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Giving life to days

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UHKDU Palliative Care Services Unit

By Sajitha Prematunge

Fifty six year-old Somalatha was diagnosed with end stage cancer and was already bedridden by the time she was admitted to hospital. With proper care she was able to walk again and was looking forward to making a secure future for her children. But tragedy struck Somalatha’s family again. After her husband suddenly died of a stroke, she was forced to fend for herself. Soon after her condition worsened. Unfortunately Somalatha didn’t live to see her kids receive scholarships with the help of the dedicated University Hospital, Kotelawala Defence University staff, who cared for her.

Although her name is fictitious her predicament is all too real and thousands like her die annually without vital palliative care they are denied just because they couldn’t afford it. It is true that the Sri Lankan healthcare system is one of the best in the world, in that it is almost exclusively free of charge. But no system is infallible. It is patients like Somalatha who have to bear the brunt of its shortcomings, falling through the cracks of the Sri Lankan healthcare system.

In this light, University Hospital, General Sir John Kotelawala Defence University Palliative Care Services Unit, inaugurate on February 3 should be lauded as a timely intervention, although they had been practising palliative care long before. The UHKDU Palliative Care Services Unit was initiated at a time when repeated attempts to establish such services by various institutions had failed.

 

Palliative care

 

“The simple definition of palliative care is to optimise the quality of life of patients and care givers or loved ones, from the moment the patient is diagnosed with a chronic illness. The definition of ‘chronic’ here has wide implications, ranging from terminal cancer, schizophrenia, chronic neurological diseases, motor neuron disease, stroke to multiple fractures. Any of these conditions require palliative care,” said Consultant Oncologist Dr. Sachini Rasnayake.

It is difficult to believe that this personage of slight build heads Palliative Care Services at UHKDU, deftly fielding inquiries of changes to medication, pain management, financial issues and fears of patients, while breaking bad news to patients as gently as possible on an all too regular basis. “The responsibility of the palliative care giver is to uplift lives of the patients physically, psychosocially and spiritually,” said Rasnayake.

 

Goals

 

UHKDU Palliative Care Services was established with four main goals in mind. The first of which was to appoint a palliative care team. Rasnayake said that having so many expert consultants from different fields within the UHKDU was an added advantage. “A number of consultants volunteered to provide their services,” said a grateful Rasnayake. She opined that this team spirit was vital in establishing palliative care services. “A team of consultant anaesthetists volunteered to conduct a pain management clinic,” said Rasnayake, who pointed out that pain management is key priority when dealing with any chronic illness. “A group of physicians volunteered to attend to medical issues of palliative care patients. Onco-surgeons and the surgical team looks into the surgical aspect of palliative care.” For example, a Percutaneous Endoscopic Gastrostomy (PEG) tube is surgically inserted into a patient’s stomach through the abdominal wall for feeding purposes. “This is much more desirable than the nasogastric (NG) tube. An NG, inserted through the nose, past the throat, and into the stomach, is very uncomfortable for the patient.”

The team at UHKDU has performed the procedure on multiple long term paralysed patients and patients with throat cancers. “Long term bedridden patients require catheter care and may suffer from urinary incontinence, accidental or involuntary loss of urine; or faecal incontinence, accidental or involuntary loss of faeces or flatus.” Rasnayake explained that indwelling catheters could cause a host of other problems such as urinary track infections. “Genitourinary (GU) surgeons are tasked with addressing such issues.” Rasnayake appreciated the fact that the few oncologists at KDU were able to volunteer for palliative care despite their heavy workload. “Palliative care at UHKDU has no designated Medical Officers. But with much difficulty we were able to secure one nurse. The whole oncology team along with the pharmacists are all experts at palliative care and are wholeheartedly supportive of this initiative.” The rest of the palliative care team consists of a dedicated group of psychiatrists, psychologists and ENT surgeons.

Their second goal is to conduct ongoing medical education programmes. She explained that the team, including the supporting staff had undergone training. “By 2022 we hope that the whole hospital staff would be trained in palliative care,” said Rasnayake hopefully. “It’s vital that everyone undergoes training, since every service accompanies a component of palliative care.” Rasnayake informed that virtual teaching clips were used to train and online assessments used to ascertain the success of candidates, validated through a certification process. “If there is one thing we learned from the COVID-19 pandemic, it’s how pragmatic and applicable virtual training is. For example training a whole staff at the same time would mean that they would have to expend vital work hours. But with virtual training clips the potential care-givers can learn at their own pace.” UHKDU, Executive Director and Senior Consultant Psychiatrist, Dr Jayan Mendis was the first to identify the crying need for a palliative care facility within the University Hospital. Mendis reiterated the significance of such an initiative, pointing out that the training students receive at the facility will be crucial.

