Opinion
Paediatrics: At some time in the past, I absolutely hated it!

By Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
This must surely be quite a resounding bombshell—from the computer keyboard of a Specialist Consultant Paediatrician. What I have written in this article is most definitely from the past, quite a bit of it from over 50 years ago. I have to qualify the title of this article with the caveat that it should not be misinterpreted as hating children. I loved children with no reservations whatsoever, and still do. Witnesses to that statement are my daughter, three grandchildren, a large number of nieces and nephews, and even grandnieces and grandnephews as well as a very large cohort of little ones that I have seen and treated over many a decade. I have unconditionally loved children; period. Now then, one might wonder, quite justifiably perhaps, what on earth is this character talking about? How is it that the word ‘hate’ has come into the picture?
The term “Paediatrician”, is derived from two Greek words; pais meaning “child” and iatros meaning “healer”. Paediatrics is the science, which deals with the medical care of infants, children, and adolescents. Child healthcare has a legacy as old as any other constituent of medicine. It is also held in the highest esteem because of the notion that children are the jewels of our future, and consequently, their health and well-being are a matter of broad social concern. Of course, if you are a healer of children, you cannot hate children!
At the very outset, I have to explain why I hated paediatrics over five decades ago. At that time, as a late-teenaged medical student and a young junior doctor, I had the bitter experience of seeing scores of children succumbing to many different diseases for which we had very few answers. At the Lady Ridgeway Hospital for Children, it was not an uncommon sight to see bodies of innocent little children being wheeled out of the wards as a regular occurrence. As a young man, I could not come to terms with these frightening manifestations of a branch of medicine which was somewhat unsuccessful in saving children. Hence the intense dislike for paediatrics and a firm determination to avoid getting into the field of paediatrics at any cost.
In that era, the newborn death rate was around 40 per 1000 live births, meaning around 40 newborns out of 1000 did not live beyond 28 days. The Infant Mortality Rate was around 55 per 1000 live births, meaning 55 of 1000 did not reach their first birthday and the Under 5-year Mortality rate was around 70 per 1000 live births meaning 70 out of 1000 live births did not survive up to their 5th birthday. These were horrendous statistics that accounted for significant numbers of child deaths, year in and year out. What killed these children were prematurity, congenital defects including heart malformations, many types of major infectious diseases, malnutrition, acquired heart problems, accidents, and a whole host of a multiplicity of other childhood maladies. To make matters worse, some diseases that affected the brain and others like polio which affected the peripheral nervous system, left the afflicted children maimed for life with cruel disabilities. As a medical student and a young junior doctor, I felt helpless in not being able to do something, or anything worthwhile at all, to try and stem the tide and the slide. Hence my intense dislike for paediatrics. I desperately wanted to be a Consultant Physician who treats adults. At that time, it was quite a glamorous speciality.
Yet for all this, destiny dictated otherwise. I was forced to do paediatrics for the second six months of the internship. I went to work as a very junior House Officer at the Lady Ridgeway Hospital for Children and quite honestly took up that position with the greatest reluctance and very serious concerns about my abilities to treat children. It was extremely hard work as large numbers of children were admitted to the ward with all kinds of diseases. It was a matter of working day and night, even foregoing meals, to try and save children.
As time went by, something struck me very strongly and ever so forcefully as well, while working with children. Of course, the deaths were there and that was the worst scenario that one could ever imagine. But there were a considerable number of children who recovered and went home as well. We managed to even save many desperately ill children. We were sending back those who recovered, into a full life of many decades to be spent as useful citizens of our Motherland.
As it happened, when you work with children, they kind of ‘grow on you’. At the end of my internship, my feelings towards paediatrics were a bit mollified and somewhat neutral. At the end of the internship, fate decreed for me to be posted to the Out-Patients Department of the Lady Ridgeway Hospital for Children as a Medical Officer in the OPD. That was a most rewarding experience as we treated and cured quite a large number of children who came with various illnesses to be treated in the OPD. By the end of one year in the OPD, I had secured a postgraduate qualification that enabled me to get a position in the Faculty of Medicine of the University of Peradeniya. I spent a year there doing adult medicine and teaching pharmacology.
At the end of that year, as was decreed ever so firmly by providence, I applied for a position and came back to the Lady Ridgeway Hospital for Children as a Paediatric Registrar, the second-in-command of a Children’s Ward. By that time the die had been cast; firmly and forever more. I was going into a lifetime career in paediatrics and there was no turning back from then onwards. A 3-year training period in the UK ensued where I did adult medicine simply because the mandatory MRCP examination was in adult medicine. Then I came back to Sri Lanka and at the rather early age of 31 years, I was posted as the Specialist Consultant Paediatrician to General Hospital Badulla; the only paediatrician for 70 to 80 kilometres around. I was thrown unceremoniously, into the deep end.
The rest is history. Over a stint as a Consultant Paediatrician spanning 46 years, right up to the present time, I have seen it all. I served in Badulla, Ratnapura, Kurunegala and Colombo. More than anything, I have seen the tremendous advances made by the incessant forward march of child healthcare. We are now able to handle quite successfully a lot of the diseases that killed children 50 years ago. Many of the killer infectious diseases are practically eliminated from our country. Loads of congenital malformations including major heart problems are now being effectively treated. We save many lives of children who would have succumbed to all those major diseases just 50 years ago. Many people do not believe it but the Cardinal Health Statistics of Sri Lankan children are now on par with the developed Western World. Currently, the newborn mortality rate is around 4 per 1000 live births, the infant mortality rate is around 7 per 1000 live births and the under 5-year mortality rate is around 6.5 per 1000 live births; ALL IN SINGLE DIGITS. When compared to the really high values of the 1960s and 1970s, the extremely significant fall of these parameters is nothing but miraculous. People all over the entire world are really in wonder about this little island nation which has achieved so much with so few resources
The success story of paediatrics in Sri Lanka is not only due to the dedication and clinical acumen of Consultant Paediatricians but also to the untiring efforts of all other grades of child healthcare staff, in hospitals as well as in the field over many a grassroots level. The way the paediatric scenario has developed in Sri Lanka is most definitely due to a team effort of absolute splendour. We now see only very few deaths of children in our hospitals. We have collectively turned the tide for the better.
As for me, to have worked in and given my all in a branch of medicine that I originally tried hard to avoid, practically loathed and intensely detested, is perhaps the kind of thing that dreams are made of. It has very definitely warmed the cockles of my heart to be a witness to the vast strides that have been made in child healthcare over the last few decades. Today, to see a little child recovering and going home is akin to a precious gift that nothing else could even remotely match. My attitude and perceptions towards child healthcare have gone through a complete 180-degree swing, quite early in my career as a practising doctor. For me, quite thankfully and over the years, the practice of paediatrics has become not only a matter of doing what I love, but most clearly and persistently loving what I do; daily. I believe that I have adequately given back to this country, even more than what I owe, for the most beautiful things that it has given me, including free education.
Opinion
HW Cave saw Nanu Oya – Nuwara rail track as “exquisite”

