Ensuring a high level medical service

I have been following the recent ongoing polemics involving the Medical Association of Malta, Alex Manché and the public with a rather sad and disappointed frame of mind, more particularly as it became evident that what should have been a concerted effort to present and defend a genuine and just issue of great concern to the medical profession has turned into a war of words, unnecessarily involving individuals and the public.

The MAM must shoulder responsibility for the way it has handled this issue. Although there have been genuine attempts by the president and secretary of the association to back-track on the initial pronouncements and to clarify the true position of the MAM, the damage had been done and the public alienated.

I shall not dwell on individual aspects except in as much as to clarify historical facts which are known to me as the then director of surgery who appointed Mr Manché some 10 years ago.

Hospital specialists who practised at St Luke's Hospital before the setting up of the medical and surgical cardiology departments will remember the concerns at the time. Although very capable cardiac surgery teams from the UK successfully operated locally, they generally left the island on completion of the surgery, leaving a vacuum which could have been dangerous in case of unexpected complications.

Moreover, certain cardiac procedures could not be carried out locally and patients had to be referred abroad with great expense and inconvenience.

A decision was taken by the Department of Health, in consultation with myself, to open the speciality of cardiac surgery. I interviewed a number of eminent foreign cardiologists who were interested in the job and the choice fell on Mr Manché, who was then working in the UK and had a British passport.

The remuneration had to be comparable with what he would have earned in the UK. The choice proved to be an excellent one. I will not repeat what has been amply mentioned in The Times columns regarding Mr Manché's contribution to Maltese surgery and the resultant benefits to the Maltese public. He has earned every cent and it is not his fault that he now finds himself with the same contract he had 10 years ago. That should have been the point of departure of the MAM.

Indeed, it is regrettable that an important and just issue which the MAM wished to bring to the attention of the authorities and the public should have been eclipsed in the mist of unhelpful polemics. The issue at stake should have been the absolutely inadequate remuneration of the specialists working in the public sector even though many of them have contributed, within their various specialities, as much as Mr Manché has done in his specialist sphere. They have gone unsung and grossly underpaid.

It is not fair to simply point to the fact that specialists in government service are allowed private practice for this comes at a very high price to the individual regarding his health and family commitments.

It is only fair that specialists should have an equal opportunity to work solely (or predominantly) in the public service with adequate remuneration commensurable with their experience and training. This would greatly improve the wilting health services. The alternatives could spell disaster.

The present situation is different from that of 10 years ago. We are now members of the EU with the added opportunities for our medical specialists to find highly paid employment abroad. Certain attractions which encouraged physicians in the past to work locally are no longer binding. The possibility of an exodus (comparable to that imposed on the medical profession in the 1970s) is not just a remote theoretical possibility.

I think there is an urgent need for the major players in this scenario, particularly the health authorities and the medical profession, to dissociate from the present polemics and, rather than focusing on individuals, to discuss more general issues in an attempt to work out an equitable long term solution, within the ambit of the new realities, which will ensure that the Maltese public will continue to enjoy the high level of medical service as it has done in the past.