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SLMC 100 years on: Are people’s concerns being heard?

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The Sri Lanka Medical Council (SLMC) is “a statutory body established for the purpose of protecting health care seekers by ensuring the maintenance of academic and professional standards, discipline and ethical practice by health professionals who are registered with it.” Speaking at the centenary celebrations of the SLMC held recently, Justice of the Supreme Court Yasantha Kodagoda called for the SLMC to perform its primary role of regulating the health professions more effectively. In particular, the Justice drew attention to certain gaps in the SLMC’s investigative and inquisitorial procedures for malpractice, and suggested that the SLMC address these problems in the forthcoming reforms to the Medical Ordinance.

Current complaint procedure

The SLMC is empowered to inquire into complaints lodged against any practitioner registered with it. Based on details available on the SLMC website, the procedure requires that the complainant lodge their complaint “by way of a letter addressed to the Registrar along with an affidavit stating facts/matters alleged against the medical practitioner/s.” On receiving a complaint, the Council decides whether there is an ex-facie case of professional misconduct, negligence, or incapacity relating to professional duties, and if there is, places the complaint before the Preliminary Proceedings Committee (PPC).

The complainant(s) and the accused practitioners must appear before the PPC whose mandate is to conduct a fact-finding inquiry and submit its findings to the President of the SLMC, who chairs the Professional Conduct Committee (PCC). This second committee then determines whether a Professional Conduct Inquiry is needed. If the inquiry proceeds, the committee considers the evidence submitted and determines whether the charges have been proven. The outcome of this second inquiry could be one of three: exoneration from charges, temporary suspension, or erasure from the register. The SLMC’s Annual Report 2023 shows that 24 inquiries were initiated before the PPC that year, and 15 of them were referred to the PCC. Of them, 10 were dismissed, and a professional penalty was imposed only in one case.

Justice Kodagoda’s recommendations

According to the Justice, the SLMC is perceived by the public to take a “protectionist” approach that favours medical professionals. As the SLMC’s function is quasi-judicial (i.e. it can function like a court), the Justice emphasized the importance of the SLMC remaining “equidistant” from the medical profession and the public, especially in its investigation of medical malpractice. Addressing the latter, the Justice proposed reforms in four areas for the SLMC to consider in the ongoing Medical Ordinance reform process: 1) Enhancing procedural integrity; 2) Strengthening neutrality and representation; 3) Ensuring compliance with timelines and transparency; and 4) Modernizing sanctions and corrective measures.

With respect to the SLMC’s inquiry procedure, the Justice proposed extending the SLMC’s mandate from investigating complaints formally lodged against individual members to also conducting inquiries based on credible information in the media and other public reports. To facilitate this reform, he suggested setting up a ‘Complaints Secretariat’ that is independent from the Council. The Justice also recommended establishing an investigations unit with professionals qualified in conducting investigations and emphasized the importance of the unit involving suitably qualified independent persons representing other professions. Lastly, in relation to the inquiry procedure, the Justice proposed instituting an “independent and in-house prosecutorial authority” to conduct prosecutions on the SLMC’s behalf.

Second, to enhance neutrality and representation, Justice Kodagoda, highlighted the need for investigation panels to include independent and non-elected professionals representing other professions (at present these Committees comprise only medical professionals). Third, he recommended instituting fixed time lines for inquiries and making information available on the progress of inquiries. Finally, under sanctions and corrective measures, apart from temporary suspension and erasure from the register, the Justice proposed empowering the SLMC to: name and shame where appropriate; issue written warnings; impose mandatory requirements to participate in continuous professional development (CPD) programs; and impose compensation orders to victims (at present, the SLMC does not award compensation, which means the complainant must seek redress in courts of law).

What’s missing?

Justice Kodagoda’s talk resonated with me personally, as it must have for many in the audience, based on our encounters with the health system. Based on my experience, however, the problems lie deeper than could be addressed through a strengthened inquiry process—which is also much needed.

Whether at public or private hospitals, most patients know very little about what is happening to them, the tests and interventions carried out on their bodies, their treatments and their possible side effects and complications. Patient records are usually not accessible to patients and it is very difficult to access information through health care providers. Consent is usually assumed and when taken, rudimentary. Breaches of privacy and confidentiality are common. When families make inquiries about patients, they often face the ire of health care providers, unless one has a ‘connection’ with one of them. The sorry state at public hospitals is blamed on resource constraints, which are real, but the situation is not very different in the private sector. There is very little we, the public, can do, other than submit a complaint to the Director General of Health Services or the Private Health Sector Regulatory Council as the case may be. The public is not informed of the outcomes of investigations or inquiries following such complaints.

