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Doctors striking and their moral responsibility

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British doctors protesting over pay photo courtesy BBC

This is an account about the Industrial action taken by British doctors. They have indeed become more militant lately. These are about the events from the UK. It is not always possible to interpolate the narrative to the situation and events in Sri Lanka. But when doctors strike, wherever in the world, it affects patient care and the moral responsibilities of the medical professionals remain the same.

Industrial action is when workers collectively refuse or reduce their work due to a dispute. It is often organized by a trade union when negotiations have failed. Common forms of industrial action include strikes and picketing.

The British Medical Association is the doctors trade union in Britain. Recently, the organisation has marshalled the junior doctors (now called resident doctors) to a series of strikes. This has seriously affected patient care in hospitals and has damaged the esteem and goodwill the patients have for the profession. The long running dispute of the junior/resident doctors with the government started in March 2023. The BMA argues that resident doctors’ pay is 20% lower in real terms than it was in 2008, even after the 2025 increase. There have been 14 strikes since 2023 causing immense disruption to healthcare in the NHS. The government says resident doctors have received the largest pay rises of any public sector employees over the last three years – totalling nearly 30% – and insists the government won’t offer any further increases.

The beginning of industrial action goes way back into the 17th Century. Then the workers faced appalling working conditions and dangerously long hours. They earned very low wages. There were many accidents at the work place due to the lack of safety regulations. In Britain the Trade Union Act of 1871 legalized trade unions, giving workers a legal way to protect and advance their rights. This led to an increase in industrial activity which in turn improved the lives of workers. Workers strikes had the propensity to damage the economy of the country and cause hardship to the public.

The National Health Service was established in 1948 by Aneurin Bevan providing comprehensive medical care free at the point of use, funded through general taxation. An association for doctors was formed in 1832 and it was called the Provincial Medical and Surgical Association. In1856 this organisation changed its name to British Medical Association. For many years, as a profession doctors never struck work. The first doctors strike took place in 1975. Firstly it was the consultants who went on strike to retain the privilege of private practice. Later that same year the Junior doctors struck work wanting payment for their on-call duties. These instances of strikes have been notable for their scale and impact. They represent the largest and the most disruptive action seen in the 75-year-history of the NHS.

The Hippocratic Oath is an oath of medical ethics historically taken by physicians. It pledges to uphold professional standards, to help the sick, do no harm, and maintain patient confidentiality.

The original oath is often revised for modern use. The core principles of the oath still continue to guide the medical profession. The Declaration of Geneva was created by the World Medical Association in 1948.

World Medical Association Declaration of Geneva – 1948

The Physician’s Pledge

AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

I WILL RESPECT the autonomy and dignity of my patient;

I WILL MAINTAIN the utmost respect for human life;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I WILL RESPECT the secrets that are confided in me, even after the patient has died;

I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour and noble traditions of the medical profession;

I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely, and upon my honour.

Wherever I have worked I have seen the dedication of the doctors to patient well-being. They work long and unpredictable hours providing a selfless service. This often involves personal sacrifice. Money is a vital component of modern life. It provides security and stability, social inclusion and a better quality of life. We all want more of it and there are times we all feel that way. It is the responsibility of the government to pay the doctors adequately for the important work they do. The public too has a responsibility to force governments to provide adequate remuneration for the doctors for their work.

The medical profession is more than just a job. We all have an important duty of care to our patients. As doctors we must not forget the core principles of our profession. World Medical Association Declaration of Geneva (1948) is a useful reminder to all doctors of their responsibilities.

In the UK, pay review bodies are independent, non-departmental public bodies that advise governments on public sector pay. Their function is to gather evidence from various sources, such as government departments, unions, and employers, to provide independent, evidence-based recommendations on pay and working conditions. This advice helps the government set public sector pay levels that aim to attract, retain, and motivate staff. Governments are not legally bound by the recommendations. These review bodies sit annually to advice governments. Hence the doctors pay is reviewed every year and is adjusted when necessary. The British Medical Association has a significant input into the Review Body on Doctors’ and Dentists’ Remuneration.