The third goal is to provide palliative care home visits. Rasnayake explained that such a service would be beneficial to bedridden patients who experience financial constraints. “Unfortunately we still don’t have a free a

mbulance service.” Rasnayake said that while serving in Polonnaruwa the Cyril Dharmawardana Foundation provided an ambulance service free of charge, which facilitated Rasnayake’s travel to distant parts of the country so she could provide palliative care services to patients who could not afford to travel. “With home visits we can address issues such as constipation, administer IV drips, train care givers and optimise the condition of the patient’s accommodation, including lighting and ventilation.”

The fourth goal is to establish a palliative care hospice. “Palliative Care Unit, Karapitiya Teaching Hospital, Onco Sergeon Dr. Krishantha Perera has achieved just this,” said Rasnayake. “There isn’t such a hospital in Colombo.” She explained that a hospice would see to the psychosocial well being of a patient, in a homely environment, providing symptomatic support. Towards achieving their last goal KDU Vice Chancellor Major General Milinda Peiris has announced his agreement to allocate 10 such rooms from the KDU hotel, to extend this facility to short term palliative care patients. “For the first time in Sri Lankan health tourism, UHKDU has introduced the hospital hotel concept,” said Peiris. “Moreover, in an emergency the patient can be transferred to the hospital in less than five minutes.”

Rasnayake informed that a host of other services concerning palliative care is provided in-house by physiotherapists, psychologists and social workers. Providing radiation therapy at the palliative care facility is also in the works. “But to establish such services and facilities we must have the man power and resources,” Rasnayake pointed out. Rasnayake said that manpower, resources and understanding are integral to palliative care, aspects Sri Lanka is lagging behind in, compared to developed countries. “Unfortunately this has not been well communicated to the community. Most don’t know how they can provide such services,” said Rasnayake. She explained that this is the greatest difference between a hospital and a hospice. “At a hospice you can offer your services, clean and wash patients, subject to supervision, and even entertain them. In a hospital there are rules and regulations that prevents this.”

“One doesn’t have to be medically proficient to practise palliative care. Many who’ve had fallen on hard times in their lives later want to help others through such times,” said Oncology Department, Research Assistant, Dr. Sandini Liyanage. Liyanage and her ilk are stuck between a rock and a hard place. “We want to help, but there’s only so much we can do. We can only treat the patient, with chemotherapy or radiotherapy. But a lot more goes on in the patients’ lives. A terminal illness entails a host of psychosocial issues.” For example, Liyanage explained that, from the moment someone is diagnose with stage four cancer, they’ll invariably start to worry about everything from money, treatment to how to educate their children. “They will mentally fall apart.” Liyanage who is volunteering for palliative care service said that the services are available to any patient, although most who currently receive services are oncology patients. “It’s not just about treating the cancer. The families are also devastated. Cancer takes not only lives but a lot of other things from the family the patient leaves behind.”

 

Socio-economic constraints

 

As medical officers of palliative care those like Liyanage are able to build a complete picture about the socio-economic background of a patient by studying their history. She pointed out that most of the patients who require palliative care services are of lower socio-economic backgrounds, who were struggling to make ends meet when the illness in question exacerbated the situation.

“That’s why communication is vital. Palliative care strives to provide a patient-friendly environment,” said nurse Yashmi Kaushalya. Oncology Department nurse, the only such working full time for the Palliative Care unit, Kaushalya is a far cry from the average nurse. With a temperament befitting palliative care, Kaushalya’s calm and measured speech will no doubt assuage her patients. “As nurses we are required to communicate with patients and family members.” Palliative care nurses must be privy to psychological, physical, socio-economic problems of patients. She opined that palliative care is instrumental in caring for patients who have little family backing.

