Encounter – Dr Dr Francois Saw Lan Ip
‘To be good at both politics and medical practice depends on the degree of humaneness of each one concerned’
Dr FSL Ip is one of the veterans of the medical profession in Mauritius, having been in practice both public and private since 1959. He shares with our readers his considered views on the pandemic and vaccination, the public health services, medical education. Read on:
* We are not yet out of the woods, but the easing of the second lockdown restrictions due to the Covid-19 pandemic indicates we may be getting there. As regards the national vaccination programme, 500,000 persons have already been with a first dose of vaccine. Do you have fears of a resurgence of infection with the easing of the restrictions?
With the possible emergence of more virulent variants, we cannot lower our guard which has served us so well and, in the meantime, get those defective respirators acquired under infamous conditions in good working order. The ongoing vaccination programme can be better organised; for example, at the start of each session, the doctor and the nursing staff should know how many doses would be available and limit the size of the queue accordingly. Hence avoiding frustrating people who would have waited in vain.
* Some 180.7 million cases have been reported globally, of which 165.4 million persons have been successfully treated. The latest press release issued by the government informs us that in Mauritius ‘1887 cases (including imported cases) of Covid-19 had been registered as from March 2020 to 25 June 2021… there were 391 active cases in Mauritius, out of which 369 were local cases and 22 imported cases’. Have would you rate the country’s handling of the pandemic? Could we have mitigated its impacts?
In the first wave, the measures taken were very satisfactory but some people seem careless. For instance, the queue outside NTA Office in Port-Louis where most of the time no social distancing is maintained, as it can easily be seen from the main road at most times. Reinforcing measures against air pollution (smoke-belching buses & motorcycles) and tobacco are certainly not superfluous.
* There has been resistance from an important number of the public education and health personnel to the vaccination drive, and besides restrictions of access to health and educational establishments to non-vaccinated people, government might go for legislations to make vaccination mandatory. What’s your take on that?
The people have been welcoming vaccination against influenza with many voicing their thanks. However, when people were asked to sign away any possible claim for mishaps allegedly due to a Covid-19 vaccine, some, as the saying goes “smelled a rat” or thought that there were “anguille sous roche” and so became mistrustful.
If I were the Government I would have told the people there is an enemy invading our country and let us join forces; Government is providing ammunition and protection in the form of vaccines and it needs volunteers to help – to help themselves as well as others. In any war, injuries are inevitable; in any case the health services provided by Government are free of charge. So, the consent form is redundant and has scared some people unnecessarily.
When I went for medical studies in 1959 in the UK, there was conscription in force – that is the enlistment of people for compulsory military service – and conscientious objectors were accepted after convincing a tribunal of their sincerity. Compulsions often raise hackles unnecessarily. Providing the public with accurate and full information is in brief my response to mandatory measures.
* You have worked in the public health services for about 30 years, and you have been on your own to date since 1988. What’s your opinion of our public health services which benefits today thanks to a huge budget from more resources in terms of personnel, technology and logistics?
Year after year during the past three decades or more, the Director of Audit reports have exposed waste in the Ministry of Health (and others).
As regards personnel, hospital administrators are better qualified to emit an opinion, but I can say that I have found many sinecures. While I was working at Long Mountain Hospital there was a noisy incident between the steward and some labourers over who should work over a public holiday. Later the steward told me that each one wanted to work on a public holiday because of extra pay (for easier work) on such days. Rumours sometimes are rife amongst hospital staff that so and so got a job through political backing when that so and so was not pulling his weight.
On the other hand, technological facilities are often misused. One example: MRI are often requested and carried out on patients with backache or other ailments. Had proper tests been done, these would have obviated the use of the expensive MRI. Often this is done as part of the Defensive Medicine when the doctor tries to avoid being accused of medical negligence.
Finally, regarding logistics, I recall how the late B. Ramlallah would go and check on the quality & quantity of the vegetables brought at Poudre d’Or hospital by the contractor. Now and again one hears of improbable theft of, for example blankets, sputum-mugs with lid in stainless steel, etc., in the hospital.
I have seen many prescriptions for unjustified items, notably NSAID (Non-SteroidalAnti-Inflammatory Drug or Antibiotics). Early on in the medical curriculum, students are taught the signs of inflammation – an easily remembered Latin rhyme, namely: Calor, Dolor, Rubror and Tumor – that is Heat, Pain, Redness and Swelling respectively. Many such NSAIDs have been prescribed in the absence of those signs.
