Features
Healthcare in a bankrupt Sri Lanka
By Dr Ajith Amarasinghe
On the eve of the Sinhala and Tamil New Year day, of the 12th of April 2022, Sri Lanka pronounced that it is a bankrupt country by declaring that it cannot pay its debts. It is predicted that the shrinking economy of Sri Lanka will not bounce back to the level of 2018 for at least three to five years. The impact this state of bankruptcy would have on the health-care of the people of Sri Lanka has not been discussed in depth. The ramifications of the effect of economic bankruptcy has on the health of Sri Lankans are multifaceted. To many, it would result in a shortage of medicine and healthcare equipment. Emergency measures are taken to obtain these, as donations from other countries or philanthropists. Although the loss of a human life, due to lack of medications or services caused by an economic meltdown, generates emotional and sensational stories, healthcare providers should look beyond these and take remedial steps to prevent a bigger healthcare catastrophe.
Sri Lanka spends about 3.4% of its GDP on healthcare, which amounted to Rs 423 billion in the year 2018. With a very low level of per capita healthcare spending of 161 USD, Sri Lanka has achieved very high levels of healthcare indices. In comparison, per capita healthcare spending in the USA is approximately USD 10,900, and in the UK USD 4,300. A country which has comparable healthcare indices, such as Cuba, spends six times that of Sri Lanka, being USD 1,321. In fact, Sri Lanka has become a success story in the eyes of international agencies, as a model where high healthcare indices and qualitatively higher levels of care have been achieved at a very low cost. Under these circumstances, further curtailment of per capita healthcare expenditure is near impossible. Although the Prime Minister emphasized, in public, that reducing healthcare expenditure would not be done at any cost, a shrinking economy would make this a necessity through compulsion. This article is an attempt to initiate a serious, in depth discussion about the impact the economic bankruptcy will have on the healthcare system in Sri Lanka, ways to minimize morbidity and mortality patterns in the country, and to protect the nation’s overall health.
Private spending on healthcare
Although Sri Lanka boasts of having a “free” healthcare system, nearly half of its healthcare spending is through private sources. Private financing is done through out-of-pocket spending by patients, private insurance, insurance paid by enterprises, and contributions from non-profit organisations. Of all the private health spending, out-of-pocket expenditure by patients for medical care was 81% in the year 2018. In contrast, in many developed countries where a genuine free health system exists, direct government spending and widespread public health insurance schemes account for more than 90% of healthcare spending.
Although government spending on hospital (inpatient care) expenditure is 74% and private spending is 24%, in non-hospital expenditure (outpatient care), private spending by patients is 77%. Overall, about 84% of the expenditure to supply medicines and other medical goods to outpatients was privately financed, mostly by household out-of-pocket spending. This indicates that when the economic meltdown affects individual income badly and the per capita income of Sri Lanka falls, outpatient care will be seriously affected. The exorbitant increase in prices of drugs, due to the devaluation of the rupee, would make it even more difficult to purchase essential medications. In recent months, certain drug prices have risen by 60%, forcing patients to reduce the quantity of medications they take or abandon taking medications at the expense of other essential commodities, such as food, fuel, electricity, cooking gas, etc. This reduction in the buying power of medicines would mainly impact patients with non-communicable chronic diseases, such as diabetes, ischemic heart disease, hypertension, renal diseases etc., in which lifelong treatment is essential.
To safeguard this economically marginalized segment of society and the “new poor” created by economic collapse, they will have to be helped by redirecting them to the government sector where drugs are provided free of charge. When this happens, the government’s expenditure on health care would naturally increase. The other option is to introduce a national health insurance scheme with government intervention, to cater to this segment, which is currently not serviced through government funding. Sri Lanka still has underdeveloped medical insurance schemes. Although company medical benefits, which provided 2% in 1999, increased to 9% in 2018, it is still a minute proportion of the total health care spending.
Public spending
In analyzing the sources of financing for health care expenditure, it could be observed that during the period of 1999 to 2018, the relative share of public financing in health care has increased from 40% to 58% and private financing has reduced from 60% to 42%. The central government’s share of public sector financing was 60%; provincial governments 32%; and local governments 2%. The Suraksha student insurance scheme and ETF contributed a minute 0.3% in the year 2018.Government expenditure on health care is mainly financed from revenue generated through public taxation. The reduction of government taxation in the year 2019 had a strong impact on government revenue. In addition, the government obtains its income through foreign aid and loans. Due to the default of loans obtained, further harnessing of loans has become a near impossibility. All these would contribute to a drastic reduction in government income and, in turn, the ability of the government to spend on health care would be reduced. The practical solution would be to increase government taxation or even introduce a “social benefit tax” and use the revenue generated to maintain current levels of government financing of health, education and social services.
The contribution of donations through foreign sources to health care spending was less than 1% throughout the years. With the downfall of the economy, foreign donor agencies such as WHO, UNICEF, World Food Program, and international non-governmental organizations may come to our assistance, increasing the contribution of direct foreign donations to health care. Establishing a separate unit in the Ministry of Health to identify and harness the organizations that are willing to help Sri Lanka by harnessing their contributions and directing such donations to essential sections of health care is important. However, even with these measures, it would still be essential to cut down on government expenditure on health care. In the event of such a scenario, the healthcare managers should have a clear idea as to which expenditure should be curtailed.