Teaching and Higher Education Act 1998 allowed universities to charge tuition fees from students. Currently it is £9,250 annually. When the cost of food and lodging is included, it adds an extra £10,000. Hence the medical students when they complete their course could have a debt of £100,000. I hope the BMA and the Review Body take this into consideration when doing the pay review. I wish the BMA does a deal with the government to wave the university tuition fees if medical students sign a contract to work for the government for five years after they qualify.

In the UK, doctors provide an excellent service, often beyond the call of duty. It must be said that those in the medical profession are under greater pressure than ever before. Their workload is increasing exponentially, and their work is more closely scrutinised. This adds to the stress in the workplace. We live in a litigious world and legal action against doctors is much more common now. Here too we assume the review body is aware of these issues.

Strikes by doctor’s lead to the cancellation of appointments and postponement of elective surgery and other procedures. These cause significant delays and distress to patients. Depending on the cover provided by the striking doctors, the emergency and urgent care services will be restricted and there will always be the inevitable unacceptable delays. Strikes disrupt the overall efficiency of the NHS, leading to longer waiting times and a higher risk of patient deterioration. Cancer diagnosis and treatment gets delayed. There is also a huge physical and emotional impact on the staff that work during the strike providing cover. The total impact on the NHS is huge.

While many organizations can strike, professions in the armed forces, police, and prison services are legally banned from striking. These are deemed as essential services and strikes by them would seriously disrupt and endanger life. Front-line medical services too are essential and will endanger life if withdrawn. Should the doctors be allowed to strike when the other essential services aren’t?

As a medical professional who has worked in the health service both in Sri Lanka and the UK for 50 years, I feel strongly that doctors should not strike. There are adequate safeguards to keep their pay in line with the rest of the public sector. The British Medical Association should be negotiating with the government about pay and conditions retaining their respect as a body that is committed to providing a good service to the public. The leader of the Conservative party has said she would ban doctors from taking industrial action.

by Dr. Nihal D. Ameresekera



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Trade preferences to support post-Ditwah reconstruction

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Ditwah disaster

The manner in which the government succeeded in mobilising support from the international community, immediately after the devastating impact of Cyclone Ditwah, may have surprised many people of this country, particularly because our Opposition politicians were ridiculing our “inexperienced” government, in the recent past, for its inability to deal with the international community effectively. However, by now it is evident that the government, with the assistance of the international community and local nongovernmental actors, like major media organisations, has successfully managed the recovery efforts. So, let me begin by thanking them for what they have done so far.

Yet, some may argue that it is not difficult to mobilise the support for recovery efforts from the international community, immediately after any major disaster, and the real challenge is to sustain that support through the next few weeks, months and years. Because the recovery process, more specifically the post-recovery reconstruction process, requires long-term support. So, the government agencies should start immediately to focus on, in addition to initial disaster relief, a longer-term strategy for reconstruction. This is important because in a few weeks’ time, the focus of the global community may shift elsewhere … to another crisis in another corner of the world. Before that happens, the government should take initiatives to get the support from development partners on appropriate policy measures, including exceptional trade preferences, to help Sri Lanka in the recovery efforts through the medium and the long term.

Use of Trade Preferences to support recovery and reconstruction

In the past, the United States and the European Union used exceptional enhanced trade preferences as part of the assistance packages when countries were devastated by natural disasters, similar to Cyclone Ditwah. For example:

  • After the devastating floods in Pakistan, in July 2010, the EU granted temporary, exceptional trade preferences to Pakistan (autonomous trade preferences) to aid economic recovery. This measure was a de facto waiver on the standard EU GSP (Generalised Scheme of Preferences) rules. The preferences, which were proposed in October 2010 and were applied until the end of 2013, effectively suspended import duties on 75 types of goods, including textiles and apparel items. The available studies on this waiver indicate that though a significant export hike occurred within a few months after the waiver became effective it did not significantly depress exports by competing countries. Subsequently, Pakistan was granted GSP+ status in 2014.

