By Devanmini Wijesinghe
Following the economic crisis, Sri Lanka has been grappling with the unfortunate issue of the migration of professionals seeking better opportunities abroad. The lack of economic stability has prompted many medical professionals to choose emigration over remaining in Sri Lanka. This trend is particularly pronounced in specialized fields such as psychiatry.
According to Dr. Sajeewana Amarsinghe, President of the College of Psychiatrists in Sri Lanka, out of 120 consultant psychiatrists in the country, only 70-80 remain. This exodus of skilled professionals has far-reaching implications for the healthcare sector and the broader society.
Dr. Amarasinghe explained, “In the case of psychiatrists, the final stage of our training is often completed abroad, and we are expected to return to the country following the work experience we gained there. However, most doctors are choosing not to return. They would simply pay the bond to the government, which is easily feasible once they obtain their salaries abroad, and they choose to remain there.” He further emphasized, “It’s also important to note that it is not solely about compensation driving this trend. While offering doctors a comparable wage is a significant factor, it is also a matter of a lack of certainty.”
The migration of medical professionals has had a particularly significant impact on the most vulnerable groups in communities, especially the marginalized groups, most notably the transgender community in Sri Lanka. This community heavily relies on consultant psychiatrists to obtain their Gender Recognition Certificate, which allows them to change their gender assigned at birth to the one they now identify with.
The impact on the transgender community
Sri Lanka, despite its numerous shortcomings, has been progressive in one aspect affecting sexual and gender diverse communities – notably the transgender community obtaining the Gender Recognition Certificate (GRC) in order to change their gender identity on their national identity documents.
The GRC is a legally enforceable document obtained courtesy of the Ministry of Health in Sri Lanka. It is a certificate issued for the purpose of changing the gender and name on a Birth Certificate, and it can only be certified by a consultant psychiatrist under the Ministry of Health as per the general circular No. 01-34/2016.
However, despite the availability of this progressive piece of policy, there has been a recent breakdown of the system due to the migration of medical health professionals, specifically consultant psychiatrists. as a consequence of the economic instability of the country. Medical professionals are choosing to migrate abroad looking for greener pastures, in droves.
The transgender community in Sri Lanka faces significant challenges, enduring violence and abuse from both conservative societal attitudes and state authorities. Much of this mistreatment stems from their struggle to prove their identity, particularly as their gender identity does not align with the gender assigned to them at birth. Given that their ability to prove their identity directly affects their security as natural citizens of Sri Lanka, the migration of psychiatrists from major hospitals in the country has become increasingly detrimental to the transgender community.
In Kandy
While this is a challenge around the island it was recently brought to light in Kandy, in the Peradeniya teaching hospital where there Dr. Pabasari Ginige, the head of the psychiatry unit at Peradeniya Teaching Hospital, recently traveled abroad, leaving many transgender individuals in Kandy feeling uncertain about their access to essential services.
Visiting the hospital ourselves, to observe the situation following Dr. Ginige’s departure, it appeared that while her absence has created a noticeable gap in the practice, there is an alternative arrangement in place. Four other psychiatrists have stepped in to fill her shoes. Despite the transition, concerns remain about ensuring continued access to care and support for transgender individuals in Kandy and beyond.
However, speaking to hospital staff and several community members whom are currently registered at the Peradeniya Clinic waiting to receive services, they noted that, while there is a system in place to cover Dr. Ginige’s loss, there is a persisting issue of a lack of resource personnel and experts.
Praveen, a resident of Kandy and a transgender man, shed light on the challenges faced by the transgender community in Kandy due to the migration of medical professionals. He explained that many in the transgender community have relocated to Colombo seeking better access to services in light of the limited resources available in Kandy. Additionally, the absence of a consultant Endocrinologist in Peradeniya necessitates travel to Colombo for essential treatments. Praveen remarked, “I personally chose to remain in Kandy because this is my home, but it was a struggle to travel to Colombo for my hormone therapy and then return for counseling in Peradenia. I wish it was available in one place, and now it is even worse because things are getting progressively more delayed as there are less and less doctors in all of the hospitals.”