Health care expenditure
Current expenditure on health goods and services in Sri Lanka in 2018 was estimated at Rs. 423 billion. Overall, current health expenditure (CHE) nearly quadrupled in real terms between 1999 and 2018. Per capita Health expenditure of Sri Lanka increased from 44 US dollars in 2000 to 101 USD in 2010 to 161 US dollars in 2019 growing at an average annual rate of 7.44%.The ratio of CHE to GDP fluctuated between 2.6% and 3.7% during 1990–2019. This indicates that health care expenditure increased more or less proportionately to the increase in GDP. With the shrinking of GDP due to the economic downfall, it would necessarily mean that expenditure on health care would naturally be reduced. Going back to the 2009 level of spending patterns after proper cost-benefit analysis may become essential.
The largest part of health spending is for curative inpatient care, which is mainly financed by public spending. Total spending on hospitals has quadrupled between 2009 and 2019 (estimated), and it has become more inclined towards large hospitals in this period. This is very likely to be due to spending on infrastructure development and purchasing expensive equipment for large hospitals. To reduce the cost of this segment, non-essential capital expenditure in inpatient care has to be curtailed. As the expenditure on health in an economically vulnerable period has to be done carefully, in the future, any government health care spending has to be done after careful cost-effective analysis by the Ministry of Health through a transparent scientific mechanism. A cost-effectiveness analysis is a method for assessing the gains in health relative to the costs of different health interventions. Even though it is not the only criterion to decide on the allocation of resources, relating the financial and healthcare implications of different interventions is important.
From 2009 to 2019, spending on healthcare institutions increased fourfold, with no significant improvement in communicable or non-communicable disease case fatality rates. During this period, mortality from cardiovascular disease, diabetes, and chronic renal disease decreased from 22.3 to 17.5 percent. Therefore, if there is a need to reduce the costs, the government may have to take a difficult decision to roll back to the past to reduce the health care costs based on spending patterns of 2009.This may include curtailment of expensive drugs, instruments, equipment, and constructions .
To reduce the cost of purchasing medications, essential drug lists have to be made by respective professional colleges of specialties, based on scientific analysis of mortality and morbidity patterns. The purchase of quality generic drugs has to be done and a special unit has to be established in the MOH to coordinate the donated drugs and equipment monitoring. Distribution and maximum utilization of drugs has to be done through the currently underutilized IT based centralized method, to maximize utilization and minimize wastage. Producing drugs and equipment in Sri Lanka has to be done after a careful cost benefit analysis of the wisdom of producing each item in Sri Lanka.
Preventive health services
Of the total health expenditure, only 5% is spent on preventive care services, though the government’s slice of expenditure on preventive health is 98%. Expenditure on preventive health includes universal vaccination programs, family health worker network maintenance, health education, health promotion, and related public health services. Arguably, the current excellent health care indices of Sri Lanka were achieved through its spending on public (preventive) health. Therefore, the meager spending of 5% on public health should not be reduced at any cost. In fact, it may be essential to increase it to match the inflation, without which the public health services may collapse. Foreign donor agencies such as UNICEF and GAVI (Global Alliance for Vaccines and Immunization) should be requested to provide us with vaccinations free of charge for the expanded program of vaccinations (EPI), as it happened before we became a middle income country. Of the inpatient services, cost reduction should not be done at all in maternal and child health services.
Reduction in morbidity and mortality in communicable diseases, which were the main causes of illnesses in the past in Sri Lanka, was achieved through preventive health campaigns. Similarly, through public education campaigns, reductions in 1st and 2nd leading causes of hospitalization, namely traumatic injuries (most of which are domestic and occupational accidents) and non-communicable diseases, could be achieved.
Production of medicine
Encouraging local production of drugs is one proposal made to provide medicines at a lower cost. Although manufacturing medications would reduce the foreign exchange drain, the cost of producing certain drugs locally may be higher than importation. Therefore, encouraging local manufacturing with the intention of reducing prices has to be done after careful analysis on an individual basis.
Impact on nutrition
Souring food prices due to hyperinflation and food shortages caused by the shortsighted implementation of organic fertilizer policy has made food items unaffordable to the poor. This would result in acute and chronic protein energy malnutrition, vitamin and micronutrient deficiencies, especially in children and pregnant women, affecting future generations of the country. Health education and health promotion programs have to be conducted to make the public aware of cheap, nutritious food and a balanced diet. Common food programs for the poor, provision of micronutrient and vitamin supplementation programs to the vulnerable population, and the reintroduction of school mid-day meal programs through the existing public health and education structure may become essential. Utilization of existing official networks would ensure such programs are not politicized and ensure only the needy get the essential food items.
Conclusion
Although paying attention to the urgent supply of medication is an important aspect of saving human lives, it is critical that healthcare managers look beyond the medication shortage and initiate a serious scientific discussion about maintaining health services in Sri Lanka during the economic crisis. If this is not done soon, the population of Sri Lanka would face a major health care crisis which could not be salvaged by a late intervention.