  • Similarly, after the 2015 earthquakes in Nepal, the United States supported Nepal through an extension of unilateral additional preferences, the Nepal Trade Preferences Programme (NTPP). This was a 10-year initiative to grant duty-free access for up to 77 specific Nepali products to aid economic recovery after the 2015 earthquakes. This was also a de facto waiver on the standard US GSP rules.
  • Earlier, after Hurricanes Mitch and Georges caused massive devastation across the Caribbean Basin nations, in 1998, severely impacting their economies, the United States proposed a long-term strategy for rebuilding the region that focused on trade enhancement. This resulted in the establishment of the US Caribbean Basin Trade Partnership Act (CBTPA), which was signed into law on 05 October, 2000, as Title II of the Trade and Development Act of 2000. This was a more comprehensive facility than those which were granted to Pakistan and Nepal.

What type of concession should Sri Lanka request from our development partners?

Given these precedents, it is appropriate for Sri Lanka to seek specific trade concessions from the European Union and the United States.

In the European Union, Sri Lanka already benefits from the GSP+ scheme. Under this arrangement Sri Lanka’s exports (theoretically) receive duty-free access into the EU markets. However, in 2023, Sri Lanka’s preference utilisation rate, that is, the ratio of preferential imports to GSP+ eligible imports, stood at 59%. This was significantly below the average utilisation of other GSP beneficiary countries. For example, in 2023, preference utilisation rates for Bangladesh and Pakistan were 90% and 88%, respectively. The main reason for the low utilisation rate of GSP by Sri Lanka is the very strict Rules of Origin requirements for the apparel exports from Sri Lanka. For example, to get GSP benefits, a woven garment from Sri Lanka must be made from fabric that itself had undergone a transformation from yarn to fabric in Sri Lanka or in another qualifying country. However, a similar garment from Bangladesh only requires a single-stage processing (that is, fabric to garment) qualifies for GSP. As a result, less than half of Sri Lanka’s apparel exports to the EU were ineligible for the preferences in 2023.

Sri Lanka should request a relaxation of this strict rule of origin to help economic recovery. As such a concession only covers GSP Rules of Origin only it would impact multilateral trade rules and would not require WTO approval. Hence could be granted immediately by the EU.

United States

Sri Lanka should submit a request to the United States for (a) temporary suspension of the recently introduced 20% additional ad valorem duty and (b) for a programme similar to the Nepal Trade Preferences Programme (NTPP), but designed specifically for Sri Lanka’s needs. As NTPP didn’t require WTO approval, similar concessions also can be granted without difficulty.

Similarly, country-specific requests should be carefully designed and submitted to Japan and other major trading partners.

(The writer is a retired public servant and can be reached at senadhiragomi@gmail.com)

by Gomi Senadhira

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Lasting power and beauty of words

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Novelists, poets, short story writers, lyricists, politicians and columnists use words for different purposes. While some of them use words to inform and elevate us, others use them to bolster their ego. If there was no such thing called words, we cannot even imagine what will happen to us. Whether you like it or not everything rests on words. If the Penal Code does not define a crime and prescribe a punishment, judges will not be able to convict criminals. Even the Constitution of our country is a printed document.

A mother’s lullaby contains snatches of sweet and healing words. The effect is immediate. The baby falls asleep within seconds. A lover’s soft and alluring words go right into his or her beloved. An army commander’s words encourage soldiers to go forward without fear. The British wartime Prime Minister Winston Churchill’s words still ring in our ears: “… we shall defend our Island, whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender …”

Writers wax eloquent on love. English novelist John Galsworthy wrote: “Love is no hot-house flower, but a wild plant, born of a wet night, born of an hour of sunshine; sprung from wild seed, blown along the road by a wild wind. A wild plant that, when it blooms by chance within the hedge of our gardens, we call a flower; and when it blooms outside we call a weed; but flower or weed, whose scent and colour are always wild.” While living in a world dominated by technology, we often hear a bunch of words that is colourless and often cut to verbal ribbons – “How R U” or “Luv U.” Such words seem to squeeze the life out of language.

