Patients At Risk With Health Tug-Of-War
By Nirmala Kannangara
Nurses unions have urged the Health Ministry to re-start the hindered four-year Allied Health Degree course and the midwifery training given to nurses immediately without allowing the Government Medical Officer’s Association (GMOA) to take an upper hand to obstruct the nurses’ rights or face consequences
As a result, the National Hospital Colombo, Teaching Hospital Kurunegala and other hospitals in Kuliyapitiya, Dambadeniya, Diyatalawa and Hambantota have been badly affected and according to the President of Health Services Trade Union Alliance (HSTUA) Saman Ratnapriya, unless their demands are met, the strike will continue and the rest of the hospitals too would join the trade union action.
“It is purely due to professional jealously the GMOA has blocked the nurses from getting midwifery training and also the four-year degree course, which is an accepted norm in many developed countries. The reason for this is that the GMOA does not want the nurses to go up in the salary ladder. The doctors fear that if the nurses get the four-year training, our salary scales would come closer to theirs,” said Ratnapriya.
According to him, midwifery training has been given to nurses over the past several decades but questioned as to why the GMOA has now started agitating against the training.
“We have never interfered in their service and do not want them to interfere in our service as well. As doctors they should be happy to see the nurses getting a good training in midwifery service. In addition they should also be happy if the nurses get the allied health degree so the nurses’ health knowledge could be improved and it would be easy for the doctors in patient care,” claimed Ratnapriya.
Ratnapriya further added as to how the GMOA has used the midwives as a cat’s paw to prevent the nurses getting further training in their service.
“The midwifery training is not new for the nurses as they have been trained over the decades. But why all of a sudden the midwives started agitating against midwifery training given to nurses? The doctors have created a fear psychosis among midwives that the nurses are to take over their profession and their service would be diluted in future. We do not have any intention as such but we want the midwife service to continue as they carry out an excellent job. The GMOA has now put the midwives in front to stop our training in fear of nurses getting a salary scale that is closer to doctors,” added Ratnapriya.
According to Ratnapriya, the nurses unions have never asked for a salary hike for those who get more training but need further training to get better health knowledge to offera better service to the patients.
“Midwifery is an important discipline and is under the nursing administration. On the request of the GMOA, the midwives attached to the Teaching Hospital Kurunegala had stopped marking their attendance with the Matron and had entered the labour room which is illegal. Hence the nurses walked out from their work last week,” said Ratnapriya.
Ratnapriya queried as to who has vested powers in GMOA to get the Health Ministry silent over the nurses issues when the Health Secretary has given his approval for the Midwifery training and also for the Allied Health Degree.
“The GMOA is a trade union that has to look after doctors issues in the country. But the present GMOA members do not want to talk about the doctor’s issues but merely dance to the government tune to get more perks for them. It is not a secret as to how the present GMOA office bearers work hand-in-glove with the politicians and that is why most of the doctors in the country are fed up with the GMOA. These office bearers want foreign training, scholarships, good schools for their children and even better posts in the Ministry but do not want others to gain knowledge or a better salary. It is they who are connected to most of the Health Department malpractices and try to be saints and stop the nurses getting good training,” alleged Ratnapriya.
He further said the Higher Education Minister S. B. Dissanayake and Chairman, University Grants Commission (UGC) had confirmed that it was the GMOA that wanted the UGC to stop the four-year Allied Health Degree that was started in 2009.
“After two batches, this degree course was stopped and as a result the allied health students started a continuous agitation and this ongoing strike is to help them win their demands. The GMOA has now got the College of Obstetricians and Gynaecologists that trained the nurses in midwifery service to stop training the nurses. Unless both our issues are addressed, we will continue the ongoing strike,” said Ratnapriya.
However refuting these allegations, former Secretary GMOA and the Committee Member appointed to look into the midwifery issue Dr Chandika Epitakaduwa said that the College of Gynaecology has taken a decision not to train the nurses in midwifery care in future.