As a nurse new to palliative care, Kaushalya has not broken bad news to a patient’s family yet, for which she would accompany Rasnayake tomorrow. “It can’t be easy breaking bad news,” admitted Kaushalya. “In fact, our services have a lot more to do with caring for patients psychologically than physically,” said Kaushalya. “This is what makes palliative care nurses different from the average nurse.”

“When the patient does not have money to buy drugs, palliative care ends then and there. Although palliative care has been practised for ages, when social and financial capability is curtailed the quality of service drops. This is why social and economical support is vital,” admitted Rasnayake, who had bought drugs for patients out of her own pocket on several occasions. She reiterated that trust and continuous social care services and above all financial support is imperative for maintaining sustainable palliative care.

Rasnayake is positive that money will not be an obstacle for the continuity of the programme. Cancer Care Association founder and Chairman of the National Authority on Tobacco and Alcohol, Dr. Samadhi Rajapaksa provides much needed support, while Indira Caner Trust Director Dr. Lanka Dissanayake and Cancer Society President Anuja Karunaratne have pledged support for the programme. Rasnayake emphasised the significance of establishing a palliative care trust and a governing body to coordinate funds and all stakeholders, to ensure continued support for patients. Rasnayake appreciated the support of senior journalist and former diplomat late Bandula Jayasekara in making the programme a success.

Rasnayake readily admits that Oncology Department Head, Senior Oncologist Dr. Jayantha Balawardhane is the driving force behind the programme. Balawardhane explained that the main objectives of palliative care is to relieve and comfort patients. He pointed out that palliative care can be conducted in the ward, acute care hospital, palliative care unit or hospice, hostel, nursing home, elders home or one’s own home. “Place is immaterial when it comes to palliative care.” Balawardhane emphasized that pain relief is an integral part of palliative care. “Relieving pain is half the battle in palliative care.” Other discomforts such as bedsores, loss of bladder and bowel control adds insult to injury.

 

Psychosocial issues

 

Psychosocial issues such as sense of abandonment, anger, frustration and resentment exacerbate the psychological condition of the patient. “Patients maybe embittered, therefore we must address such psychosocial issues with care,” reiterated Balawardhane. Social abandonment, resulting from stigma, due to myths such as cancer is contagious or associating those undergoing chemo or radiation therapy could adversely affect others, and busy schedules that prevent loved ones from visiting are among the major social issues faced by palliative care patients. “Cosmetic mutilation is also a major issue,” pointed out Balawardhane. Treatment results in hair loss, palloring of skin and weight loss and this contributes to patients becoming social outcasts.

“Palliative care must also respect cultural differences and religious inclinations. For example, one who may believe in reincarnation may attempt to weigh one’s merits and demerits, contemplating on where he or she would be reborn. All this contribute to the suffering of the patient,” said Balawardhane. Quoting from American neurosurgeon, pathologist and writer, Harvey Cushing, Balawardhane said that, “‘A physician is obligated to consider more than a diseased organ, more even than the whole man – he must view the man in his world’, meaning that palliative care is holistic care. Most importantly it should be patient centred, family centred.” Palliative care should be comprehensive, leaving no stone unturned, continuous and proactive, delivered by a coordinated team and subject to regular review.”

The palliative care team consists of nurse, dietician, pharmacist, occupational therapist, paramedical aid, General Practitioner, bereavement support worker, social worker, councillor, domestic care provider and even the funeral director plays a vital role in the team. Palliative care is a support system that facilitates an active lifestyle for as long as medically possible. “This requires a lot of distractions such as games like carom, card or scrabble, listening to music or watching TV.” Palliative care practitioners use their clinical expertise and judgement to anticipate problems and treat them proactively before they manifest. “Integration of psychological, emotional, social and spiritual aspects of care between patient, family and caregivers is imperative to the functioning of the palliative care process,” emphasised Balawardhane.

Palliative care trains the patient to regard dying as a normal process, by improving the quality of life for the remainder, explained Balawardhane. “Quality is subjective, it differs from person to person.” he explained that the care provider must not enforce what he or she assumes as ‘quality’ on the patient and in stead must cater to patient demand. Palliative care promotes a degree of acceptance by the patient and immediate family, regarding the final outcome and assists the patient in the decision-making process that would result in a peaceful and dignified demise. Bereavement support helps loved ones to accept loss and does not abruptly stop with the demise of patient under palliative care. “The objective is to give life to days, whatever the remaining number of days, and not give days to life.”