Changing medium

Language is a constantly changing medium. New words and forms arrive and old ones die out. Whoever thought that the following Sinhala words would find a place in the Oxford English Dictionary? “Asweddumize, Avurudu, Baila, Kiribath, Kottu Roti, Mallung, Osari, Papare, Walawwa and Watalappan.” With all such borrowed words the English language is expanding and remains beautiful. The language helps us to express subtle ideas clearly and convincingly.

You are judged by the words you use. If you constantly use meaningless little phrases, you will be considered a worthless person. When you read a well-written piece of writing you will note how words jump and laugh on the paper or screen. Some of them wag their tails while others stand back like shy village belles. However, they serve a useful purpose. Words help us to write essays, poems, short stories and novels. If not for the beauty of the language, nobody will read what you write.

If you look at the words meaningfully, you will see some of them tap dancing while others stand to rigid attention. Big or small, all the words you pen form part of the action or part of the narrative. The words you write make your writing readable and exciting. That is why we read our favourite authors again and again.

Editorials

If a marriage is to succeed, partners should respect and love each other. Similarly, if you love words, they will help you to use them intelligently and forcefully. A recent survey in the United States has revealed that only eight per cent of people read the editorial. This is because most editorials are not readable. However, there are some editorials which compel us to read them. Some readers collect such editorials to be read later.

Only a lover of words would notice how some words run smoothly without making a noise. Other words appear to be dancing on the floor. Some words of certain writers are soothing while others set your blood pounding. There is a young monk who is preaching using simple words very effectively. He has a large following of young people addicted to drugs. After listening to his preaching, most of them have given up using illegal drugs. The message is loud and clear. If there is no demand for drugs, nobody will smuggle them into the country.

Some politicians use words so rounded at the edges and softened by wear that they are no longer interesting. The sounds they make are meaningless and listeners get more and more confused. Their expressions are full of expletives the meaning of which is often soiled with careless use of words.

Weather-making

Some words, whether written or spoken, stick like superglue. You will never forget them. William Vergara in his short essay on weather-making says, “Cloud-seeding has touched off one of the most baffling controversies in meteorological history. It has been blamed for or credited with practically all kinds of weather. Some scientists claim seeding can produce floods and hail. Others insist it creates droughts and dissipates clouds. Still others staunchly maintain it has no effect at all. The battle is far from over, but at last one clear conclusion is beginning to emerge: man can change the weather, and he is getting better at it.”

There are words that nurse the ego and heal the heart. The following short paragraph is a good example. S. Radhakrishnan says, “In every religion today we have small minorities who see beyond the horizon of their particular faith, not through religious fellowship is possible, not through the imposition of any one way on the whole but through an all-inclusive recognition that we are all searchers for the truth, pilgrims on the road, that we all aim at the same ethical and spiritual standard.”

There are some words joined together in common phrases. They are so beautiful that they elevate the human race. In the phrase ‘beyond a shadow of doubt’, ‘a shadow’ connotes a dark area covering light. ‘A doubt’ refers to hesitancy in belief. We use such phrases blithely because they are exquisitely beautiful in their structure. The English language is a repository of such miracles of expression that lead to deeper understanding or emphasis.

Social media

Social media use words powerfully. Sometimes they invent new words. Through the social media you can reach millions of viewers without the intervention of the government. Their opinion can stop wars and destroy tyrants. If you use the right words, you can even eliminate poverty to a great extent.

The choice of using powerful words is yours. However, before opening your mouth, tap the computer, unclip a pen, write a lyric or poem, think twice of the effect of your writing. When you talk with a purpose or write with pleasure, you enrich listeners and readers with your marvellous language skills. If you have a command of the language, you will put across your point of view that counts. Always try to find the right words and change the world for a better place for us to live.

