THE LONG READ: Dr Jeevana Subasinghe – How inappropriate behavior and discrimination happen at a health center and higher education in Finland

by , under Enrique Tessieri

For the past four years, Sri Lankan-Finnish dentist Jeevana Subasinghe has experienced multiple forms of inappropriate behavior and discrimination by his employer at the Porvoo Municipal Health Center. But the treatment and discrimination he allegedly claims bring to light a wider systemic problem that affects some Finnish dentists as well.

Dr Subasinghe’s relationship with the Porvoo Municipal Health Center started in 2012. He joined them as a permanent staff member in April 2013 as an orthodontic assistant and a surgery assistant dentist. The appointment was offered due to his experience and professional background. Prior to coming to Finland, he had his own practice in Newbury, Royal County of Berkshire, United Kingdom.

Dr Subashinghe, who has lived on and off in Finland since the 1980s, said that networks are everything in this country. Without them, it is very difficult to advance in a career never mind find employment. Finns have these networks while foreigners don’t have as many.


Dr Jeevana Subasinghe. 

On Wednesday, November 21, 2018, everything came to a head when Dr Subasinghe’s employer terminated his employment. He believes that the decision is wrong, and will challenge it. His last official day at work was January 21, 2019.

According to Dr Subasinghe, the employers of the Porvoo Municipal Health Center have tried to discharge him for the past two years.

A difficult relationship

“My problems with the Porvoo Municipal Health Center started when I wanted to specialize in orthodontics at a time when there was a great need for such specialists at the health center,” he said. “The waiting lists for children at the time were almost three years, or when the best time for correct intervention had passed.”

Dr Subasinghe said that he had approached the chief dentist at the center and asked her about getting orthodontic training at the University of Helsinki.

It is normal in Finland that a part of the specialist training in orthodontics is carried out under health center supervision. Since Dr Subasinghe had worked for seven years treating orthodontic patients in the United Kingdom in collaboration with Göteborg University professionals, he was confident that such training would give him the opportunity to use the latest techniques that would improve and save time in treating patients.

“The need for an orthodontist [at the Porvoo health center] arose from poor planning by the management,” he continued. “There was no replacement plan for the orthodontist that was going to retire soon.”

After he found out that health centers in Vantaa, Riihimäki, Kirkkonummi, Helsinki and others in the Greater Helsinki were arranging in-house specialization programs for dental specialists, Dr Subasinghe decided to approach the chief dentist and requested that he could pursue such training in the Porvoo health center.

At first, the chief dentist appeared surprised by the request, but she agreed only if he arranged everything himself with the University of Helsinki.

The professor of orthodontics at the University of Helsinki agreed that such specialization could be arranged for Dr Subasinghe. The next step was that the request should come from the Porvoo Municipal Health Center, which should provide a supervising specialist orthodontist.

“But to my surprise,” Dr Subasinghe continue, “the chief orthodontist declined to be my supervisor. An even bigger shock came when the health center nominated two young orthodontic assistants immediately after this discussion.”

By nominating the two dentists, one of whom was the chief dentist’s daughter, Dr Subasinghe felt that his professional career was undermined. Even his name as an orthodontic assistant was removed from the health center’s reception list.


 

Dr Subasinghe visited Sri Lanka in December-January where he assisted multiple medical professionals including military plastic surgeons. The experience gave him knowledge in treating geriatric patients. “I can use this new knowledge in my work in Finland,” he said.  

“Thus, I was unilaterally demoted from treating orthodontic patients from two days a week to almost none,” he said. “This was outright discrimination, professionally unfair and would impair my chances of getting into an orthodontic training position in universities. It also deprived  children of treatment by an experienced dentist.”

Dr Subasinghe felt that the treatment by the senior orthodontist of the Porvoo Municipal Health Center was outright discriminative. The feelings of exclusion became already in 2013 when he started to work there and was not given any legal orientation of orthodontics to understand the methodology and coding used in Finland. According to him, there was criticism of his work without scientific merit by putting such claims into documentation in email correspondence with senior health staff members of the center.

Growing unresolved issues

Dr Subasinghe said that reaching and meeting with staff members was sometimes difficult.

“Another problem I noticed was when I tried to approach the chief orthodontist,” he said. “Apart from long waits to meet her, even sometimes being ignored by her, I noticed that the treatment I got from her was different from the treatment given to my Finnish colleagues. I felt discriminated because of my background.”

