another.

Such pressure arises because of the power equation whereby those at the top have more power than those at the lower levels. Correspondingly, the higher one is the more the responsibility one has to shoulder, and hence the greater accountability demanded and expected of those who are at higher rungs. The private sector is accountable to their shareholders and is thus shielded from public scrutiny unless there is a scandal involving it. On the other hand, the public sector is more open to exposure because it is the population of the country at large that votes in the government that wields political power – which in modern societies is the ultimate form of power. Though it draws from the people, they have little or no say in how that power is wielded or exploited once they have voted a government in, and have to wait for the next election if they are not satisfied.

There are any number of cases around the world of public figures in high positions having had to bend to the political will, to resign or be forced out in ignominy and into oblivion, in extreme cases even to commit suicide because of being hounded by the powers that be. And this is where there is an outcry about politicians not respecting the autonomy of institutions, or of individuals occupying key positions who are perceived to be compliant to political directives in their decision making on certain matters. Currently this appears to be playing out in the case of the Commissioner of Police v DPP, and the issue of procurements during the Covid pandemic is in the public domain.

Granted that the nurtured image of the private sector is one of more efficiency and more autonomy to staff in certain positions. Still, one cannot rule out that the phenomenon of ‘from higher up’ is altogether unknown there, and I know about some cases where this took place.

As usual criticism is the easiest thing to do, especially from those ignorant of the nuances of decision making at levels where balancing technicalities, administrative processes, political interventionism, legal aspects and more critically the ethical dimension is so critical in arriving at just and fair outcomes for all parties concerned, and in particular the larger public interest is safeguarded.

As regards the public sector, ‘from higher up’ can happen at different levels, and has been around at all times. There are ways of handling such attempts at forcing individuals to comply, and those I am more familiar with belong to the medical and health sector where I have spent my career, and have heard and learnt valuable lessons from senior colleagues.

One of them was a junior doctor at Victoria Hospital in the mid-1960s, on duty in Casualty when there was ‘brought in dead’ – a patient who had already died when he was brought in. According to the procedure, the doctor referred the case to the Police Medical Officer since a diagnosis of the cause of death was not known. But the relatives were insisting that the body be delivered to them. Upon his refusal they left saying they would be back soon. A short while later, the doctor received a call: from the Attorney-General, who requested him to issue the death certificate, and was explained why that could not be done. Whereupon the doctor was told: ‘Je suis le Procureur Général avec 22 ans d’expérience dans la loi, et je vous dis que vous pouvez livrer le corps!’

Quietly but firmly he answered, ‘Moi je n’ai que six mois d’expérience comme médecin, Mais si vous me dites que vous êtes le Procureur Général, alors rendez-moi le service de me faire parvenir une lettre signée par vous sur papier officiel avec votre tampon et je vais livrer le corps tout de suite!’ The letter never came.

Once there was an investigation that was initiated by the Medical Council (MC) relating to a doctor who had advertised himself in the press, something which was unethical. He had already presented once with his lawyer at the MC, and was due for another call.

The Minister of Health called the Registrar and said he had received a ‘complaint’ from higher up that the MC was victimizing the doctor under investigation. He wasn’t satisfied with the explanations of the Registrar that this was not so, and the Minister pressed for more details as he too had to answer ‘higher up’. The Registrar told him that he was not mandated to go beyond what he had already said, and advised the Minister to contact the President of the MC. ‘Who is that?’ asked the Minister – and no comments!! (It’s the equivalent of the PM not knowing who is the Attorney General!)

When he heard the name of the President, his response was, ‘Oh my God! Then you go ahead with the investigation!’ Isn’t it said that it is the man who makes the institution?

As a practising doctor in the public service, only infrequently did I face such situations. The very first one was in 1972 when I had been a few months in employ at the SSRHN Hospital, and received a call one morning from Sir Harold Walter, who was the then Minister of Health. But I must say he was polite, and spoke in perfect English, and I replied in kind.

However, things were different when I became Chief Medical Officer (later Director General Health Services) based at what I call the ‘Head-Quarters’. For your head can literally be quartered there. Except when it can’t be.

This was the case when intense pressure was being applied to authorize renal transplantations in the private sector. I was then Chairman of the Organ Transplant Board, and the Board had made it clear that this was not possible, if at all, until the Organ & Tissue Transplant Act was amended. I had discussed with the desk officer at the WHO headquarters in Geneva on the sidelines of a World Health Assembly meeting, as also with the President of the World Kidney Transplant Association.

An expert of the French Agence de Biomedicine, reputed as the gold standard for the regulatory framework for organ transplants, was sent over and we reviewed our legislation and she submitted her report and recommendations. No question of kidney transplants in the private sector in a small country like Mauritius, was one such, and provisions were spelt out for cadaveric transplantations.

Bureaucratese took over, but the Board maintained its position, despite further attempts from higher up. Eventually, there was no option but to amend the Act.

In another instance, there was repeated pressure from higher up to procure one strain of measles vaccine when the annual requirements were being prepared. That strain had less efficacy, and all developed countries had stopped using it, substituting another more efficacious strain, which was also recommended by WHO. Again the technical team held its ground and ‘higher up’ had to relent in light of the overwhelming evidence presented.

When it comes to protecting the health of citizens, there cannot be any compromise. As regards other public sector departments, there surely are similar ‘from higher up’ pressures, but each responsible officer must assume their responsibility and do what is best in the public interest. Of course, ‘from higher up’ pressures will never cease but, as pointed out above, at least at certain levels there are robust exit strategies that preserve both dignity of office and defence of the public interest.

The above are but a few examples and obviously there are many more, but those cited give the gist of the larger problem

Mauritius Times ePaper Friday 10 March 2023