By R. S. Karunaratne
karunaratners@gmail.com

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Why Sri Lanka Still Has No Doppler Radar – and Who Should Be Held Accountable

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Eighteen Years of Delay:

Cyclone Ditwah has come and gone, leaving a trail of extensive damage to the country’s infrastructure, including buildings, roads, bridges, and 70% of the railway network. Thousands of hectares of farming land have been destroyed. Last but not least, nearly 1,000 people have lost their lives, and more than two million people have been displaced. The visuals uploaded to social media platforms graphically convey the widespread destruction Cyclone Ditwah has caused in our country.

The purpose of my article is to highlight, for the benefit of readers and the general public, how a project to establish a Doppler Weather Radar system, conceived in 2007, remains incomplete after 18 years. Despite multiple governments, shifting national priorities, and repeated natural disasters, the project remains incomplete.

Over the years, the National Audit Office, the Committee on Public Accounts (COPA), and several print and electronic media outlets have highlighted this failure. The last was an excellent five-minute broadcast by Maharaja Television Network on their News First broadcast in October 2024 under a series “What Happened to Sri Lanka”

The Agreement Between the Government of Sri Lanka and the World Meteorological Organisation in 2007.

The first formal attempt to establish a Doppler Radar system dates back to a Trust Fund agreement signed on 24 May 2007 between the Government of Sri Lanka (GoSL) and the World Meteorological Organisation (WMO). This agreement intended to modernize Sri Lanka’s meteorological infrastructure and bring the country on par with global early-warning standards.

The World Meteorological Organisation (WMO) is a specialized agency of the United Nations established on March 23, 1950. There are 193 member countries of the WMO, including Sri Lanka. Its primary role is to promote the establishment of a worldwide meteorological observation system and to serve as the authoritative voice on the state and behaviour of the Earth’s atmosphere, its interaction with the oceans, and the resulting climate and water resources.

According to the 2018 Performance Audit Report compiled by the National Audit Office, the GoSL entered into a trust fund agreement with the WMO to install a Doppler Radar System. The report states that USD 2,884,274 was deposited into the WMO bank account in Geneva, from which the Department of Metrology received USD 95,108 and an additional USD 113,046 in deposit interest. There is no mention as to who actually provided the funds. Based on available information, WMO does not fund projects of this magnitude.

The WMO was responsible for procuring the radar equipment, which it awarded on 18th June 2009 to an American company for USD 1,681,017. According to the audit report, a copy of the purchase contract was not available.

Monitoring the agreement’s implementation was assigned to the Ministry of Disaster Management, a signatory to the trust fund agreement. The audit report details the members of the steering committee appointed by designation to oversee the project. It consisted of personnel from the Ministry of Disaster Management, the Departments of Metrology, National Budget, External Resources and the Disaster Management Centre.

The Audit Report highlights failures in the core responsibilities that can be summarized as follows:

· Procurement irregularities—including flawed tender processes and inadequate technical evaluations.

· Poor site selection

—proposed radar sites did not meet elevation or clearance requirements.

· Civil works delays

—towers were incomplete or structurally unsuitable.

· Equipment left unused

—in some cases for years, exposing sensitive components to deterioration.

· Lack of inter-agency coordination

—between the Meteorology Department, Disaster Management Centre, and line ministries.

Some of the mistakes highlighted are incomprehensible. There is a mention that no soil test was carried out before the commencement of the construction of the tower. This led to construction halting after poor soil conditions were identified, requiring a shift of 10 to 15 meters from the original site. This resulted in further delays and cost overruns.

The equipment supplier had identified that construction work undertaken by a local contractor was not of acceptable quality for housing sensitive electronic equipment. No action had been taken to rectify these deficiencies. The audit report states, “It was observed that the delay in constructing the tower and the lack of proper quality were one of the main reasons for the failure of the project”.

In October 2012, when the supplier commenced installation, the work was soon abandoned after the vehicle carrying the heavy crane required to lift the radar equipment crashed down the mountain. The next attempt was made in October 2013, one year later. Although the equipment was installed, the system could not be operationalised because electronic connectivity was not provided (as stated in the audit report).

