Can untrained doctors rescue Sri Lanka from health care crisis?

Sri Lanka wants its doctors back from wealthy nations, or at least some money to help with training.

In 2022, the South Asian island nation went through its worst financial crisis in more than seven decades, plunging its well-respected universal healthcare system into dire straits as thousands of health care workers sought employment in other countries.

A health ministry report revealed that more than 5,000 local doctors acquired medical licenses from Australia, Britain and a few Middle Eastern countries.

“You’re taking our doctors. At least give us two more medical faculties”, says Ranil Wickremasinghe, president of Sri Lanka, seeking compensation for the mass emigration and brain drain of healthcare workers.

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Nursing staff show Sri Lanka’s first sextuplets, three boys and three girls delivered through a cesarean section, at a hospital in Colombo on November 20, 2021. (Photo by Ishara.S. Kodikara/AFP via Getty Images)

The emigration has presented health authorities with a dilemma – how should the country deal with untrained community health workers who play an increasingly important role in health care.

Because of the mass emigration the unregistered service providers (sometimes referred to as ‘quack doctors’) have now surpassed their registered ones, as reported by the registrar of the Sri Lankan Medical Council (SLMC).

In that informal group are those who impersonate doctors, and there is a group that practices Western (allopathic) medicine in addition to traditional (Ayurveda) and indigenous medicine, but have learned their medicine in non-regulatory ways. (See video at the end for fascinating look at one element of Ayurvedic medicine.)

The SLMC registers health care professionals and has a role in maintaining standards. The Council already recognises a plural medical system, where traditional and indigenous medicine co-exist alongside Western medicine.

Prof. M.W. Amarasiri de Silva explores the complexities that came with the arrival of Western medicine into the more rural settlements of Sri Lanka.

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Amarasiri de Silvia (Uni Pittsburgh)

“For [rural]settlers, [allopathic] hospitals represented a bureaucratic system,” he says.

“This context created a demand for healers akin to traditional […] or Ayurvedic doctors, leading to the popularity of quacks or unregistered doctors in remote rural villages”

The Government Medical Officers Association (GMOA), says unregistered practitioners pose “a grave risk to public health”.

de Silva, who emailed the Cosmos newsroom from his home in California, believes that while the GMOA’s concerns are valid, resolving such issues should be approached with nuance.

“Sri Lanka should take steps to provide training to these quacks and give legal power to practice. There should be a (medical) school to train them in basic allopathic medicine”.

He proposes formal recognition of the unique role played by these providers within the local community.  “The complex healthcare landscape in Sri Lanka, particularly in rural areas, reveals a multifaceted reality where unregistered doctors (quacks) play a significant role in addressing the diverse medical needs of the population.”

de Silva also believes that with the proper recognition and support, these practitioners could fill the gap left in Sri Lanka by the rising number of healthcare workers leaving the country.

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