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Yes indeed, Hippocrates is turning in his grave

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My mind time travelled thirty-seven years to the auditorium, Rahula College, Matara. Being one of the two surgeons at the Base Hospital I was a man in demand whom the service receivers respected. My good lady and I were seated in the VIP row of seats and when the curtain raised there was a man hanging from a lamp post in an ill lit left hand corner of the stage. The narrator was late the H.A.Perera and in his inimitable style and signature voice loudly exclaimed “this man hanging here was the last honest man in the country”. The stage play was Maghatha. This was a satirical play depicting the hight of corruption and lawlessness prevailing at the time.

Sri Lanka even at this moment of time is not any better. There will come a time when honesty and truthfulness would make one disqualified to continue to live here. The country is full of dishonest people. Finding an honest man might well prove an exercise that would put Kisa Gothamie in the shade.

It was Monday the 7th November 2022, a public holiday and I had to visit the NHSL,Colombo to see a man who is a distant relative of ours but more importantly a man who did some excellent salvage job for me to make a brand new bathroom screwed up by the previous workmen, up to scratch again. As a result, in a way, I am indebted to him. Having recently had some Deja vu of the thel polim yugaya, I ventured out to bus and walk the trip which I enjoyed very much as the buses were almost empty.

I got to the hospital all right but finding the ward I needed to visit would have been an uphill task if not for an ex-trainee of mine who is at present a top orthopaedic surgeon at the NHSL, whom I met at the Consultants’ lounge. He said “Sir things are very different compared with the time you were a Consultant here. Even after introducing yourself as an ex senior surgeon the response, you receive might embarrass, frustrate, or even anger you. So let me call the ward” and so he did.

It was a medical ward shared between two consultant physicians. There was an air of busyness about the place because they were probably on acute take. Ward had been partitioned into what they called ‘cubicles’ but they were more like solid rectangles or cuboids. Patients of both consultants seemed haphasardly distributed in each ‘cubicle’. Normally in such situations the responsible Physicians name is displayed on the wall at the head end of the bed. No such name boards were visible in this ward. There were three intern house officers on the ward. They knew which cubicle they were responsible for but would definitely have not known the details of patient distribution in the ward. Apparently, the consultants did independent ward rounds but from what I saw those must be reminiscent of the doctor in the house or doctor on the go series. This arrangement is ideal for the two consultants to take every other day off unofficially. I don’t know whether this happens, but I would be very surprised if it didn’t.

My patient’s ordeal exemplifies the degree of confusion that was prevailing amongst the Medical staff of this ward. He is a 51 year old previously healthy teetotaller building supervisor who was suddenly struck down with an acute coronary ailment six weeks ago. Though there has been some delay he eventually had a stent inserted into one of the main arteries of his heart. After a few days in the cardiology unit, he was discharged with a number of tablets and capsules to swallow on a daily basis. All was good till 04 November, when he developed pain under the rib cage radiating to the back of the chest and up between shoulder blades. For all intent and purposes, it was a cardiac (heart) pain and he should have been admitted to the cardiology ward. Not to be. He was bundled into this medical ward. An ECG done on admission had shown some new changes signifying reduced blood supply to a part of the heart with no biochemical evidence of permanent damage to that part of the heart. The biochemical marker of heart muscle damage is Troponin. Hence this condition is called Troponin negative Acute Coronary Syndrome. The medical team in consultation with the cardiology Registrar has started him on anticoagulants (blood thinners). ECG done next mane was normal. Thank goodness for that. Cardiology Registrar never saw the patient physically. Telemedicine at its peak!

Even after my talking to the Consultants personally who promised that a transfer to cardiology would happen, the patient continued to camp in the medical ward for a few more days before being discharged. The scenario made me feel that the Registrars functioned independently of the consultants or communication between senior and junior medical staff was happening only at a very low ebb. Either way it was a dismal state of affairs. I am not sure whether this patient’s management conforms to the accepted norms currently used in the developed world.