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The Paradox of Coercion: US strategy and the global re-emergence of Iran

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Iranians vowing resistance at a mass funeral of the victims of US-Israeli airstrikes

(A sequel to the two-part article, War with Iran and unravelling of the global order, published in The Island on April 8 and 9.)

The unfolding developments in the US-Israeli coordinated military attack against Iran reveal a striking paradox at contemporary geopolitics: efforts to weaken a state through coercion may, under certain conditions, contribute to its structural elevation within the international system. What appears as short-term tactical success can generate long-term strategic consequences that are neither anticipated nor easily reversible. In this context, the policies associated with Donald Trump and Benjamin Netanyahu, marked by unilateralism and the willingness to use force, risk producing precisely such an unintended outcome. Rather than marginalising Iran, their actions may be accelerating its re-emergence, not merely as a regional actor in the Middle East, but as a consequential player in the global geopolitics and the wider architecture of international supply chains of energy economy.

Iran not merely a state

Iran is not merely a state, but a civilisation with a distinctive political trajectory. At the heart of the present transformation lies its asymmetric strategy, rooted in the strategic exploitation of geography. Few states possess the capacity to shape the global system through geography alone. Iran’s proximity to the Strait of Hormuz, a narrow maritime passage through which a substantial share of the world’s oil and liquefied natural gas flows, endows it with a latent structural power that transcends conventional measures of national capability.

In periods of stability, this position translates into economic opportunity; in moments of crisis, it becomes a lever of systemic disruption. Recent tensions have demonstrated that even limited instability in this corridor can reverberate across global markets, triggering sharp increases in energy prices, disrupting supply chains, and amplifying inflationary pressures worldwide. Should Iran consolidate its capacity to influence or control this chokepoint, whether through military deterrence, asymmetric instruments, or diplomatic maneuvering, it would shift from being a participant in global energy markets to a pivotal arbiter of their functioning.

Energy-embedded global economy

The contemporary global economy is not merely energy-dependent; it is deeply energy-embedded. Hydrocarbons underpin not only transportation and electricity generation but also the production of petrochemicals, fertilisers, and a wide range of industrial inputs essential to modern manufacturing and food systems. Disruptions linked to Iran have already illustrated how shocks in the energy sector cascade through interconnected supply chains, affecting everything from agricultural output to high-technology industries. In this sense, Iran’s leverage is no longer confined to the traditional realm of resource geopolitics. It increasingly operates within a networked global system in which control over a single critical node can generate disproportionate influence across multiple sectors. This form of power, diffuse, indirect, and systemic, marks a departure from the more linear dynamics of twentieth-century oil politics.

The implications of such a shift are profound for the structure of the international order. For decades, the global system has been underpinned by a set of institutions, norms, and economic arrangements often described as the so-called liberal international order. Sanctions, financial controls, and diplomatic isolation have been key instruments through which dominant powers have sought to discipline states that challenge this order. However, Iran’s prolonged exposure to sanctions has compelled it to develop adaptive strategies: alternative trade networks, informal financial channels, and closer ties with non-Western partners. A crisis-induced re-entry into global markets would therefore not signify reintegration into the existing order, but rather the expansion of parallel systems that operate alongside, and sometimes in opposition to, it. In this context, Iran’s rise would contribute to the gradual fragmentation of the global economy, accelerating trends toward decoupling, regionalization, and the erosion of established institutional authority.

Decline of global order based on US hegemony

This process of fragmentation is closely linked to declining global order based on U.S. hegemony. A more globally consequential Iran would inevitably become a focal point in the strategic player in emerging multipolar world. For China, whose economic growth remains heavily dependent on secure energy supplies, deeper engagement with Iran would serve both economic and geopolitical objectives, reinforcing its presence in the broader Middle East and insulating it from vulnerabilities associated with maritime chokepoints. Russia, already positioned as a major energy exporter and a challenger to Western dominance, may find in Iran a complementary partner in reshaping global energy markets and contesting sanctions regimes. Meanwhile, countries across the Global South, including major importers such as India, would face a more complex strategic environment, characterized by heightened exposure to supply disruptions and increased pressure to navigate between competing power centers. In this emerging landscape, Iran would function less as an isolated actor and more as a pivotal node within a reconfigured network of global alignments.