In 2015, following a UNOPS (United Nations Office for Project Services) inspection, it was determined that the equipment needed to be returned to the supplier because some sensitive electronic devices had been damaged due to long-term disuse, and a further 1.5 years had elapsed by 2017, when the equipment was finally returned to the supplier. In March 2018, the estimated repair cost was USD 1,095,935, which was deemed excessive, and the project was abandoned.

COPA proceedings

The Committee on Public Accounts (COPA) discussed the radar project on August 10, 2023, and several press reports state that the GOSL incurred a loss of Rs. 78 million due to the project’s failure. This, I believe, is the cost of constructing the Tower. It is mentioned that Rs. 402 million had been spent on the radar system, of which Rs. 323 million was drawn from the trust fund established with WMO. It was also highlighted that approximately Rs. 8 million worth of equipment had been stolen and that the Police and the Bribery and Corruption Commission were investigating the matter.

JICA support and project stagnation

Despite the project’s failure with WMO, the Japan International Cooperation Agency (JICA) entered into an agreement with GOSL on June 30, 2017 to install two Doppler Radar Systems in Puttalam and Pottuvil. JICA has pledged 2.5 billion Japanese yen (LKR 3.4 billion at the time) as a grant. It was envisaged that the project would be completed in 2021.

Once again, the perennial delays that afflict the GOSL and bureaucracy have resulted in the groundbreaking ceremony being held only in December 2024. The delay is attributed to the COVID-19 pandemic and Sri Lanka’s economic crisis.

The seven-year delay between the signing of the agreement and project commencement has led to significant cost increases, forcing JICA to limit the project to installing only one Doppler Radar system in Puttalam.

Impact of the missing radar during Ditwah

As I am not a meteorologist and do not wish to make a judgment on this, I have decided to include the statement issued by JICA after the groundbreaking ceremony on December 24, 2024.

In partnership with the Department of Meteorology (DoM), JICA is spearheading the establishment of the Doppler Weather Radar Network in the Puttalam district, which can realize accurate weather observation and weather prediction based on the collected data by the radar. This initiative is a significant step in strengthening Sri Lanka’s improving its climate resilience including not only reducing risks of floods, landslides, and drought but also agriculture and fishery“.

Based on online research, a Doppler Weather Radar system is designed to observe weather systems in real time. While the technical details are complex, the system essentially provides localized, uptotheminute information on rainfall patterns, storm movements, and approaching severe weather. Countries worldwide rely on such systems to issue timely alerts for monsoons, tropical depressions, and cyclones. It is reported that India has invested in 30 Doppler radar systems, which have helped minimize the loss of life.

Without radar, Sri Lanka must rely primarily on satellite imagery and foreign meteorological centres, which cannot capture the finescale, rapidly changing weather patterns that often cause localized disasters here.

The general consensus is that, while no single system can prevent natural disasters, an operational Doppler Radar almost certainly would have strengthened Sri Lanka’s preparedness and reduced the extent of damage and loss.

Conclusion

Sri Lanka’s inability to commission a Doppler Radar system, despite nearly two decades of attempts, represents one of the most significant governance failures in the country’s disastermanagement history.

Audit findings, parliamentary oversight proceedings, and donor records all confirm the same troubling truth: Sri Lanka has spent public money, signed international agreements, received foreign assistance, and still has no operational radar. This raises a critical question: should those responsible for this prolonged failure be held legally accountable?

Now may not be the time to determine the extent to which the current government and bureaucrats failed the people. I believe an independent commission comprising foreign experts in disaster management from India and Japan should be appointed, maybe in six months, to identify failures in managing Cyclone Ditwah.

However, those who governed the country from 2007 to 2024 should be held accountable for their failures, and legal action should be pursued against the politicians and bureaucrats responsible for disaster management for their failure to implement the 2007 project with the WMO successfully.

Sri Lanka cannot afford another 18 years of delay. The time for action, transparency, and responsibility has arrived.

(The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the policy or position of any organization or institution with which the author is affiliated).

By Sanjeewa Jayaweera

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