Around the island
Dr. Kapila Ranasinghe, consultant psychiatrist and influential figure in the introduction of the Gender Recognition Certificate (GRC) to Sri Lanka, highlighted the serious impact of the migration of medical professionals on the availability of specialist medical care. He emphasized, “It is difficult for persons with specialties to remain as the pay disparity is far too glaring, and given the relative uncertainty in the country, many are choosing to go abroad.” Dr. Ranasinghe underscored the resulting understandable delay in services, stating, “This has resulted in an understandable delay in services, and I think society must also grasp that there are practical complications that we as doctors face when we are short of staff.” He further noted the difficulty in obtaining appointments and the delay in sessions, leading to a prolonged process of obtaining the GRC due to this shortage of personnel.
Iyara, a transgender woman who maintains a foundation for the transgender community in Kandy, shared insights into the challenges faced by transgender individuals seeking medical services. She noted, “Many transgender persons in the community tend to travel to Colombo because it is more convenient, but actually, in recent times, they are facing some difficulty because Colombo has too much of a backlog. Because they have this issue of fewer doctors versus more demand.” This highlights the strain on healthcare resources in Colombo as well, leading to delays and challenges in accessing necessary medical care for transgender individuals.
Thenu Ranketh, the executive director of Venasa Transgender Network, highlighted the challenges faced by transgender individuals seeking services in Colombo. He noted, “There are many who travel to Colombo for various reasons, to access quick services, and there’s also the concern of not having to face your community. They wish to be hidden from their community so they can go through their transition without the prying eyes of their community.” However, Ranketh observed that upon arrival in Colombo, many encounter difficulties, particularly regarding housing and communication barriers, especially for those from the north who primarily speak Tamil. This influx of displaced transgender individuals underscores the broader issue of limited resources and access to specialized services outside the capital.
Thushara from HNRDF, an LGBTQ service-providing organization in Galle, shared that in Karapitiya, the consultant psychiatrist Dr. Harshani Rajapakshe, while an incredibly dedicated doctor, is struggling to give appointments because she is understaffed. “She is a great ally but she cannot do it all by herself and there are no government appointments of consultant psychiatrists being appointed to Karapitiya,” he said, adding that “the community members who are desperate to get their GRC would impatiently complain and then travel to Colombo in the hopes of getting better services, but I think this lack of doctors is an island-wide problem.” This underscores the systemic issues within the healthcare system that extend beyond major urban centers, affecting marginalized communities’ access to essential services across the country.
Cultural and other barriers
While migration appears to be a shared issue around the island, there are certain nuanced challenges faced by persons coming from minority communities, such as those who live in the north. Speaking to Angel Queentus, the executive director of Jaffna Transgender Network, she shared that in Jaffna, one of the major challenges they face is that the consultant psychiatrist in Jaffna Teaching Hospital is an older gentleman who holds many traditional biases. She noted that there is a cultural barrier to be overcome, stating, “Dr. Sivayogam is elderly and understandably he has some beliefs that are very conservative, but that has resulted in deterring a lot of the transgender persons going for services to Jaffna. He would often ask for transgender girls to either bring their parents or if no parents, they have to bring their boyfriend because they are a man etc., so this has made people less likely to go to the Jaffna hospital,” she said. This highlights the importance of addressing not only the economic factors driving migration but also the cultural and social barriers faced by marginalized communities in accessing essential services.
She additionally noted a unique experience for Tamil-speaking individuals choosing to move to Colombo, sharing that they face difficulty in communications. “There is a reason why Jaffna people struggle because there is a limit to how far they can go to get alternate services. Many of them don’t speak Sinhala and that makes it difficult for them to communicate with doctors in Colombo, or even Karapitiya,” she said. This linguistic barrier further compounds the challenges faced by marginalized communities seeking access to essential services, highlighting the need for tailored support and language-sensitive healthcare provisions.
The scarcity of specialist medical personnel has exacerbated existing challenges faced by marginalized groups, including violence, discrimination, and difficulties in proving their identity. Furthermore, the geographical disparities in access to healthcare, coupled with linguistic barriers, have further marginalized communities from regions such as the North, where access to specialized services is already limited. Urgent measures are needed to address these systemic issues, including incentivizing healthcare professionals to remain in the country, improving healthcare infrastructure in underserved areas, and providing language-sensitive support for diverse communities. Without concerted efforts to mitigate the effects of brain drain in the medical field, vulnerable populations will continue to face significant barriers in accessing essential healthcare services, perpetuating cycles of marginalization and inequality.