What kinds of professional misconduct does the SLMC consider? The ‘Sri Lanka Medical Council Instructions on Serious Professional Misconduct to Medical Practitioners and Dentists’ recognizes professional misconduct in the following areas: 1) Neglect or disregard by doctors of their professional responsibilities to their patients for their care and treatment; 2) Abuse of professional privileges or skills; 3) Derogatory professional conduct; 4) Advertising, canvassing and related offences; 5) Comment on professional colleagues; and 6) Any other act of commission or omission deemed as unacceptable to the disciplinary committees of the Medical Council. But the SLMC’s complaint procedure requires submission of concrete evidence of professional misconduct/negligence/incapacity relating to professional duties. How does one submit evidence of violations of autonomy, consent and privacy and confidentiality, for instance? What kind of evidence would be admissible when consent could be assumed to be implied?

In reality, there is no effective mechanism to ensure compliance with the SLMC’s ethical and professional guidelines, except when there are clear breaches, for instance, the absence of written consent or the failure to administer a treatment when indicated. Furthermore, there is very little discussion about the professional misconduct of nurses, midwives, attendants and other allied health professionals? Healthcare providers hold unaccountable power and we are at their mercy when we enter a hospital or healthcare facility. Service delivery is also paralyzed by professional hierarchies, rivalries, competition for private practice, etc. Ironically, in its Guidelines on Ethical Conduct, the SLMC warns its membership that concerns have been “consistently raised by members of the public as well as the more discerning members of the profession,” but rejects any responsibility for such incidents “given the limitations placed by statute on our authority and responsibilities by the existing medical ordinance.”

As Justice Kodagoda points out, the Medical Ordinance needs reform with due consideration to the public’s concerns. What we need is a National Health Commission, similar to the soon-to-be-formed National Commission for Women under the Women Empowerment Act no. 37 of 2024. The Women’s Commission will have the power to investigate infringements of women’s rights, receive public complaints and conduct public inquiries. Patients and their families should have a similar mechanism that is independent from the Ministry of Health. Many countries do have independent patient advocacy or ombudsman services in place. In the United Kingdom, advocacy services support patients to navigate the NHS complaints procedure. In Australia, there is an independent Health Complaints Commissioner. Thailand has a complaints mechanism through its National Health Security Office, which is independent from the Ministry of Public Health. These avenues for redress include civil society representation.

What should we do?

As Justice Kodagoda stated, the public has very little faith in the SLMC’s long drawn complaint procedures. Even medical professionals who attempt to seek redress through them do not get very far. The medical professionals who sit on the SLMC’s inquiry committees hold too much sway over outcomes, and the Minister of Health problematically has the final say on appeals. Even if one chooses to go through the complaint procedure, which many are reluctant to do fearing consequences to their care, there is no guarantee that justice would prevail, not only at the level of the SLMC but also through the sluggish legal system. There is a critical need for alternative mechanisms for redress that are independent and located outside the SLMC. People’s collectives and public watchdog mechanisms could help. Given the prevailing situation, the demand for greater accountability, long overdue, will come from the people.

(Ramya Kumar teaches public health at the University of Jaffna, but writes as a concerned citizen here)

by Ramya Kumar ✍️



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Silence of the majority keeps West Asian conflict raging

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Pope Leo the XIVth / President Donald Trump

With no military quick-fix in sight to the ongoing, convoluted West Asian conflict it ought to be clear to the rationally inclined that there is no other way to a solution to the blood-letting other than through a negotiated one. Unfortunately, there are not many takers the world over for such an approach.

Consequently the war rages on incurring the gravest human costs to all relevant sides. Whereas it should be obvious to the Trump administration that Iran wouldn’t be backing down any time soon from its position of taking on the US frontally and with the required military competence in the Hormuz Strait and adjacent regions, the US demonstrates a stubbornness to persist with war strategies that are showing no quick, positive results on the ground.

Clearly, the virtual ‘lock down within a lock down’ situation in the Strait is not proving beneficial for either party. Instead, the spilling of civilian blood in particular continues with unsettling regularity along with an all-encompassing economic crisis that carries a staggering material toll for ordinary people all over the world.

From this viewpoint it is commendable for Pakistan to offer itself as a peace mediator and go ‘the extra mile’ to keep the principal parties engaged in some sort of negotiatory process. But its efforts need to win greater support from the world community. It is a time for peace-makers the world over to stand up and be counted.