Dynamics enhancing Iran’s strategic importance

Paradoxically, the very dynamics that enhance Iran’s strategic importance may also accelerate efforts to reduce dependence on the conditions that enable its influence. Recurrent energy shocks tend to catalyze policy responses aimed at diversification and resilience. States are likely to expand strategic reserves, invest in alternative supply routes, and accelerate transitions toward renewable energy and nuclear power. Over the longer term, such measures could diminish the centrality of fossil fuel chokepoints, thereby constraining Iran’s leverage. However, this transition will be uneven and contested. Advanced economies may possess the resources to adapt more rapidly, while developing countries remain structurally dependent on affordable hydrocarbons. In the interim, the global system may experience a prolonged period in which dependence on Iranian-linked energy flows coexists with attempts to transcend it—a duality that adds further complexity to the evolving geopolitical landscape.

Beyond material considerations, Iran’s potential re-emergence also signals a deeper transformation of the existing global order. Traditional metrics—military strength, economic size, technological capacity—remain somewhat important, but they are increasingly complemented by the ability to influence critical nodes within global networks. The capacity to disrupt, delay, or redirect flows of energy, goods, and capital can generate strategic effects that rival, or even surpass, those achieved through direct military confrontation. In this sense, Iran exemplifies a broader shift from territorial geopolitics to what might be termed network geopolitics. Control over chokepoints, supply chains, and infrastructural linkages become a central determinant of influence, enabling states with relatively limited ‘conventional’ capabilities to exert outsized impact on the international system.

Iran’s trajectory may be understood as a transition through several distinct phases: from a regional challenger seeking to assert influence within the Middle East, to a strategic disruptor capable of unsettling global markets, and ultimately to a systemic actor whose decisions carry worldwide consequences. This evolution is neither inevitable nor linear; it depends on a complex interplay of domestic resilience, external pressures, and the responses of other global actors. Nevertheless, the possibility itself underscores the unintended consequences of policies that prioritize short-term coercion over long-term strategic foresight.

Transition shaped by paradoxes

In historical perspective, moments of systemic transition are often shaped by such paradoxes. Actions taken to preserve an existing order can, under certain conditions, accelerate its transformation. The current crisis involving Iran may represent one such moment. By elevating the strategic significance of energy chokepoints, exposing the vulnerabilities of interconnected supply chains, and encouraging the development of alternative economic networks, it contributes to a broader reconfiguration of global power. In this emerging context, Iran’s re-emergence as a global actor would not simply reflect its own capabilities or ambitions; it would also embody the structural shifts reshaping the international system itself. What began as an effort to constrain Iran may ultimately facilitate its transformation into a decisive player in the global energy economy and supply chain architecture. The implications of this shift extend far beyond the Middle East, touching upon the stability of markets, the cohesion of international institutions, and the evolving nature of power in the twenty-first century.

The war with Iran is best understood not as a discrete regional conflict, but as a structural moment in the transformation of the international system. It reveals a growing disjuncture between the continued reliance on coercive statecraft and the realities of an interdependent global order in which power increasingly derives from control over critical economic and infrastructural nodes. Rather than achieving strategic containment, the conflict has underscored the capacity of a relatively constrained actor to generate systemic effects through geoeconomic leverage. In doing so, it highlights a broader shift from military-centric conceptions of power toward forms of influence embedded in networks of energy, trade, and supply chains.

This is not merely a redistribution of power, but a redefinition of how power operates. At the systemic level, the war accelerates the erosion of the post-Cold War order, reinforcing tendencies toward fragmentation, parallel economic arrangements, and multipolar competition. Iran’s potential re-emergence as a global actor should therefore be seen less as an isolated outcome than as a manifestation of these deeper structural changes. In this sense, the strategic significance of the war lies in its unintended consequences: it exposes the limits of coercive hegemony while simultaneously amplifying the importance of those actors positioned to exploit the vulnerabilities of an interconnected world.

by Gamini Keerawella ✍️

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The dawn of smart help for little ones

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How Artificial Intelligence is breaking barriers in Autism Diagnosis and Care

For any parent, the early years are a most valuable countdown of “firsts” of his or her precious child: the first step, the first clear word, the first beautiful smile, and quite a few other firsts as well. Yet for all that, for some families, that joy is overshadowed by a growing, quiet, but disturbing intuition that something is even a little bit different. Perhaps a child is not responding to his or her name, or the little one seems to be more interested in the spinning wheels of a toy than a game of peek-a-boo, or even avoids normal social responses.