Dr Subasinghe admitted that during that time he naturally did not enjoy going to work. The chief dentist created baseless complaints about him which contributed to a greater sense of discrimination and stress. The situation caused him to suffer from mental and physical pain. Back pains, high blood pressure, recurring headaches, insomnia and feelings of nausea were some of the symptoms. The shop steward suggested that he asked for a leave of absence due to the situation but it was turned down by the management.

Despite these problems, Dr Subasinghe said that he has always been faithful to his patients. The safety to the patients so far has been immaculate and has no negative remarks in the patient insurance scheme showing 100% safety at his hands as a patient.

On one occasion, Dr Subasinghe approached his boss, the chief dentist, and complained about why they had taken away his orthodontic responsibilities. His boss said that there was nothing she could do about such a matter because she was not responsible for orthodontics at the center.

Considering that the chief dentist would not raise a finger to help him, because her daughter was working at the health center as an orthodontic assistant and aiming for the specialist education, Dr Subasinghe wrote a confidential letter hoping to remedy the situation to the chief dentist’s boss, the chief physician of the Porvoo health center.

He never got a reply from her but the chief physician admitted at a meeting that she had given the confidential letter to the chief dentist.

Training in orthodontics

In 2015, Turku University and Turku Hospital District had one opening for specializing in orthodontics. Apart from Dr Subasinghe, the chief dentist’s daughter and another dentist, who also worked at the Porvoo Municipal Health Centre, applied for the specialist training position.

Both ethnic Finns were invited for interviews but Dr Subasinghe was not contacted even if he had worked at the center as an orthodontic assistant for a longer time than they as well as had many years of experience and training in orthodontics in the United Kingdom. At the time, the two young dentists who were chosen had worked as orthodontic assistants at the health center for only six months.

“I was surprised when I got a letter from Turku Hospital District stating that they had chosen my colleague who had much fewer credits than me,” Dr Subasinghe said. “I was more qualified than her because I had practical and theoretical experience in orthodontics. I had even taken part in scientific experimentations and published in a scientific journal on bone regeneration.”

Not accepting to take the matter sitting down, Dr Subasinghe turned to the Turku district court to appeal the decision by Turku University and Turku Hospital District.

A year and a half later in 2016, after going through a lot of stress, Dr Subasinghe won the appeal in the district court. The Turku University department of orthodontics finally granted him an interview. To his surprise, during this period that he appealed the decision, the daughter of his boss had a position at the orthodontics department of the same university through unknown routes.

“In my opinion, this is a clear case of discrimination and may possibly suggest [alleged] corruption,” said Dr Subasinghe. “Why wasn’t I chosen instead if I had more credits than the two dentists of my health center and one who [allegedly] got in through the back door.”

Despite Dr Subasingheś efforts, nothing changed. The two dentists from Porvoo health center were specializing in orthodontics while he was stuck in the courts appealing again to the Turku district court that the selection process by Turku University and Turku Hospital District did not go through normal rules of selection.

Unfortunately, the Turku district court ruled in favor of the Turku Hospital District. Dr Subasinghe claims that the last ruling by the court is a good example of institutional racism. “Since I’m not an ethnic Finn I am at a disadvantage even in the courts,” he added.

After analyzing the decision by the Turku district court to not give Dr. Subasinghe the opportunity to enter the specialization program, his advisors believe that the district court handed down the wrong ruling.

Since 2017, the case questioning the ruling of the Turku District Court is now at the Helsinki District Court awaiting its decision while one the dentist of the center has finished her training and is working as an orthodontist specialist in Porvoo.

Awaiting a decision 

After the Porvoo Municipal Health Centre terminated Dr Subsinghe’s employment, he had to suddenly leave Finland in December to Sri Lanka to help his father who was critically ill. Dr Subasinghe returned to Finland on the January 18.

So far no decision was made if the termination of his job was legal.

“As with this Turku University and Turku Hospital District ordeal, it’s clear that the termination of my contract hinges on unfair and discriminatory treatment I have received at the health center,” he concluded. “Despite what happened to me, I have received scores of calls and support from my Finnish colleagues and patients. They know this is wrong. Most of them believe that this kind of discriminatory and [alleged] corrupt practices affect the quality of patient care”

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