“There is no necessity to train all nurses in midwifery as it is the midwives that have assisted the doctors in deliveries from the good old days. A delivery has to be done by a VOG and is assisted by a senior House Officer and a midwife at a normal delivery. But when it comes to complicated cases midwifery trained nurses assist doctors in order to monitor the patient during the delivery,” said Dr Epitakaduwa.
According to Dr Epitakaduwa, midwives look after pregnant mothers throughout the pregnancy which includes during antenatal care, labour, postnatal care, neonatal care and contraception.
“Midwifery and nursing are two separate disciplines. An intrusion into midwifery by nurses would lead to the dilution of the quality of both nursing and midwifery,” added DrEpitakaduwa.
He accused the Public Service United Nurses Union (PSUNU) President MuruttettuweAnandaThero for his attempt to eradicate midwifery category from the country’s health service and added that it is the most cost effective category in the health sector as they are less paid but deliver an excellent service.
“This trade union also wants the public health nurses attached to the MOH offices to replace the midwives. For the midwife training course, which is one-and-a-half years the government spends Rs.1.1 million to produce a midwife whereas to train a nurse for the three-year course the government spends Rs.1.8 million. With the extension of three-year course to four-year course the government has to spend a further Rs.1.1 million per nurse, which is a huge cost for the country,” added Dr Epitakaduwa.
According to Dr Epitakaduwa, there are nine para medical categories out of which eight categories have their own administrations but not the midwives, which have become a serious issue.
“The midwifery administration comes under nursing and since the nurses come under nurses’ trade unions led by the Buddhist monk and SamanRatnapriya, the midwives are ill-treated by the nurses. These midwives get one-year theory training at the Nurses Training School (NTS) where they come under severe harassment. However during their training in wards under the VOGs they are properly trained without any harassment. In wards the nurses want the midwifery students to do odd jobs and the matrons do not roster them properly. Nurses are allowed to do overtime (OT) and the midwives are not allowed OT. As a result, two weeks ago the midwives union decided not to mark their attendance with the nursing administration and had wanted the National Institute of Health Sciences at Kalutara to give them their training but not at NTS,” said Dr Epitakaduwa.
Dr Epitakaduwa further said that the midwives are accusing the matrons for not handing over the delivery sets to them but to nurses.
“This is intimidation. After completing a three-year training period, the nurses should get four years working experience before applying for the six-month midwifery training. In addition to this six months training, which is legal, these nurses undergo a further six months training unlawfully to claim that they have completed another one-year training. With all these, the Public Service United Nurses Union President Muruttettuwe Ananda Thero wants the newest batch of nurses to continue a further year in midwifery training which will lead to the dilution of the midwife service,” he said.
According to Dr Epitakaduwa as a result the College of VOG took a decision not to train the NTS students in midwifery which has prompted the agitation from the nurses.
“We do not have any intention to support either group but when it comes to our obligations we have to take a decision. It is extremely unethical to plan to dilute the midwifery service. The longer the nurses get trained it will help them to go up in their salary ladder. That is why they want to increase the training period from a further year. If the country really needs, the three-year training period can be extended. When there is no necessity as such why do the trade unions want to get the nurses training period further extended,” queried Dr Epitakaduwa.
According to Dr Epitakaduwa the nurses’ job is nursing care that includes cleaning patients, comforting and counselling them and to give them skin and oral care. “The nurses are not discharging their duties and it is done either by attendants or bystanders. They only carry out admission and discharge which is the job of the ward clerk. Although the ward inventories are carried out by nurses, it is also the duty of the ward clerk. It is the phlebotomist that has to take blood samples for analysis and the dispenser to give medicine for patients, but without performing their duties, the nurses get involved in other’s work. The nursing union leaders are trying to get more power by taking over the midwifery service,” he added.
He further said that giving further training to nurses violates the Medical Ordinance and adds an undue cost on the country’s health sector and violates the international standards of maternity care.