It is also a time for straight-talking. To his glowing credit Pope Leo XIV is doing just that and he is the only religious head worldwide to do so. Very rightly he has called on President Trump to end the war through negotiations and described it as ‘unjust’ and ‘a scandal to humanity’.

May this crucial cause be taken up by more and more world leaders, is this columnist’s wish. Instead of speaking fatalistically about a ‘Third World War’, decision and policy makers and commentators, and these are found in plenty in Sri Lanka as well, would do better to help in drumming-up support for a peaceful solution and the latter is within the realms of the possible.

Incidentally, the commonplace definition of the phrase ‘World War’ is quite contentious and it would be premature to speak forebodingly about one right now. The fissures within the West on the Middle East conflict alone rule out the possibility of a ‘World War’ occurring any time soon.

Instead, it would be preferable for the international community, under the aegis of the UN, to take the ‘straight and narrow’ path to a peaceful solution. As implied, this path is no easy avenue; it is cluttered with obstacles that only doughty peace makers could take on and clear.

However, the path to a negotiated peace is worth taking and no less a power than the US should know this. After all, the US ‘bled white’ in Vietnam and had to bow out of the conflict, realizing the futility of pursuing a military solution. A similar lesson should have been learned by Russia which bled futilely in Afghanistan. It too is in an unwinnable situation in Ukraine.

The Pope’s observations to President Trump on negotiating peace have earned for him some snarls and growls of criticism but with time these critics would realize that peace could come only by peaceful means and not through ‘the barrel of a gun.’

For far too long the ‘silent majority’ of the world has allowed politicians to take the sole initiative on working towards peaceful solutions to conflicts and wars. As could be seen, the results have been disastrous. The majority of politicians speak the language of Realpolitik only and this tendency runs contrary to the ways of the selfless peace maker.

Power, which is the essence of Realpolitik, and peace are generally at loggerheads in the real world. Power and self-aggrandizement have to be shelved in the pursuit of durable peace anywhere and it is a pity that the likes of Donald Trump and his team are yet to realize this.

At this juncture the ‘peace constituency’ or the silent majority would need to take centre stage and play their rightful role as the ‘Conscience of the World’. If the latter begins to take on the cause of peace in earnest everywhere, the politicians would have no choice but to pay heed to their cause and take it up, since a contrary course would earn for them public displeasure and votes.

An immediate challenge would be for the ‘peace constituency’ to come together and act as one. Right now, such a coordinating role could be played effectively by only the UN and its agencies. Practical problems are likely to get in the way but these need to be managed insightfully and resourcefully by all stakeholders to peace.

In fact the time couldn’t be more appropriate for the backers of peace to come together and work as one. Right now, economic pressures are increasing worldwide and no less a public than that in the US is beginning to feel them in a major, crushing way.

Going ahead the US public, along with other polities, would find the economic consequences of war to be intolerable. There would be no choice but for governments and peoples to champion peace. Peace makers would need to ‘strike while the iron is hot.’

The success of the above endeavours hinges on the importance humans attach to their consciences. The danger about prolonged wars is that they deaden consciences; particularly those of politicians. The latter deaden their consciences to the extent that they prove impervious to the pain and suffering wars incur.

Thus, the ‘peace constituency’ has its work cut out; it cannot rest assured that politicians would prove sensitive to their demands. The latter would need to be constantly dinned into the hearts and minds of politicians and decision-makers if peaceful solutions to conflicts are to be arrived at.

Likewise, the publics of war-torn countries would need to demand the activation and sustaining of accountability processes with regard to those sections that are suspected of committing war crimes and like atrocities. Those publics that cease to demand accountability from powerful sections among them which are faced with war-time atrocity charges are as good as condemning themselves to lives of permanent dis-empowerment and enslavement.

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Don’t take the baby: In the quiet night, mother always returns

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Grey Slender Loris

Chaminda Jayasekara

There is a particular stillness in Sri Lanka’s forests, after dusk — a kind of hushed expectancy where shadows lengthen, cicadas soften their chorus, and the night begins to breathe in its own rhythm. It is a world that does not reveal itself easily. You have to wait for it. You have to listen.

And then, suddenly, you see them — a pair of luminous, unblinking eyes suspended in the dark.