Abuse or over prescription of antibiotics are well known. Likewise, many vitamins are prescribed when not really needed and many people do not realise that excess Vitamins A & D can have harmful effects.
Then there was the bad quality of medicines supplied to hospitals which was demonstrated by a member of the Legislative Assembly some years ago. I hope that progress has been made on that front.
There are sometimes medicines in the central stores which were left unused or ordered in excessive amounts from some pressure groups. I hope that with digital control of stocks things have improved.
There is also the poor maintenance of hospital equipment which I think need to be looked into.
* Do you think we could have done more in terms of better healthcare delivery with less public funding, as some frugal budget specialists would want us to believe?
Yes! A good time-and-motion study of staff and patients will also help in that regard.
* Alternative medicines have not taken off in our health system. Why is that so? Lack of interest from the public authorities/medical practitioners, or is it due to resistance from insurance agencies?
60 Mauritian doctors had followed courses on Acupuncture by a lady doctor and a lady interpreter from Beijing over three courses per year for a two-year period (1986/1987) under the sponsorship of the UNDP. 54 were awarded the appropriate certificate. There is a committee in the ministry of health regarding Chinese Traditional Medicine and Ayurvedic Medicine. Acupuncture is relatively time consuming, each session averaging 20-30 minutes per patient. Local insurance companies do not refund for acupuncture because I think their reinsurers do not, but they refund on prescription medicines.
* Will it take much to improve the quality of our public health services, and which particular area/s should be looked at right away or on a priority basis?
The quality of our public health services needs faithful and complete auditing and diligent application of their recommendations.
* There have been enormous advances in medical training across the world. We speak today of the technological transformation of medical education. Would you say that we are now producing better doctors than what the University of Edinburgh, for instance, could do half a century ago?
The question is basically about whether Medicine is an art or a Science.
In the 19th Century it was predominantly Art, but nowadays predominantly Science.
High-tech Medicine is ever innovating but the teaching of the art comes from gifted teachers. At the University of Edinburgh where I trained we had some excellent teachers, amongst whom we had Professor Derrick Dunlop whose expressions still ring in my head, for example: “Use your God-given senses”, or he would refer to such and such vague diagnosis as “the refuge of the diagnostically destitute doctor”.
Are present-day medical schools better at teaching both the Art & the Science?
I can’t say, but I hope so. The University of Edinburgh had teaching hospitals of good repute because of the many generous donations but with the advent of the National Health Service, such donations are probably getting rare so the level of the different medical schools in the UK are more or less on the same level.
* There seems to be some nostalgia (just like there is to this day the same feelings for our earlier generation of politicians) amongst our seniors about some particular doctors in the public service and in private practice who in decades past did very well as medical practitioners. If that was indeed the case, what was different then?
When I started working in Mauritius in 1959 up to 1980s, patients and their relatives were really appreciative of most doctors in hospitals or private practice. But in the 1970s things started to change in the attitude of patients and their relatives. For example, in the 1960s when an elderly had been treated in hospital and had not fully recovered, some relatives were keen to take their relative home but in the 1980s such a patient even fully cured were left behind in the ward for days because there was dissension amongst his/her children as to who should take the relative home. Likewise, patient’s relatives demand more attention for their sick people and tend to sue for negligence more and more.
* How would you rate the medical training of our doctors today and their performance?
I have not seen the curriculum of the medical schools at which our present-day doctors have been trained, but I have some reservations on a simple thing such as taking the blood pressure with a mercury thermometer by certain doctors whom I have had had the chance to see in operation.
* We spoke about the earlier generations of medical practitioners and politicians. Do you think doctors make good politicians?
In the 1960s and 1970s the medical practitioners who were also in politics rendered good service in both activities. I have had the privilege and honour of working for Sir Seewoosagur Ramgoolam and appreciated him very much both as a doctor who even as a busy Prime Minister managed for quite some time to govern with only a two-vote majority. He kept reading medical journals and kept asking me questions. He also showed great concern for all the patients whom he asked me to help. Dr R. Chaperon and Dr LeckrazTeelock were also much respected. To be good at both politics and medical practice depends on the degree of humaneness of each one concerned.
* Published in print edition on 29 June 2021
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