My visit was a little over 24 hours after all this had happened. Thanks to my ex-trainee, current Consultant Orthopaedic surgeon, I was greeted well by the doctor at the front desk who passed me on to the doctor my friend and ex-trainee had spoken to over the phone. She and the doctor in charge of the ‘cubicle’ escorted me to my patient. They were two lovely innocent looking girls who seemed trying to find their way around still.

They were thorough with the patient’s condition but didn’t seem to know much logistics around it. They didn’t know if an official referral had been made to the cardiologist who performed the index procedure. They perused the notes but couldn’t find one. They didn’t know which of the two consultants was on call. No consultant has visited the ward on Sunday. I was there till past midday on Monday (07) and didn’t see any consultant doing a round. My patient told me no consultant had gone round the ward on the whole of Monday too. Apparently, the young sweet innocent doctor was not that innocent, after all. She had made a long scribble in the notes without asking the patient a single question and without examining him at all. What a country and what a department of health services!

My response to the two young ladies was this. “Doctors, as budding consultants please remember these are the most vulnerable of human beings because they are acutely unwell. It is our duty to do our best for them. Always try to recognise an urgent situation and treat it to prevent it becoming an emergency. Public holidays are public holidays in which microorganisms are still active causing infection, blood clots still form on ulcerated plaques inside arteries causing acute arterial insufficiency in different parts of the body including the heart, blood pressures and sugars still keep going up and down unconcerned and a whole lot of other known and unknown pathological processes still go on unrelenting. Hence, if you are rostered for the weekend or the public holiday, please make sure your services are physically available. When I was here at the NHSL about twenty years ago there used to be a weekend and public holiday roster made by a man called Mr. Gamage without whom the director felt crippled. There were no computers and printers installed. A simple cyclostyling machine did the job. All wards, all consultants all clinical and other departments received a copy each. So, everybody knew who was on call. Every on-call consultant did a full ward round in the morning. If an emergency cropped up with one of his patients (rarely the case) needing a re-operation he did it himself without handing it over to the casualty team. Exotic investigations and high-tech interventions may well be needed but not the bread and butter of patient care. Awareness, availability ability and empathy constitute holistic care. Please don’t hold them back. Shower your patient with all of the above and you would be a great doctor”. They listened to me so intently in pin-drop silence that they looked as if they were devotees listening to a sermon delivered by Ven. Narada Thero of Vajiraramaya in the distant past.

Unlike in my active working days, in this day and age, even consultants get paid for extra duty they perform. They do get paid for working on holidays as well. Those who get paid for work they haven’t done are as guilty as those who wilfully robbed the country to drag us into economic doldrums. Also, crimes can be perpetrated by commission or by omission. Those who hold back their services to the sick, when rostered, commit a grave crime by omission specially if the juniors who have been entrusted the boss’s job miss an urgent situation which later becomes an emergency to which the poor patient succumbs.

This is in stark contrast to the time I was a trainee and then a consultant and a trainer. The second half of my internship in 1973 was with a tough boss but a great obstetrician Dr. D. E. Gunatilleke, who was to become the Professor of Obstetrics and Gynaecology, University of Ceylon, Colombo, the following year. We had a post MRCOG (part l) Registrar (called SHO those days) who came down to the De Soysa Hospital for Women to take up the job from being MOH Atakalampanna, an area in the Ratnapura Health District. He was a gentleman par excellence too. Being an inexperienced trainee, he was very worried about taking the lead so I almost became his equal instead of his intern. He used to talk to the boss through me. This was one of our emergency admission days and we had already done four Caesarean sections for the night when we received a patient transferred from the Base Hospital, Horana with the baby lying crosswise and the mum in labour. Baby’s hand has prolapsed into mum’s vagina. Baby was still alive but in distress. My Registrar the late Dr. Shanthan Perera said, “Machan boss has just returned home after doing the fourth section. I don’t feel confident to call him. Could you please help me with this? I readily obliged as I had a great rapport with my boss. I picked up the phone and spoke to him. “Sir I am awfully sorry to bother you at this ungodly hour especially knowing you have just returned home from hospital. We got this young lady whose second pregnancy has been complicated by her going into labour with a transverse lie of the foetus, hand prolapse and foetal distress. I have resuscitated her with intravenous fluids and intermittent boluses of 50% dextrose. She is on oxygen and an indwelling catheter is showing a good urine output. I have got blood cross matched and the theatre is ready” “Don’t worry Janapriya, I will be there in 10 minutes” Lo and behold he was there in little over five minutes––he lived at Rosemead Place––did a Caesarean section and extracted a healthy baby. It was 5 am and the fifth Caesarean section was done and dusted! Time for a cat nap before the next day starts.