The Grey Slender Loris, or unahapuluwa, emerges, not with drama, but with quiet precision. Small, slow-moving, and almost impossibly delicate, it is one of Sri Lanka’s most enigmatic nocturnal primates — a creature that has survived millennia by mastering the art of stillness.

Yet, during these months — from late March through July — the forests hold a more tender story. It is the breeding season of the slender loris, and with it comes a scene that is often misunderstood by those who encounter it for the first time: a tiny infant, alone on a branch, barely three inches long, its fragile body silhouetted against the night.

Grey Slender Loris with twin babies

To many, it appears to be a moment of abandonment.

To nature, it is a moment of trust.

“People often act out of compassion, but without understanding what they are seeing,” explains Chaminda Jayasekara of the University of Hertfordshire. “A baby loris left alone is not necessarily in danger. In fact, it is part of a natural process that is critical for its survival.”

According to Jayasekara, when a baby loris is about a month old, the mother begins a remarkable routine. As darkness settles, she gently places her infant on a secure branch and moves off into the forest to forage. Her journey can take her hundreds of metres away — sometimes close to 800 metres — as she searches for insects and other small prey.

In those hours of solitude, the infant is not abandoned. It is learning.

Clinging to the branch, it begins to explore its immediate surroundings. Tentatively, almost hesitantly, it reaches out — testing balance, grip, and instinct. It may attempt to catch tiny insects, mimicking behaviours it will one day rely on entirely. This is its first classroom, and the forest its only teacher.

“Those early nights are crucial,” Jayasekara says. “The baby is developing motor skills, coordination, and the ability to interact with its environment. These are things that cannot be replicated in captivity.”

And yet, this is precisely where human intervention often disrupts the process.

Across rural and even semi-urban Sri Lanka, stories circulate of well-meaning individuals who come across a lone baby loris and assume the worst. Driven by concern, they pick it up, take it home, or attempt to hand-rear it — believing they are saving a life.

Grey Slender Loris

But the reality is far more complex — and far more tragic.

“When a baby is removed unnecessarily, it loses something fundamental,” Jayasekara emphasises. “It loses the chance to learn how to survive in the wild. Without that, even if it survives in the short term, its long-term prospects are extremely poor.”

The forest, after all, is not just a habitat. It is a living, evolving system of lessons — how to detect predators, how to navigate branches, how to hunt silently, how to recognise territory. These are not instincts alone; they are behaviours refined through experience.

And the mother, contrary to assumption, is rarely far away.

“If people simply waited — even for several hours — they would often see the mother return,” Jayasekara explains. “She knows exactly where she left her baby. Her absence is temporary, purposeful.”

The advice from conservationists is clear and consistent: observe, but do not interfere.

If you encounter a baby loris, watch quietly from a distance. Avoid using bright lights or making noise. Give it time — at least 10 to 12 hours — before drawing conclusions. In most cases, the situation will resolve itself, just as nature intended.

35 days old Grey Slender Loris

Only if the animal is clearly injured, or if there is strong evidence of abandonment after prolonged observation, should intervention be considered — and even then, it must be done through the proper channels, particularly the Department of Wildlife Conservation.

Attempting to care for such a delicate animal at home is not only ineffective but often fatal.

Sri Lanka is home to two species of slender loris — the Grey Slender Loris and the Red Slender Loris — each adapted to specific ecological zones across the island. Both are protected under national legislation and recognised internationally as species requiring urgent conservation attention.

Their threats are many: habitat loss, road mortality, illegal pet trade, and, increasingly, human misunderstanding.

Yet, in the midst of these challenges, there are also signs of hope.

In recent years, the slender loris has become the focus of a unique form of wildlife tourism — one that values patience over spectacle. Night walks, conducted with trained naturalists and strict ethical guidelines, offer visitors a chance to witness the loris in its natural environment without disturbing its behaviour.

At places like Jetwing Vil Uyana, this approach has been refined into a model of responsible eco-tourism. Over more than a decade, the property has developed a dedicated Loris Conservation Project, recording thousands of sightings while educating visitors and supporting local communities.

Here, the loris is not handled, chased, or exploited. It is simply observed — a quiet presence in a carefully protected landscape.

“The success of such initiatives shows that conservation and tourism do not have to be at odds,” Jayasekara reflects. “When done responsibly, tourism can actually support conservation by creating awareness and value for these species.”

There is something profoundly moving about encountering a loris in the wild. It does not roar or charge. It does not demand attention. Instead, it exists — quietly, deliberately — as it has for millions of years.

And perhaps that is why it is so easily misunderstood.