Plans to resurrect the Nanu Oya – Nuwara Eliya rail track are welcome. The magnificent views from the train have been described by H W Cave in his book The Ceylon Government Railway (1910):
‘The pass by which Nuwara Eliya is reached is one of the most exquisite things in Ceylon. In traversing its length, the line makes a further ascent of one thousand feet in six miles. The curves and windings necessary to accomplish this are the most intricate on the whole railway and frequently have a radius of only eighty feet. On the right side of the deep mountain gorge we ascend amongst the tea bushes of the Edinburgh estate, and at length emerge upon a road, which the line shares with the cart traffic for about a mile. In the depths of the defile flows the Nanuoya river, foaming amongst huge boulders of rock that have descended from the sides of the mountains, and bordered by tree ferns, innumerable and brilliant trees of the primeval forest which clothe the face of the heights. In this land of no seasons their stages of growth are denoted by the varying tints of scarlet, gold, crimson, sallow green, and most strikingly of all, a rich claret colour, the chief glory of the Keena tree’.
However, as in colonial times, the railway should be available for both tourists and locals so that splendid vista can be enjoyed by all.
Dr R P Fernando
Epsom,
UK
Opinion
LG polls, what a waste of money!

If the people of this country were asked whether they want elections to the local government, majority of them would say no! How many years have elapsed since the local councils became defunct? And did not the country function without these councils that were labelled as ‘white elephants’?
If the present government’s wish is to do the will of the people, they should reconsider having local government elections. This way the government will not only save a considerable amount of money on holding elections, but also save even a greater amount by not having to maintain these local councils, which have become a bane on the country’s economy.
One would hope that the country will be able to get rid of these local councils and revert back to the days of having competent Government Agents and a team of dedicated government officials been tasked with the responsibility of attending to the needs of the people in those areas.
M. Joseph A. Nihal Perera
Opinion
What not to do