Those were the days. If I fall seriously ill, I will use my time machine and go back in time to be treated by one of those doctors and gentlemen. They had no flashy cars. They had no private practice or indeed extra duty payment or holiday pay. They had no CT and other scanners to help them with diagnostic work up. What they had in plenty were knowledge, skill, empathy and duty consciousness. They were honest, worked very hard and placed patient welfare at the pinnacle. Even a physically diminutive figure like the boss of mine I was referring to, stood head and shoulders above self-conceited big burley medical men of today proudly plying around in expensive top of the order automobiles.

It was Lord Moynihan, a pioneer surgeon who, seeing patients with advanced bladder cancer suffer with excruciating pain due to the cancer invading pelvic nerves said, “Lord, if you want to take me please do not take me through my bladder” I have modified this as per below,

Lord, if you want to take me please don’t torture me through the corridors of the hospitals of Sri Lanka, be it state run or privately owned but simply knock me down with a train, a bus, a lorry or a truck. I will accept it with grace and the drivers will go scot-free too.

Dr. M. M. Janapriya



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Opinion

‘Outpost of Empire’

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Review

by Colleen Figg, Editor
and Reviewer – Amazon, New Voices Publishing

“Fernando echoes Macbeth with the line, “There is judgment here.” It captures the question running through the novel: can anyone participate in corruption and remain untouched by it? Beneath this satire is a dark story about power and the danger of believing, that someone else will always pay the price.”

Shavindra Fernando’s Outpost of Empire is a political novel set in the fictional country of Lackadasia. At its heart is a strong idea: an exploration of world politics, terrorism and the ways in which powerful countries manipulate smaller ones. Fernando is clearly writing about political issues that matter deeply to him.

The names immediately establish the book’s satirical character. Lackadasia, Burgherbugaria and the various Klowns suggest a world in which the people and places are exaggerated, but the issues beneath the exaggeration are recognisable. The playful language allows Fernando to approach terrorism, religious conflict and political corruption from an unusual angle.

Henry Stockwell is a central character: an ambassador who arrives in Lackadasia presenting himself as a friend of the country. He believes he understands how power works and treats the country, its politicians and its people as pawns on his personal chessboard. In his arrogance, he never doubts that he controls events rather than being controlled by them. This confidence makes him a compelling figure and in him, we explore the workings of political influence and the potential traps contained therein.

As the story develops, Fernando reveals a political world where causes are adopted when they are useful, people are exploited and discarded, and the truth becomes whatever those in power need it to be. Ordinary people suffer the consequences of decisions made far beyond their reach or knowledge, while those making those decisions continue to justify their actions. Even the people who help keep this world running may not be as important or as safe as they imagine.

Stockwell brings this idea into focus. He recognises corruption in others and willingly takes part in it himself, yet he cannot see that he might also suffer its consequences. Ultimately, he thinks his position will keep him safe. He is intelligent enough to understand the game, but not insightful enough to grasp the limits of his place within it. This blindness gives the novel a strong sense of irony.

The satirical approach gives Fernando room to criticise political hypocrisy without turning the novel into a direct political argument. By using fictional countries and exaggerated names, he creates some distance from specific governments and events while still making the larger targets of the book clear. The humour does not take away from the seriousness of the subject; instead, it makes the cruelty and self-interest beneath the political performance stand out more sharply.

Near the end, Fernando echoes Macbeth with the line, “There is judgment here.” It captures the question running through the novel: can anyone participate in corruption and remain untouched by it? Beneath this satire is a dark story about power and the danger of believing that someone else will always pay the price.

