We stand in solidarity with MP Dr Asha Kissoon

Dear Editor,
We would like to take the time to respond to a response by the Ministry of Health, dated January 28, 2024, titled “Asha Kissoon Misrepresents Facts by Giving Incomplete Information”.
Practitioners of this noble profession of Medicine have many chronic grievances, which have spanned the lifespan of successive administrations. The current Minister of Health, Hon. Dr Frank Anthony, outlined very accurately six causes for the sufferings of physicians in a letter to another media house on September 25, 2018, titled “Public service doctors working under gruelling conditions for poor pay, authorities need to act”.
He highlighted and ably expounded on the issue of long work hours and the implications of physician burnout, and he was quoted as saying, “It should be noted that GPHC is regarded as the best staffed public hospital; one can only imagine how many more hours doctors have to work at the regional and district hospitals across Guyana”.
On the issue of inadequate accommodation for doctors on call, he was quoted as saying, “When physicians are “on call” they are required to be physically present in the hospital compound. This is to ensure that, if needed, these doctors would be immediately available if an emergency arises… Many of them who bring their food to work have often had to resort to eating in the wards, or often standing at one of the corner shops around the hospital.”
When speaking about the issue of overtime vs on-call allowance, he was quoted as saying, “Doctors are required to work ‘on call’: that is, for extended periods after their regular 8 hours’ shift during the work week, from 4pm to 8am Monday to Friday, and on weekends from 8am to 8am Saturday, Sunday and holidays. For each on-call session, the doctor is paid $2500 as an “On Call” allowance, which the PPP/C Government had agreed would not be taxed…Many doctors believe that this is no longer an allowance, and would like to be paid under the applicable laws of Guyana”.
In his description of the issue of compensation for interns on call, the minister wrote: “For these additional ‘On Call’ sessions of work, they do not receive any compensation. In other jurisdictions, Interns are given adequate reimbursements for work done. This anomaly must be corrected immediately, as it seems that this is in breach of our labour laws.”
On meritocracy or party loyalty, he said, “…efforts must be made to have an open and transparent system, where persons are promoted based on their assessed competence, or sent for postgraduate training based on merit.”
Concerning the grievances of salary and allowance, Dr. Anthony was quoted as saying, “The doctors at GPHC would get a monthly housing allowance of $20,000, but most of them complain that they are unable to rent a house in or around Georgetown for this sum of money. They also receive a meal allowance of $500 per call; this is far less than what an actual meal would cost. If a doctor decides to buy a real meal while ‘on call’, s/he would often end up spending more than $1000.”
While we acknowledge that some of these issues have been partially addressed by this administration, there are those which remain a bane to physicians. In the scope of the budget debate, we would highlight three.

Illegality of the rate paid for ‘on call’ vs overtime
By the Ministry’s own admission in their table in the letter, they highlighted the still prevalent illegal arbitrary on-call rates alluded to by the Minister of Health in his 2018 letter. The rate of $4000-$5000 ($250/h-$312/h for 16 hours of on duty) is not in keeping with Labour Act Chapter 98:01 Part III 12(1), which regulates overtime. The Ministry and GPHC have inserted an “on call” rate where there should be overtime at x1½, and this is designed to rob physicians of their rights under the law. There is no designation in the Laws of Guyana for the period worked as “on call”, except for overtime.
The contracts of Government Medical Officers in MOH do not stipulate the “on call” they are forced to work. Should overtime be applied to them, it should also be voluntary. Therefore, under the current situation, they are not contractually obligated to work on call.
The overtime stipulated in the table is far less than the legal rate of x 1½, and is given only to Accident and Emergency doctors at GPHC. Doctors at other locations do not receive that rate.
There must be no discrimination. The law must apply to all physicians as well. Even unskilled labourers are not subject to the on-call rates consultants receive in Guyana.

Medical Interns are not compensated for
on-call or overtime
As outlined by the Minister of Health in 2018, and correctly highlighted by the table in the letter in Guyana Times, Medical Interns are targeted illegally, in that they are on duty “on call” (which should be overtime) for 16hrs weekdays and 24hrs weekend, and still receive absolutely no compensation for it. This is not the case in any of the Caribbean countries, and is the main factor, along with low pay, driving newly graduated doctors to migrate.

Inadequate Allowances
Housing allowance for doctors at MOH remains a paltry GY$600. According to the table provided by MOH letter, even interns at GPHC do not receive a housing allowance. Therefore, according to the table, there is a gross discrepancy ($19,400-$34,400) with that of MoH vs GPHC doctors, which receive an inadequate $20,000-$35,000 in today’s housing market.
b. Meal allowance is $500.
c. Transportation allowance is $3,500 per month.
d. Institutional allowance is $1,500 per month.
The attached Memorandum from Regional Health Services on the subject “All doctors are required to do on-call” states, “health center doctors are required to support their colleagues by doing 10 on-call sessions monthly.” This refutes the challenge by the Ministry to demonstrate health center doctors do not work on weekends, or work beyond the regular working hours. The news media is free to contact doctors working at Skeldon, New Amsterdam, Fort Wellington and Port Mourant, to name a few.
Additionally, while it is erroneous to state, “For most doctors, on their on-call days, they are never called out”, the fact remains they are on duty for that period, and must be compensated at the legal hourly rate.
This administration indeed adjusted the salaries of healthcare workers. However, all those adjustments were done outside of the legal framework of the Trade Union Recognition Act 98:07 Article 23(1), which speaks to negotiation in good faith and collective bargaining with a recognized union. As a result, complications developed where a Junior Department Sister who is senior to a Ward Sister earns more. Also, Staff Nurses whose salary was above Midwives because of qualifications now receive the same salary as midwives.
Additionally, staff such as clinical instructors and tutors did not benefit from increases.
The Ministry of Labour must look into the irregularities concerning the “on-call” situation of doctors and the lack of collective bargaining to regularize labour practices as they have done with other entities. Let us not deny these are real grievances which affect job satisfaction and performance, which ultimately impact the quality of health care delivered to our fellow citizens. At a time when there is a noble vision to create a world-class health care system fitted with new state-of-the-art facilities, all hands should be on deck to ensure our human resources are treated fairly according to the law, in order to create the environment for the success of that vision.

Sincerely,
Doctors standing in
solidarity with MP