In many countries, especially in the developing world, the road from that first “gut feeling” that there is something wrong, to a formal diagnosis of Autism Spectrum Disorder (ASD) is often a long and exhausting journey. While doctors can often identify autism in children as young as 12 to 18 months, the average age of diagnosis in our communities still hovers around four years. In these critical years, when a child’s brain is most like a machine ready to learn and adapt, time is of the essence and is the most valuable resource a family has.

Today, a new “algorithmic dawn” is offering a shortcut to really cut that delay. Artificial Intelligence (AI), the very same smart technology that helps us navigate traffic, suggest a new song, or help people with ChatGPT, is moving out of the lab and into the children’s nursery. By acting as a digital “magnifying glass”, specifically designed AI tools can now spot subtle patterns in a child’s gaze, some little quirks in the rhythm of their babbling, or the way they move, often much faster than the human eye can. Then the machine can issue a warning signal and indicate that further action and a proper evaluation are necessary. This is most certainly not about replacing the brain, the heart and the expertise of a paediatrician; it is about providing “Smart Help” that can be accessed from a smartphone in a family living room. For millions of “little ones on the spectrum”, most notably in the developing world, this technology is turning a journey once defined by waiting, uncertainty and even tears, into one of proactive care and even brighter horizons. The time gained is most certainly a very valuable window of opportunity.

What is the “Spectrum,” and Why Does Time Matter?

Autism is described as a “spectrum” because it affects many children somewhat differently and to varying degrees. Some children may have advanced technical skills but struggle to hold a conversation; others may be non-verbal or have intense sensory sensitivities. It can be very mild or very severe, and perhaps everywhere in between as well.

The common thread is that the brain develops differently in these affected children. This is why Early Intervention is the gold-standard goal. During the toddler years, a child’s brain is incredibly “plastic”, meaning that it is a highly adaptable and ready to learn type of organ. Starting therapy and management strategies during this valuable period of opportunity can fundamentally change a child’s future life path.

The problem, to a certain extent, is that traditional diagnosis of ASD is a slow, manual process. It requires intensively trained experts to watch a child play for hours and fill out complex checklists. In many countries, including Sri Lanka, where there is a massive shortage of these highly qualified specialists, the waiting list for a consultation alone can take months or even years. These doyens are rather thin on the ground and even when available, are heavily overworked.

Enter the AI Revolution: Seeing the Unseen

AI certainly does NOT replace doctors, but it acts like a high-powered magnifying glass. By using “Machine Learning”, computers can analyse massive amounts of data to find tiny patterns that the human eye might miss. Here is how it is changing the game:

1. Tracking Gaze and Smiles

One of the earliest signs of autism is how a child looks at the world. AI “Computer Vision” can analyse a simple video of a child playing. It can track exactly where the child is looking. Does the child look at a person’s eyes when they speak, or are they drawn to the spinning wheels of a toy in the corner? AI can quantify these “social attention” patterns in seconds and add them to a cache of things that ring warning bells.

2. The Sound of a Voice

Did you know that the “music” of a child’s speech can hold clues? AI can listen to the pitch and rhythm (called prosody) of a child’s voice. Children on the spectrum sometimes have a “flat” or monotonic way of speaking. AI algorithms can measure these vocal biomarkers with incredible precision, helping to flag concerns long before a child is old enough for a full conversation.

3. Movement and Play

Repetitive behaviour, like hand-flapping or rocking, are core traits of ASD. Sensors in smartphones or simple video analysis can now categorise these movements objectively. Instead of a parent trying to describe how often a behaviour happens, the application or ‘app’ provides a clear, data-driven report for the doctor.

Innovation at Home: India’s Digital Solutions

The most exciting part of this technology is that it does not require a million-dollar lab. In India, where smartphone use is booming, several “homegrown” apps are bringing specialist-level screening to rural and urban homes alike.

Apps like CogniAble, which give parents a step-by-step intervention plan based on the child’s specific needs, or START, a tablet-based tool used by local health workers in areas like Delhi slums to spot risks via simple games, or LEEZA.APP, which offers free AI screening to remove the “money barrier” that keeps many families from seeking help, or AutismBASICS, which provides thousands of activities and a milestone tracker to help parents manage daily therapy at home, are just a few of the programs in use at present. These tools are “democratising” healthcare. A mother in a remote village with a basic smartphone can now access the same level of screening logic that was once only available in a major city hospital.