I came away feeling that Outpost of Empire is a valuable and thought-provoking book, particularly in today’s political and social climate. It has a distinctive voice, and the questions it raises about power, responsibility and foreign interference remain relevant far beyond the fictional borders of Lackadasia.
About the Author

Shavindra Fernando has worked as a reporter. He read English & Classics at the University of Peradeniya in Sri Lanka, and took International Relations & Ethnic Politics as a Reuter Fellow at the University of Oxford in England. The Vague Poetess (1999)was his first novel.

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Opinion

Speaker’s dilemma

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The Opposition, in its wisdom (or perhaps stupidity), has submitted yet another No-Confidence Motion (NCM) against the Speaker of Parliament. Perhaps it hopes to score some brownie points in the eyes of the public, which is hardly indifferent to such developments. Yet, knowing full well that the motion is unlikely to succeed, the exercise may well prove futile — akin to banging one’s head against a solid rock.

Nevertheless, the nearly fifty allegations levelled against the Speaker, whether justified or mere mudslinging, cannot simply be brushed aside. Such allegations may well have a bearing on the individual concerned, particularly where it matters most — his conscience — and few would dispute that possibility.

From a protocol standpoint, the Speaker occupies one of the highest positions in the country, ranking third in the hierarchy of state. He consequently belongs to the uppermost echelons of public life, with acquaintances and associates extending across a wide spectrum of society, including diplomats and other distinguished personalities. Such a position carries with it not merely prestige and privilege, but also an onerous responsibility to uphold the dignity and integrity of the office.

As the guardian of Parliament, the Speaker is expected to maintain standards of conduct, impartiality and discipline that are beyond reproach.

Whether the allegations are justifiable or not may be of little consequence to members of the ruling party, who will undoubtedly defend their colleague to the hilt. Nevertheless, the stigma arising from such allegations may prove difficult to erase, particularly in the eyes of his family, close associates and, ultimately, the voters who placed their trust in him. Of course, it is common knowledge that politics can be a dirty game and that, as Lord Acton famously observed, “power tends to corrupt, and absolute power corrupts absolutely.”

Yet, nothing could be more devastating than a person losing his own soul in the process. On the one hand, stepping down could be construed as an admission of responsibility for the allegations levelled against him. On the other, allowing the No-Confidence Motion (NCM) to proceed could expose him to further public scrutiny and potentially inflict lasting damage on his character, dignity and reputation. Thus, he finds himself caught between two unenviable choices, each carrying consequences that may extend far beyond the immediate political fallout.

The Speaker is therefore confronted with a classic Hobson’s choice, with neither option likely to be without consequences. After all, in politics, there are no permanent friends or enemies—only permanent interests.

WILLIAM

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Opinion

How long can Sri Lanka remain silent on its demographic crisis?

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I write this with a sense of profound disappointment, rather than as a critic of the government or any individual public official. For several months, I have been drawing public attention to what I consider one of the most serious long-term challenges facing Sri Lanka—the country’s rapidly changing demographic structure, declining fertility, population ageing and the consequent contraction of the working-age population.

I have written several articles on this subject, believing that informed public discussion could encourage policymakers, academics and relevant institutions to examine the issue before its consequences become irreversible. I went a further step by addressing a detailed letter to the President on 28 August 2026, seeking consideration of a National Demographic Action Plan.

That letter was not merely an expression of concern. It contained practical proposals: long-term demographic projections, assessment of the consequences for labour supply and productivity, examination of declining fertility and delayed family formation, reassessment of education and employment policies, consideration of migration, and the establishment of continuous demographic monitoring.

I deliberately addressed the matter to the highest level because demographic change is not the responsibility of one ministry. It cuts across Finance and Planning, Education, Labour, Health, Higher Education, migration, social protection and national human-resource planning.

Yet, after sending that registered letter, I have not even received an acknowledgement.

