Edward Francis Small Teaching Hospital

It is extremely concerning to see ongoing sit down strike by the Gambia Doctors’ Association despite heartfelt apology from the minister of Health and Social Welfare, Dr Saffie Lowe, regarding truthful statements she made few weeks ago.

At the said press conference, Dr Lowe alleged that : “When you talk about corruption in the health system we all know how it is…These young doctors that will just go and practice pharmaceutics, some of them have opened their own pharmacies with the resources that we have. I am very sure of what I am saying because I was the Permanent Secretary.”

The continuing sit down strike by these young doctors is resulting to inaccessible healthcare and increasing death rate among the patients population. This harmful action is total violation of three of the most important principles of biomedical ethics.

Every healthcare professional is required or obligated to show nonmaleficence ( an obligation to do no harm), beneficence ( action taken to benefit and promote the welfare of patients and their families) and justice( doing what is morally and legally right or fair ).

These principles are currently being ignored and abandoned by the Gambia’s protesting doctors who took the hippocrates oath to uphold and defend these principles in every decision making process . The most significant of the hippocrates oath is that patients’ responsibility should always be the highest priority of any medical doctor because it supersede any other interest or responsibility that doctors may pursue. It is this simple reason that early in this crisis, I called on the Gambia Doctors’ Association to acknowledge and accept responsibility. Continuing the sit-down strike would have accelerating detrimental effects on the already poor healthcare system in the country.

The ethical principles of nonmaleficence, beneficence and justice are the guidelines which serves doctors and other healthcare professionals to make justifiable moral decisions and evaluate the morality of their actions. Since these biomedical ethical principles are guidelines that our protesting doctors should have followed before embarking on any actions that are detrimental to our patients’ wellbeing and healthcare system, then the most important question any reasonable person should be asking is: “Is it morally justifiable for Gambia’s young doctors to continue sit down strike despite increasing death rate, prolong suffering , delay treatment and overall poor healthcare delivery experienced as a result of their actions”?

I believe that there is no professional justification to embark on this strike which violates every Biomedical ethical principle and medical standard of care . Thus, there is no moral or ethical basis for this protest. Attaining maximum level of health is a basic right of every citizen. Our government has constitutional responsibility to provide optimal health services and resources to citizens. The ongoing protest is violating the constitutional rights of patients to access healthcare and be cared for.

Nonmaleficence

Considering the biomedical ethical principle of Nonmaleficence which requires doctors and other healthcare professionals to do no harm, it has so far indicates that the continuing sit down strike cause more harm to patients, their families and already deteriorating healthcare system. This is evidenced by lack of services provided by these young doctors resulting to increasing death rate, delay in treatment, waste of state resources , continuing suffering of patients as well as overall poor health care delivery.

The Gambia healthcare system is in poorer condition today than before the strike began due to limited number of doctors available in public hospitals across the country. Nonmaleficence has significant implications in the medical practice and health care, some of these implications means that doctors should absolutely try at all costs to avoid negligence in medical care, to avoid harm when deciding to abstain from work or withdraw from treatment team due to unprofessional conduct or actions such as sit down strike that are detrimental to welfare of patients and their families.

Everyone knows that continuing protest has already affected these implications. The Gambian people have already questioned the morality and responsibility of these young doctors when they decided to protest. It is therefore justifiable to state that the unreasonable actions of Gambia’s young doctors will continue to cause more harm to our patients and healthcare system than the resignation of health minister they have demanded as a top most priority since the beginning of this unnecessary and consequential crisis created by these young doctors. This is unacceptable professional misconduct.

The Gambia doctors are well respected and admired by majority of citizens despite countless medical errors or problems they have made over the years resulting to devastating consequences. The protest is increasingly eradicating that respect and it is creating mistrust and lack of confidence in therapeutic relationship between the doctors and general public.

Beneficence

As far as this protest is concerned, the ethical principle of beneficence which guides doctors to take actions or decisions that are beneficial and promotes the welfare of patients and their families has been violated. This ongoing protest efforts by young doctors’ association did not benefit the patients currently and the long term consequences will be greater since most patients condition will deteriorate as a result of lack of care , delay treatment and continuing suffering they are experiencing.

This violation signifies that the protest is detrimental to welfare and interest of patients. Doctors’ responsibility is to embark on actions or decisions that are beneficial to patients and general public but not to cause harm. They are look up to as saviors during illnesses. It is also this reason that during time of civil conflict, doctors and other healthcare professionals stay to offer help and care for wounded, sick and vulnerable people. A mere factual statement by the minister has led the country’s young doctors to embark on protest. How about during the time of civil conflict, would they even stay to help general public? This bring to mind the idea of duty and justice to serve wholeheartedly.

Justice

The hallmark of medical profession is always to ensure that healthcare practitioners do the right thing by putting the patients first as top most priority in every decision making process. This should also be based on individualized cultural competence care guide by compassion, moral and legal justifications.

The protest of the Gambia’s doctors is not based on due consideration of patients as far as their demands are concerned. This is because the ongoing crisis has justifiable led to death and suffering of patients and their families which is a violation of medical standard of care and biomedical ethic of justice.

In other words, the protest also led to unfair treatment of our fellow citizens who deserve better treatment than abandonment which is unprofessional behavior. However, I recognize the doctors’s constitutional rights to peaceful protest but such rights has also violated constitutional rights of patients whose care and needs should be superior responsibility for this protesting doctors since it involve life and death situations.

The role of doctors is to alleviate suffering by providing therapeutic medical interventions. Instead of being patients advocates , the Gambia’s young doctors are advocating for their selfish interest and protection of professional integrity. During this crisis, the actions of young doctors has conflicted with their medical professional role. In conclusion, there is a justifiable reason to state that their action cause more harm than benefits to patients and general public in both short and long terms. I believe that they are also violating the rights of patients who are under their care.

Peaceful protest is a constitutional right but that right must not infringe on the rights of others especially the vulnerable patients. The Gambia’s protesting doctors should quit their strike and get back to work. This crisis can only be solved through honest dialogue and accepting responsibility that there are some doctors who steal drugs and engage in pharmaceutical drugstore business. There is no doubt that working conditions of all healthcare practitioners need improvement. The Ministry of Health should begin necessary reforms to end corruption and to invest in health technologies that would improve healthcare outcomes.

The online media need to be responsible and understand that their role is to hold government and junior doctors accountable to Gambian people instead of instigating or giving platform to junior doctors without questioning their unethical actions they have began few weeks ago.

At this critical time of our political dispensation, Gambian people are looking for honest and fair reporting but not political driven or sensational story which has no positive impact to advance our country.

Max Jarju