Beyond the Diagnosis: A Robot Tutor?

The role of AI does not stop once a diagnosis is made. It is also becoming a tireless “co-therapist.”

For many children with autism, the human world can be unpredictable and overwhelming. AI-powered “Social Robots” or interactive apps provide a safe, predictable environment. These “Robo-Therapists” do not get tired, they do not get frustrated, and they can repeat a social lesson even 100 times until the child feels comfortable.

Furthermore, for children who are nonverbal, AI-powered communication apps serve as a “voice”. These apps use smart technology to predict what a child wants to say, allowing and facilitating them to express their needs and feelings to their parents, even for the very first time.

The Human Element: Proceed with Care

As bright as this dawn is, experts warn that we must move forward carefully and most intelligently.

= Privacy: Because these apps collect sensitive videos and data about children, keeping that information secure is a top priority.

= Cultural Differences: An AI trained on children in the US or Europe might not perfectly understand a child in Sri Lanka. We need “diverse local data” to ensure the algorithms understand our local languages, gestures, and social norms. Many of these programs need to be home-grown or baked at home in Sri Lanka.

= The Human Touch: Most importantly, we need to always remember that AI is a tool, not a replacement. A computer can spot a pattern, but it cannot give a hug, provide emotional support to a struggling parent, or celebrate a breakthrough with the same joy as a human therapist.

A Brighter Future

We are moving toward a world where “waiting and seeing” is no longer, and quite definitely, not the only option for parents. By combining the heart of a parent and the expertise of a doctor with the speed of an algorithm, we can ensure that no child is left behind because of where they live or how much money they have.

The “Algorithmic Dawn” is not just about code and data. It is about giving every child the best possible start in life. It is the main principle on which Hippocrates, the Father of Medicine, all those centuries ago, based all his postulations on how physicians should work.

 The “Red Flag” Checklist: 18 to 24 Months

The American Academy of Pediatrics recommends screening all children at 18 and 24 months. If you notice several of these signs, it is time to use an AI screening app or consult your paediatrician.

Communication and Social Cues

= The Name Test: Does your child consistently fail to turn around or look at you when you call his or her name?

= The Pointing Test: By 18 months, most toddlers point at things they want (like a biscuit) or things they find interesting (like a dog). Is your child using your hand as a “tool” to get things instead of pointing?

= The Eye Contact Test: Does your child avoid looking at your face during social interactions or during play or when being fed?

= The Shared Smile: Does your child rarely smile back when you smile at him or her?

Behaviour and Play

= The Toy Test: Does your child play with toys in “unusual” ways? (e.g., instead of rolling a car, they spend 20 minutes just spinning one wheel or lining them up in a perfect, rigid line).

= The Routine Rule: Do they have an extreme “meltdown” over tiny changes, like taking a different route to the park or using a different coloured cup?

= Repetitive Motions: Do you notice frequent hand-flapping, rocking, or spinning in circles, especially when they are excited or upset?

The “Golden Rule” of Regression

Finally, an extremely important rule for concerned parents to follow.

If your little one had words (like “Mama” or “Dada” or “Amma” or “Thaththa” or Thaii/Amma or Appa) or social skills (like waving “Bye-Bye”) and a beautiful social smile etc, and then SUDDENLY STOPS USING THEM, that could be a most significant red flag. In such situations, the standard advice would be: Please consult a doctor immediately.

by Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics),
MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK),
FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow,
Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

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Governance, growth and our regional moment:Why Sri Lanka must choose wisely

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The recent disclosure of a substantial internal fraud at National Development Bank has understandably unsettled the financial community. What began as a relatively contained incident has since been revised upwards, revealing a scheme that operated over an extended period within a specific operational area. To their credit, both the bank and the Central Bank of Sri Lanka responded with speed. Staff were suspended, arrests followed, an independent forensic review was commissioned, and clear assurances were given that customer funds remained secure. The institution’s capital and liquidity positions continue to meet regulatory requirements, and day to day operations have not been disrupted.