This is what troubles me most. I fully appreciate that government has numerous urgent problems to address. Economic recovery, disaster management, employment, education and many other immediate concerns understandably demand attention. But demographic change is different. It operates slowly, almost silently, while steadily narrowing the choices available to future governments.

By the time the shortage of workers, accelerated ageing, increased dependency and the economic consequences of very low fertility become impossible to ignore, remedial action may be enormously more difficult and expensive. What is equally disappointing is the apparent silence of the institutions that should be at the centre of this discussion.

The latest Census has provided the country with an invaluable body of demographic evidence. My own published work has attempted to connect those findings with national development, productivity, education, employment and human-resource planning. On the top of these endeavours, I have seen voluminous articles written by Professor Manori Weerathunga, of the Population Department of the Colombo University, President Population Association of Sri Lanka, and Director Centre for Ageing Studies of University of Colombo. Yet I have seen little evidence of a visible national policy response from the relevant planning and statistical authorities.

Given the multiplicity of the roles and the credentials she possesses, I would strongly urge her to take the bull by the horns and formulate a draft national demographic policy with the expertise of the demographic scientists. This task cannot be delegated to the SLAS or Planning panjandrums. The government should seriously think why the thinktanks are abdicating their mandatory responsibilities and playing a passive role when the country is confronted with burning issues. Are there any sinister plans by disgruntled senior officers to derail the development plans is the question that begs an answer? Alternatively, the government should seriously enlist the support of the IMF or the World Bank, before the demographic bomb explodes!

Are we treating the Census merely as a statistical exercise, rather than as an early-warning the system for national planning? This question deserves a public answer.

I went even further by writing on “Educational Delays, Biological Clock and Sri Lanka’s Fertility Crisis.” My purpose was not to blame the education authorities. I sought to draw attention to the possibility that prolonged delays in university education, examinations, admissions and graduation may interact with delayed family formation and the biological realities of childbearing. I had hoped that this would stimulate examination by the Education sector and other relevant stakeholders.

Unfortunately, I have yet to see any meaningful response. My concern is therefore not whether my own articles have been acknowledged. That is completely irrelevant. The issue is whether the substantive national questions raised in those articles are being examined by anyone in authority.

A citizen who spends considerable time studying a national problem, writing about it publicly and then submitting a constructive proposal to Government should not necessarily expect agreement. But surely an acknowledgement—or better still, a response indicating that the matter is being examined—is not too much to expect.

There is also another dimension which I recently highlighted in discussing Sri Lanka’s transition from an “Age of Longevity” towards an “Age of Experience”. Sri Lanka is simultaneously facing a shrinking younger workforce and an expanding reservoir of older citizens possessing decades of professional and institutional experience.

The demographic challenge, therefore, should not be viewed only through the lenses of pensions, healthcare and elderly care. The country must also ask how the accumulated knowledge, expertise and institutional memory of its experienced citizens can be mobilised for national development.

This is precisely why I find the present silence so difficult to understand. I have no personal or political agenda. I have spent decades working in human resources, productivity and management specialist, and I have chosen in the later stage of my professional life to devote my writing to contemporary national issues which I believe deserve national attention.

Perhaps my concerns are misplaced. Perhaps the government already has a comprehensive demographic strategy under preparation. The relevant institutions have already initiated studies that are not yet public.

If that is the case, I would be delighted to be proved wrong. But if no such comprehensive process exists, then I respectfully ask: how much longer can Sri Lanka afford to remain silent?

The demographic clock does not stop while governments deliberate.

My appeal is therefore not for recognition of my efforts. It is for recognition of the problem. I hope the relevant authorities will prove that the silence I have encountered is not indifference, but merely the silence before meaningful action.

Sri Lanka cannot afford to discover, ten or twenty years from now, that the warnings were visible, the evidence was available, the proposals were made—and nobody acted.

The time to respond to the demographic crisis is now, while choices still remain.

Over to you, the President, the Prime Minister, the Minister of Finance and National Planning, Vice Chancellor of Colombo, Director General of Census and Statistics.

Athula Ranasinghe

Productivity Specialist and Management Consultant

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