By Dr Upul Wijayawardhana
It is immaterial whether you like him or not but one thing is crystal clear; Donald Trump has shown, very clearly, who is the boss. Surely, presidents of two countries are equal; perhaps, that is the impression Volodymyr Zelensky had when he went to the White House to meet Trump but the hard reality, otherwise, would have dawned on him with his inglorious exit! True, the behaviour of President Trump and VP Vance were hardly praiseworthy but Zelensky did what exactly he should not do. Afterall, he was on a begging mission and beggars cannot be choosers! He behaved like professional beggars in Colombo who throw money back when you give a small amount!!
Despite the risk of belonging to the minority, perhaps of non-Americans, I must say that I quite like Trump and admire him as a straight-talking politician. He keeps to his words; however atrocious they sound! Unfortunately, most critics overlook the fact that what Trump is doing is exactly what he pledged during his election campaign and that the American voters elected him decisively. When he lost to Biden, all political commentators wrote him off, more so because of his refusal to admit defeat and non-condemnation of his supporters who rioted. When he announced his intention to contest, it only evoked pundits’ laughter as they concluded that the Republican Party would never nominate him. Undaunted, Trump got the party to rally round him and won a non-consecutive second term; a feat achieved only once before, by Grover Cleveland around the end of the nineteenth century. His victory, against all predictions, was more decisive as he got more collegiate votes and, even though it does not matter, won the popular vote too which he did not get when he got elected the first term. Even his bitterest critics should accept this fact.
Zelensky was elected the president of Ukraine after the elected pro-Soviet president was deposed by a ‘peoples revolution’ engineered by the EU with the support of USA. After this, the EU attempted to bring Ukraine to NATO, disregarding the Munich agreement which precipitated the Russian invasion. He should have realised that, if not for the air-defence system which Trump authorised for Ukraine during his first term, Russian invasion would have been complete. It may well be that he was not aware as when this happened Zelensky may still have been the comedian acting the part of the president! Very likely, Trump was referring to this when he accused Zelensky of being ungrateful.
Zelensky also should have remembered that he disregarded requests from Trump, after his defeat by Biden, to implicate Biden’s son in some shady deals in Ukraine and that one of the last acts of Biden was to pardon his son and grant immunity to cover the alleged period. Perhaps, actions of the European leaders who embrace him every time they see him, as a long-lost brother, and invitations to address their parliaments has induced an element of the superiority complex in Zelensky that he behaved so combative.
Trump wanted to be the mediator to stop the war and spoke to Putin first. Instead of waiting for Trump to speak to him, egged on by EU leaders Zelensky started criticising Trump for not involving him in the talks. His remark “He should be on our side” demonstrated clearly that Zelensky had not understood the role of a mediator. His lack of political experience was the major reason for the fiasco in the White House and the subsequent actions of Trump clearly showed Zelensky where he stands! PM Starmer and President Macron seem to have given some sensible advice and he seems to be eating humble pie. In the process Trump has ensured that the European nations pay for their defence than piggy-backing on the US, which I am sure would please the American voter. By the way, though Macron talks big about defence France spends less than 2% of GDP. Trump seems vindicated. Of course, Trump could be blamed for being undiplomatic but he can afford to be as he has the upper hand!

Ranil on Al Jazeera
Zelensky has shown what not to do: instead of being diplomatic being aggressive when you need favours! Meanwhile, Ranil has shown what not to do when it comes to TV interviews. God only knows who advised him, and why, for him to go ‘Head to Head’ with Mehdi Hasan on Al-Jazeera. Perhaps, he wanted to broadcast to the world that he was the saviour of Sri Lanka! The experienced politician he is, one would have expected Ranil to realise that he would be questioned about his role in making Sri Lanka bankrupt as well, in addition to raising other issues.
The interview itself was far from head to head; more likely heads to head! It turned out to be an inquisition by Tiger supporters and the only person who spoke sense being Niraj Deva, who demonstrated his maturity by being involved in British and EU politics. The worst was the compere who seems keen to listen his own voice, reminding me of a Sinhala interviewer on a YouTube channel whose interviews I have stopped watching!
Ranil claims, after the interview was broadcast, that it had been heavily edited reduced from a two-hour recording. Surely, despite whatever reason he agreed to, he should have laid ground rules. He could have insisted on unedited broadcast or his approval before broadcast, if it was edited. It was very naïve of Ranil to have walked in to a trap for no gain. Though his performance was not as bad as widely reported, he should have been more composed at the beginning as he turned out to be later. Overall, he gave another opportunity for the Tiger rump and its supporters to bash Sri Lanka, unfortunately.
Medhi Hasan should watch some of David Frost interviews, especially the one with Richard Nixon, and learn how to elicit crucial information in a gentle exploratory manner than shouting with repeated interruptions. He does not seem to think it is necessary to give time for the interviewee to respond to his questions. I will never watch Al-Jazeera’s “Head to Head” again!
Ranil’s best was his parting shot; when asked by Hasan whether he would contest the next presidential election, he said “No, I will retire and watch Al-Jazeera and hope to see you better mannered”!
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