In a world that often equates visibility with importance, the loris reminds us that some of the most extraordinary lives unfold beyond the spotlight.

It also reminds us of something else — something simpler, yet harder to practice.

Restraint.

Because conservation is not always about stepping in. Sometimes, it is about stepping back. About recognising when nature does not need our help, but our patience.

So if, on some future night, you find yourself walking beneath the trees, and your light catches a tiny figure sitting alone on a branch — do not rush forward.

Pause.
Watch.
Let the moment unfold.

Because somewhere, moving silently through the darkness, guided by instinct and memory, a mother is already on her way back.

And by morning, the forest will be whole again.

 

By Ifham Nizam

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Kumar de Silva: 40 years of fame and flair

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Kumar de Silva: The four-decade journey

We first saw him on the small screen in January 1986 – a relatively raw, totally untrained and a very nervous 24-year-old presenting ‘Bonsoir’ on ITN.

And now, 40 years later, and as one looks back, one realises what a multi-dimensional journey Kumar de Silva has navigated across the small screen yes, from your television screens to your laptops, and iPads, tabs, and mobile phones.

Says Kumar: “It is the French language I speak that opened the world of television to me, 40 years ago. It was ‘Bonsoir’ alone, and so to my French teacher at Wesley College, Mrs. BA Fernando, to ‘Bonsoir’, and to the Embassy of France in Sri Lanka, I am eternally grateful”.

Promoting the French language, and culture, in Sri Lanka, in a big way

Kumar went on to say that on the heels of ‘Bonsoir” came ‘Fanclub’, on ITN, describing it as yet another resounding success story which saw him as a music DJ on TV.

His inherent talent saw him handle a range of contrasting programmes across ITN, TNL, Prime TV and SLRC with consummate ease – from News Reading, Business Talk Shows, Celebrity Chats, to Dhamma discussions, on Poya Days, to name a few.

Kumar – the 1986 look

Trained in Paris in television production and presentation, the Government of France, in 2012, conferred on him the title of ‘Chevalier dans l’Ordre des Arts et Lettres’ (Chevalier in the Order of Arts and Letters) in recognition of his contribution to promoting the French language, and culture, in Sri Lanka.

In celebration of his four decades on the small screen, Kumar recently launched ‘Bonsoir Katha’, the Sinhala translation (by Ciara Mendis) of his English book ‘Bonsoir Diaries’ (2013), at a gala soiree. at the Alliance Francaise de Colombo, under the distinguished patronage of the French Ambassador in Sri Lanka, Remi Lambert, and francophone President Chandrika Kumaratunga.

He’s now excited about launching the French version of this book, ‘Les Coulisses de Bonsoir’, in Paris, in autumn this year. It is currently being translated by Guilhem Beugnon, a former Deputy Director of the Alliance Francaise de Colombo. This will, co-incidentally, also be Kumar’s 30th visit to Paris.

Chief Guest French Ambassador in Sri
Lanka Remi Lambert

Says Kumar: “The word GRATITUDE means a lot to me and so I always make it a point to spend time with two very special French people every time I go to France. One is Madame Josiane Thureau, formerly of the French Foreign Ministry, who began ‘Bonsoir’ in Sri Lanka. way back in the mid-1980s. The other is Madame Aline Berengier, the lady who designed the ‘Bonsoir’ logo – the Sri Lankan elephant in the colours of the French national flag”.

Kumar is also a much-sought-after Personal Development and Corporate Etiquette Coach in Colombo’s corporate world. Over the past 15 years, tens of thousands of corporates, have been through the different modules of his interactive training sessions. There have also been thousands of school leavers and undergraduates from national and private universities, many of whom will constitute the corporates of tomorrow.

Guest of Honour francophone President Chandrika Kumaratunga at the gala soiree
at the Alliance Francaise de Colombo

The multi-talented Kumar turns 65 next year, and his journey on the small screen still continues – you see him on the (monthly) ‘Rendez-Vous with Yasmin and Kumar’ on the French Embassy’s YouTube Channel, and (every Friday) on ‘Fame Game with Rozanne and Kumar’ on Daily Mirror Online, Hi Online and The Sun Online.

There’s yet another podcast in the pipeline, he indicated, but diplomatically declined to give us details. All he said, with a glint in his eye, was, “It will hit your screens soon.”

Whatever he has in mind, one can be certain that the new programme will continue to showcase Kumar de Silva’s enduring presence in Sri Lanka’s entertainment scene.

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