Can we advance if culture holds us back?

By Dr Upul Wijayawardhana

I cannot remember the exact dates, though I ought to because it was the most traumatic experience of my life. Around six months before my final MBBS examination, I noticed a little lump at the base of my right index finger. Though it was not tender, I wondered whether it could be an infection but as it did not settle after a fortnight, I walked in to the surgical clinic of Dr R A Navaratna, Senior Lecturer in Surgery who later became Professor. ‘Nava’ as he was fondly referred to. Son of the famous Ayurvedic physician R Buddhadasa, he had already established the reputation not only as one of the best surgeons but also as one of the most approachable. I introduced myself and requested him to have a look at the lump. He readily agreed and after very careful examination told me “Wijayawardhana, frankly I do not know what it is. Please come back next week, so that I can have another look.”

I saw him the following week and after a thorough examination he said, “It has not changed but I still do not know what it is. As we are totally in the dark, shall we remove it and get the pathologists to have a look.” I readily agreed and he wanted me to come the following day, as he happened to have a list of surgeries. At the end of his list, sitting on either side of the operating table, with my hand on the table, he injected a local anaesthetic and carefully dissected out a fleshy lump. “It looks like a lymph gland but there are no lymph glands in this area. It is still puzzling. Let us see what the histology (appearance under the microscope) shows,” he told me.

Two weeks later, just before an Obstetric lecture, I went to the Pathology Department to collect the report and hit the ceiling when I read the diagnosis: Malignant Synovioma. Even with my limited knowledge I knew it was a death sentence; giving me, at most, eighteen months. Deciding immediately that I should die a qualified doctor, I went to the lecture but my lecture notes were botched with tears flowing down my eyes. ‘Nava’ was shocked and referred me to Dr. H.K.T Fernando, Radiotherapist, who told me that he could give me high dose radiation but that would lead to permanent damage to my right hand. Though I was prepared to take that risk, for the sake of dear life, he insisted that I got a second opinion on the histology, though both Professors of Pathology were in unison. By a stroke of luck, a cousin of my mother, Dr. A.G. Abeywickrama, who later became a Paediatrician, was a demonstrator in the Department of Forensic Medicine and knew the former Professor of Pathology who agreed to look at the slides. He was not convinced and wanted the slide sent to a colleague of his in London which I did with great difficulty, as it was no easy task to send even a small parcel abroad in the sixties.

Few weeks before my final examination, my uncle gave me the good news that the lady Professor has informed that what I had was ‘Pseudosarcomatous fasciitis’, an inflammation due to a virus, which can mimic a Malignant Synovioma. But, as he did not show me the letter, I always had a lingering doubt whether it was a ploy to reassure me! In fact, on many occasions I prevailed upon friendly radiographers to do a chest x-ray, looking at them with my heart pounding, to see whether there are ‘cannon-ball’ secondaries; the characteristic finding of Synovioma spreading to the lungs, before it kills you. Obviously, I have been paranoid as I am still alive but whether I would have done even better in the final examination, if not for this hassle, is another question.

I have gone into great detail to show the fallibility, at times, of science but, more importantly, the openness which science encourages, as it does not depend on faith. I never went to any Temple or Kovil for vows or prayed to anyone for a cure. Had I been to a Catholic priest, my miraculous recovery would have helped his path to sainthood!

The doctor who has jumped to the defence of the Minister of Health, challenging my view that she does not deserve to hold that portfolio (On ‘misinformation’ against Minister of Health, The Island 23 July) asserts that her unscientific actions could be totally justified on our cultural practices and goes on to state:

“One would be hard pressed to find anyone in this country who has not fulfilled a vow; be it for himself or herself/siblings/parents/children with regard to examinations, illnesses, promotions, etc.”

Surely, I cannot be the only one who dared not take a vow even when the grim reaper was staring in the face!

Many have wondered why we had such superb control at the beginning of the pandemic and lost the plot later. The good doctor provides the answer:

“From the onset of this pandemic a multitude of rituals have been conducted and they are still in force; all night Pirith, Bodhi Pooja, continuous chanting of the Ratana Sutta,” etc. The MOH releasing pots to the rivers that would wash down the ‘pandemic’ to the sea was one such ritual. A salient point to be appreciated is that while there is the possibility that the MOH herself believed in the effects of releasing these pots; this ritual was done primarily for the country/public rather than herself, hence the coverage on TV and news.”

Is there any basis for these practices other than blind belief? Whilst the only way to overcome this pandemic is the application of scientific methods, it is unfortunate that emphasising on these ‘cultural methods’ only dilutes the efforts of those fighting the pandemic. Even my compliment to these has been ridiculed by his following statement:

“As a side note, I am amused by the use of the term ‘Sri Lanka is blessed with’. Based on UW’s logic ‘who are highly trained in Sri Lanka’ ought to have been a more appropriate term as blessings have nothing to do with a scientific reality!”

One of the dictionary definitions of ‘blessed with’ is ‘to have something that you feel is special’ and I personally feel very special as three physicians in the forefront, fighting the pandemic, have had their compulsory foreign post-graduate training with me!

May I stress that I have nothing personal against Minister Wanniarachchi. In fact, having watched her in the musical programme on Rupavahini, ‘Sihinayaki Re’ I developed a great respect for her. Further, considering the politicians we are ‘blessed with’, she deserves to be a minister but not hold the portfolio of Health. Just like the British Secretary of Health who resigned when he was caught flouting his own regulations, she should have had the decency to resign when the ‘peniya’ she helped to promote was found to be useless. I reiterate that her actions fall far short of what is expected of a Minister of Health.

Whereas heritage cannot be changed, culture is a dynamic process and could change, provided we are willing. Instead, if we use culture to justify unscientific practices there is no hope for us. Let us stop using culture as an excuse to retard progress!