Yet it would be a mistake to view this as an isolated operational error at a single respected institution. When a fraud of this magnitude, equivalent to more than a year’s profit for the bank, emerges within one of our most established listed companies, the implications extend well beyond the banking sector. It prompts a necessary and uncomfortable question. Are we truly strengthening the foundations of our economy so that every part of our society can operate with the integrity and confidence that sustainable progress demands?

Banking sits at the heart of any modern economy. It channels savings into investment, supports enterprise, and underpins household security. When even a leading institution reveals weaknesses in internal controls, risk oversight or governance culture, the signal to international observers is difficult to ignore. It suggests that the financial system upon which growth depends may not yet possess the resilience we aspire to project. If institutions that have undergone significant reform since 2022 can still experience such failures, what assurance can investors reasonably expect in other sectors of our economy? At a time when Sri Lanka needs to demonstrate strength and reliability, perceptions of fragility carry a heavy cost.

This matters profoundly because a genuine window of opportunity is now opening. Geopolitical shifts in the Middle East and beyond are prompting global investors and entrepreneurs to seek stable, well governed destinations for capital and talent. Sri Lanka possesses distinct advantages. Our geographical position offers natural connectivity. We have invested in critical infrastructure, including two major ports, international airports and strategic energy reserves. In an era where businesses prioritise rule of law, institutional predictability and sound fundamentals, our potential alignment with these criteria is significant. However, high profile governance failures at this precise moment risk undermining that narrative before it can gain meaningful traction.

The stakes are equally significant for initiatives such as the Port City Colombo. With substantial projects now approved, foreign investment commitments secured and early construction underway, this endeavour is moving from concept to delivery. Yet persistent concerns about governance standards in our established companies can act as a drag on investor sentiment. The confidence required to attract high value international tenants and long- term capital depends not only on physical infrastructure but on the perceived strength of our institutions and the consistency of our regulatory environment.

For decades, Sri Lanka has experienced growth averaging around four to five per cent per year. While this is not insignificant, it falls short of our potential, particularly when measured against the progress of our regional neighbours. India, for example, has sustained growth at roughly twice our rate for more than twenty years, driven by consistent policy execution and strengthening institutional credibility. Our own trajectory has been held back not by a lack of ideas or ambition, but by recurring shortcomings in how our major institutions are governed and held to account. The result is a cycle of unrealised potential, where promising openings are not fully converted into lasting advancement.

The current situation, though challenging, can serve as a catalyst for meaningful change. Boards of listed companies must move beyond procedural compliance to foster a genuine culture of ethical leadership, proactive risk management and zero tolerance for control failures. Regulators have an opportunity to undertake a comprehensive review of fraud prevention frameworks, whistle-blower protections and monitoring standards across the financial sector, with lessons applied to other key industries. Greater transparency in reporting material incidents and more timely forensic follow through will help rebuild trust with both domestic and international stakeholders.

Crucially, the government must tread carefully as it responds. Short term fixes or reactive measures may address immediate concerns but will not deliver the enduring stability that investors seek. What is required is a coherent long-term strategy that balances the imperative for rapid economic development with the equally vital need to conserve our natural environment and strengthen regional cooperation. Our neighbours in South Asia and Southeast Asia offer not only markets for trade and investment but also partners in shared challenges such as climate resilience, sustainable infrastructure and digital connectivity. By deepening these relationships through practical collaboration, Sri Lanka can position itself as a reliable and forward-looking partner in a dynamic region.

Sri Lanka stands at a pivotal moment. Global realignments are creating rare opportunities for capital inflows, technology transfer and new economic partnerships. Yet these opportunities will flow most readily to nations that demonstrate they can protect investor interests, uphold the rule of law and operate with predictability and transparency. If we allow governance weaknesses in our flagship institutions to persist, we risk once again watching potential pass us by.

This is a defining moment, and our response must be equally purposeful. We can treat the recent events as an unfortunate but isolated incident and return to established patterns. Or we can seize this moment as a timely reminder to strengthen every pillar of our economy, with particular attention to environmental stewardship and regional collaboration. Only by getting our house in order, with patience, consistency and a clear-eyed commitment to long term goals, can we convert today’s challenges into tomorrow’s competitive advantage. The path to sustained prosperity demands nothing less.

by Professor Chanaka Jayawardhena
Professor of Marketing
University of Surrey
Chanaka.j@gmail.com

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