Strike to Kill: Why Doctors Should Rebel with Caution
Our collective patience weans when the long road to a Yes between motley groups of labour and the government is derailed by failure of the latter to honour its commitments. Even more frustrating is the price that society pays when respective groups call on a strike action by way of abdicating their duty posts. Although the aggrieved parties would usually cite a breach of contractual terms as their reason for rebellion, refuge is often sought in the level of public upheaval such actions generate by the negotiating government in power. In the midst of such standoffs, it is the public not the dueling parties who bear the brunt. It is therefore unnerving when the tussle between labour groups and government persists. Neither civil disobedience nor administrative lobbying should degenerate to the point of civil strife. After all, contention is often peculiar to the demanding party and the outcome of such negotiations usually satisfy the specific demands of the aggrieved parties involved.
Demanding due or improved conditions of service by any group is as legitimate as it is legal, well within their labour rights. However the discussion has morphed from what is due labour to what labour deserves. Herein lies the problem as negotiations concerning wages, allowances and other gratuities hinge on group preferences and not institutional capacity and means. As a result, the politics of labour negotiations rather than the realizable outcomes of such negotiations distract the process.As the calls for a swift resolution between labour and government mount in the background, parties have often hasted for a settlement. The lack of a concrete plan of action based on achievable outcomes and deliverables has seen the monotonous cycle of strikes in the country.It would also be expected that negotiating labour groups would be informed and convinced of the modes and means of settlement in order to set realistic expectations of their demands being fulfilled.
Admittedly, peculiar challenges constrain government’s ability to adequately fulfill the demands of labour.These include forecasts regarding expected revenue and actual expenditure, barriers to calculating actual policy outcomes due to the probable unforeseen shocks as well as the proportion of available time vis-à-vis competing policy priorities. This could be a general factor to consider when assessing government’s reticence to fully stretch its arms at the negotiating table although the same disposition is hardly seen when politicians mount the campaign pulpit. While we may not be able to trust government to govern prudently, we can at least oblige labour to negotiate reasonably based on achievable or workable outcomes.
I now turn to the specific cold war between striking Doctors and the government. It’s a case of broken trust between both parties. However, in the current situation, the doctors came to the negotiation table armed to the teeth. Government sensing that these life gatekeepers would not budge, adopted the Pontius Pilate principle, by presenting their demands (leaking) before the crowd for judgement and condemnation. In response, the Ghana Medical association have retaliated in full arsenal by towing the nuclear path. Gradually withdrawing emergency services and using their monopoly over the treatment of human life as leverage to coerce government to submission.
Largely the outcome of unattended to demands by government(s), the GMA have remained obstinate in their position accusing government of treating their demands for improved conditions of service with levity over the years. Without deriding the course being pursued by the doctors, it is worth questioning whether the current means being adopted grants doctors better leverage or leaves both course and means with higher deficits? Does it lend credibility to the profession or does it betray their course all together? How does a mission to improve the well-being of health service providers succeed when it violates the wellbeing of others? Does the GMA’s decision to abandon their duty posts owing to ignored conditions of service, insulate them from the consequences of such a decision?
These and many more questions beg the attention of our uniformed men and women whose recourse to professional safety does not recuse them from the impact of that decision. It may be alleged that once government swiftly meets their demands, the sooner they would resume and the fewer fatal casualties will be incurred. But same goes the argument that if they delayed in stand-off with government, they could eventually have their demands met in view of the many who may have given up their desperate lives in order that this course may deliver the necessary message of how serious the doctors are. Is the question then not, how doctors would pay back these human shields unless they deny that the death toll of patients does not contribute to the urgency to reach a settlement?
In my opinion, any link between the loss of a patient’s life and the prospect of closing the GMA deal ought to be compensable.If we cannot compensate for the loss of patients’ lives which have invariably contributed urgency to a negotiated settlement between the GMA and government, then both parties must conduct negotiations under non-life threatening conditions. Unlike other labour strikes whose postponement of duty can be compensated for by a speedy catchup regime, no amount of superfluous medical activity can resuscitate, reverse or regain a lost life or worsened health condition. The deceased would have had their rights to life grossly violated and no degree of logical justification could right that wrong.
