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It is my understanding and belief, that calling for and going on strike is not the problem. It is the method of the strike and the way the strikers and the media "sell" the cause and effect of the strike. Most strikes that disrupt services, no matter how small the impact, would face resistance and hence has the potential to be disliked by the public. Perhaps, this was one of the reasons for the apparent poor acceptance of the doctors Sick-Leave-Strike!

I wrote earlier, at another forum, on how I'd prefer to "strike", at least during the initial phase. I think in Maldives, at this stage of realization of our rights, we'd do better with a more visual strike than industrial action. That is my opinion. I had discussed using the "lunch break" for demonstrating. It shouldn't halt services at IGMH because people taking part would be on their official break! The striking staff could stand along the sea wall just to the west of IGMH with banners and posters. These could display reasons for demonstrating and their demands. Perhaps slogans could be used too. Media could be invited to cover the daily Lunch-Break Strikes. The protest for the day must be wrapped-up before the lunch break ends to allow staff to return to work. A form of visual demonstration could be continued beyond the lunch-break using arm bands or badges. If these strike fail to achieve results or at least a constructive dialog then further steps could be considered.

The medical service providers, including those of us at IGMH, have had unnecessary and unacceptable stress and inconveniences added to the frustrations of a grossly inadequate and under-resourced medical care provision system for years and years. Any time something good happends and the expectations and hopes for a better health care system gives us hope for the future, someone comes along to kill those dreams. The frustrations build and finally the last straw breaks the camels back!

I can understand, perhaps because I am an "insider", why the doctors at IGMH went on the Sick-Leave-Strike. There are several reasons for a strike or a show of disapproval and displeasure. Salary is an issue, but it is certainly not the sole or major one, as some politicians and Commissions would like the public to believe. That was just bad politics adding insult to injury.

Pay is an issue because, in addition to our work being one which is in itself  humanitarian, it is our work and means of earning a living too. There will be people who disagree with me, and that is perfectly fine with me, but it is not wrong to ask for a pay increment when your official work hour has increased by 2 hours per day too! Fine, we are faced with financial and fiscal challenges and one may need to revise pay scales to suit the financial capacity of the government. But then, why would the authorities call the changes to pay; a "pay increment"? Just for the technical truth in it? How is it that they then justify  the political elite being allowed to continue to draw salaries that truly burden the national budget during this same financial hardship?

A doctors work should be professional, capable, caring and humane. Drawing a salary or getting paid for providing that service does not make it any less humane! I'd be happy if doctors participate in Free-Medical care. May of us do that too in our own capacity. It is disgusting and painfully hurting to think that people look at us as money hungry and inhumane. That is so far from the truth. Perhaps ensuring alternative striking methods wouldn't have caused these false accusations. I wonder if it is fair to expect anything different from opportuistic politicians either way. Nonetheless, industrial action that results in service disruptions could have allowed for bad politics taking advantage of the situation.

Just for the record, my take-home pay has not decreased during this pay scale revision. It is exactly the same Rufiyaa for Rufiyaa as it was before. All my allowances were canceled, according to my employers, but my basic salary was increased to adjust for that. So technically there is some form of increment in my case, the basic pay was increased, but my take-home salary is unchanged despite the significant increase in official work hours. I am told, however, that some of my colleagues didn't fare as well. They will be taking home a significantly less salary than earlier. That too when the purchasing power of the Rufiyaa is falling due to various reasons. It puts a different perspective to the situation if one would accept that the change in economic condition has affected everyone and not just the government.

During the recent presidential election campaign we heard the then Health minister, Ilyas Ibrahim, say that it was a failure of the administration at IGMH that was the primary cause for its failures. Many of us had literally gone blue in the face saying the same thing to the authorities without them heeding a ward of it. The only action they were ready to take was to try to silence the very people who tried to convey the truth. Members of the current ruling party both before and after the election continue to say that the administration at IGMH is a failure. Is it then not surprising that the very elements that they have so openly labeled as utter failures are now either in the same posts (may I mention with a better pay) or at similar or higher posts within the ministry? All that, when the public continue to suffer the inadequacies and failures of the health system and its institutions. We anxiously wait to see what the 3 month deadline to a A-Z change at IGMH would actually bring about!

Truth be told, the attitude and lack of professionalism among the service providers including doctors has not helped either. There is no smoke without fire and there must be reasons why the public mistrust health care workers! We hear again and again of few doctors speaking rudely to patients, doctors who fail to see patients under their care (even when patient is in ICU), doctors failing to provide reasonable explanations and information to their patients, etc. These are some of the reasons for the mistrust but there will be many other that one could list, should one attempt to make an all inclusive record. Having said that, it is also true that there are several doctors who are truly professional, caring and capable in their work. The few bad apples certainly spoil the whole basket. It would take much effort to bring out the kind, caring and professional face of this profession to the forefront. That is a challenge we must meet.

It is no secret that quality medical services require certain infrastructure, including human infrastructure. Medical equipment at IGMH and many other health institutions are at best; basic and historically poorly maintained. Once in a while the media highlights non-functioning of certain essential equipment and brings it to the publics notice. CT scans being out of order, ultrasound scan machines out of order, ECHO machines out of order, blood culture services being discontinued for months and ventilators out of order happen far too frequently. The lack of back-up systems has on several occasions compromised the institutions ability to provide even essential care! The brunt of all this is usually borne by the clinical workers. Add to that the lack of several important drugs despite repeated requests at various forums. Even those that are supposed to be available, running out of supply is a major concern.

Personnel development and training opportunities has over years has been on the decline. Seats for MBBS and specialization supported by government funds has apparently decreased. Private funding has tried to fill that gap in past years. Thankfully such arrangements have helped and we are very thankful to the parties who have sponsored many of us. It is not only about doctors though. Providing health care requires a team: doctors, nurses, lab technicians and several others. Training opportunities for the support services too is far from adequate. For instance, medical equipment need maintenance and service to keep them in proper working order. The lack of appropriately trained Biotechnicians at IGMH is one reason for the poor maintenance of vital medical equipment.

So there are reasons for unhappiness. That list isn't an all inclusive list either.

I'd like to hope that there will be no need for a next time. Strikes don't always work. They sometimes make things even worse then they were before. Perhaps a re-think of the method, a more thought-out, better planned and less disruptive strike could be more effective and acceptable with the public. Or would any strike be acceptable? For the opposition it may. Certainly not for the party in power. The public maybe more receptive if they could be engaged and better informed.