I do not intend to heap the pile of dirt on the respected men and women of honour in the medical profession. Theirs is a calling of great diligence to service and a route paved with a strong test of cerebral fortitude. They have demonstrated beyond the wage scale, their unwavering commitment to serve. Even when the threat of Ebola seemed imminent, their cautious of poor safety work conditions did not scare them away from duty. They serve under most stringent climates and rarely make excuses for their obligations. This brief is by no means oblivious of their demonstrated commitment to duty. My intention here is to raise a moral injunction to a cause that proceeds from a principled judgement call but travels at a highly emotional pace and makes no exception to who it tramples upon. What is sort in the end is not fundamentally different from what is needed to accomplish that end. Doctors seek to attain the most suitable conditions of service to guarantee their assured capability to provide the needed health services they currently render. In effect, doctors seek to improve their efficiency and effectiveness of health care delivery tomorrow as much as they wish could be provided today if those conditions were available. Both are related and furthering any constraints to regular health services today would not minimize but accumulate the gross failures of tomorrow. Government may be unreasonable, the citizens may lack the civic courage to mount pressure on the government, but none of them has the calculative power to decide the fate of a patient’s life which cannot be compensated for.
While I implore doctors to exercise greatest responsibility in minimizing the morbid toll of the strike, the attitude of the general public in aggravating the situation should also be acknowledged. There is no doubt that sitting on the fringes and behaving as though spectators, the lack of a concerted front to persuade or pressure either faction has dragged what could have been a smooth negotiation process to a fragile one. There has been a fluctuation of empathy and sympathy from various quarters of the public but where is the telepathy? This is a citizen’s call by all shots and it is one that requires a stand on where to place the onus. We need to protect the citizen’s interest as that has been terribly managed by the government faction in the negotiations. They have failed to abide by non-disclosure principles, hedged their decisions against public agitation and invariably turned the citizens against their trusted health allies. The vacillations of the media has only made the situation worst considering how they have cherry-picked the issues and failed to provide the needed historical guidance to previous and current negotiations between the two parties.
As the impasse between both parties persist, it is worth acknowledging that issues of unresolved labour demands are perennial and trans-governmental. Both the NPP and NDC governments have either failed to broker a sustainable deal or reneged on their commitments. While the GMA has remained a solid, coherent negotiating party, the government front is a rather fractured one being represented by different negotiating actors at any given time and faced with different political realities as far as yielding to labour demands are concerned. An imbalance of emotional commitment to the process could be said to have generated since new governments do not experience the same degree of negotiation fatigue and have their integrity questioned being new partners involved in an old negotiation tussle. Here is why, the media who have been the vehicle for communicating these issues all these years, ought to herald the crusade of setting the records straight! Much currency has been generated because the media scape is wont to focus on what is making the news instead of what ought to be the news.
Perhaps, the best way to orient the debate is to address he dire concern at stake. Exert pressure on the compelling issues and actors responsible and to be unequivocal about the right thing to be done. The government’s resort to seek alternative service providers like retired doctors and foreign professionals will only severe ties in the negotiation room. Doctors on the other hand cannot continue to wield their axe of ‘leave from office’ since they would be turning themselves into soldiers of war.
It goes without saying that doctors are lifelines to the state, their scarce expertise and disproportionate number further aggravates a situation fast deteriorating. An extended stalemate would trigger a groundswell labour uprising among other aggrieved unions. This would generate negative international publicity and regress our hard won reputation as a constitutional democracy. On the other hand, the territorial integrity of the state includes the prevention and protection of its citizens from any known harm. This includes all calculative attempts to hold the authority of the state to ransom in exchange for the settlement of peculiar grievances. A belligerent position by doctors would turn an omission of the state to a deliberate commission of terror on their part. A chorus of protest should be mounted by respective quarters of the public towards reverting negotiations from a state of emergency to one of normal arbitration.
There is a price to pay for taking sides as that could obliterate prospects of good faith during negotiations but there is even greater price to be borne by us all if we remain on the fringes. Making innocuous calls for peace without it being targeted at the most critical negotiating party would tantamount attempting to tread cautiously with no qualms about the outcome of delayed negotiations. In my estimation, the ongoing negotiations are unbalanced.Doctors have resorted to a ‘do harm’ strategy to negotiations although the suspension of such an approach will not constrain their already fortified position. In this protest brief, I propose a triple win solution. One that does not ultimately disadvantage the aggrieved party, loosens the noose around the neck of government not to negotiate under duress and at the same time, insulating citizens from the unintended wrath of doctors. This is why I challenge doctors to cease fire by resuming duty even if this would require for the start, only emergency cases.
In whichever way it is viewed from, government as a duty-bearer has a RESPONSIBILITY to provide commensurate conditions of service to doctors. However, in their obligation to duty, doctors have and will ultimately be the ones to make a CHOICE as to whether or not to attend to the health needs of patients. The result of that choice would be a direct consequence whereas any attribution to government does not make it the hand that pulled the plug on the patient.
The author is the Head of Research and Programmes for the Policy and Governance think tank, Mutation Institute. He can be contacted on [email protected]