Dr Ajith Amarasinghe- MBBS, DCH, MD (Sri Lanka), MRCP, MRCPCH (U.K), P.G Dip in Asthma & Allergy (CMC-Vellore), MBA-Health Care (Manipal) could be reached through amarasinghe_ajith@yahoo.com
About the writers: Dr Ajith Amarasinghe is a Consultant Paediatrician and a Clinical Allergist who holds an MBA in healthcare from the University of Manipal. He has held administrative positions in the public and private sectors.
References
-Rannan-Eliya, Ravi P. Sri Lanka- “Good Practice” in Expanding Health Care Coverage – Institute for Health Policy Colombo- 2009
-Medical Statistics Unit- Annual health statistics 2019- Ministry of health Sri Lanka
-Ministry of health Sri Lanka-Annual health bulletin 2018- Ministry of health Sri Lanka
-Sarasi Nisansala Amarasinghe [et al.] – Sri Lanka health accounts: national health expenditure 1990- 2019 (IHP health expenditure series; No. 6) – Institute for Health Policy- Colombo- 2020
-World Health Organization, Global Health Observatory Data Repository- Mortality from CVD, cancer, diabetes or CRD between exact ages 30 and 70 male% -Sri Lanka- apps.who.int/ghodata.
-Department of Census and Statistics- Economic Statistics of Sri Lanka 2021- 5th bulletin- The Department of Census and Statistics 2021
-Department of Census and Statistics- The 2016 Sri Lanka Demographic and Health Survey-SLDHS- Department of Census and Statistics
-World Health Organization – Current health expenditure per capita (current US$) – Sri Lanka https://data.worldbank.org › SH.XPD.CHEX.PC.CD- 20th Jan 2022
Features
Reading demands for change
by Jehan Perera
The political avalanche that swept the electoral landscape due to the demand for change was unprecedented. In some electorates the majority achieved by the NPP exceeded 70 percent. The overall majority in the country was 61 percent. The avalanche swept aside many who had earned names for themselves on account of their long years of commitment to influence policies in the national interest. In their place will be a host of much younger persons who will come in with their ideals and hopes for positive change but with little experience of governance and even administration. The government is aware of this issue and has arranged for a three-day workshop on parliamentary procedures, session activities and the functioning of committees.
With 159 seats the NPP has won more than a 2/3 majority. This is not the first time that a government has enjoyed such a huge majority. The last time was as recent as 2019 when the SLPP under the leadership of President Gotabaya Rajapaksa obtained close to a 2/3 majority which it speedily converted into a 2/3 majority by persuading several opposition members to cross over and be rewarded accordingly. A 2/3 majority is not a panacea as was experienced shortly after 2019 by disastrous decisions including constitutional amendments from which the country is yet to recover. The huge majority meant that the government leaders felt they could do anything and get away with it. This led to crooked deals, to murder and to impunity.
Prior to that in 1970 and 1977 there were 2/3 majorities in parliament won by the SLFP and UNP respectively, though under the first-past-the-post system which made it possible to win a huge number of seats even with less than 40 percent of the electorate voting in favour of the ruling party. Here, too, there were crooked deals, murder and impunity. This time it has got to be different. The government needs to seize this moment of unprecedented goodwill to address the country’s long-standing problems. The people have voted with great expectations and if the results are not seen soon then cynicism and vested interests will make their comeback.
SIMILAR OUTCOMES
Significantly, the widespread support for the NPP, cutting across geographical, ethnic, and religious divides, represents a remarkable step toward national unity. Even regions historically disillusioned with central governance have placed their trust in the president’s leadership. This inclusivity, evidenced by the support of ethnic and religious minorities, is an encouraging sign that the NPP has succeeded in fostering a national perspective that transcends traditional divisions. However, this trust brings with it a significant responsibility.
The electoral outcome in the north and east of the country in which the ethnic and religious minorities predominate is a first-time occurrence. In these parts of the country, the electorate had voted for parties that represent particular ethnic and religious interests for many decades, during which the ethnic conflict and their sense of neglect grew exponentially. Likewise, in the rest of the country, the ethnic and religious majority voted for political parties that represented their own particular ethnic and religious interests.
As a result, the electoral map in the aftermath of elections invariably took on a two-tone complexion, with the north and east being in one colour and the rest of the country being in another. Even 15 years after the end of the three-decade long war for separation, the electoral map resembled the maps produced by the LTTE which spearheaded the military campaign. For the first time the map is now of a uniform colour with the exception of a single district, the other 24 being of one colour.
What has been noteworthy at these elections has been the similarity of outcomes in the north and east and the rest of the country even though some of the most pressing problems of the people in the north and east was not a part of the election campaign of the major political parties. All parts of the country share the problems of economic recovery and have a common interest in ensuring that corruption is minimised and the poor are protected rather than being subjected to economic extraction. But the north and east has a special interest in issues of devolution of power, demilitarisation and return of land and resolving the problems of missing persons and long-term prisoners from the days of the armed conflict. And though less discussed, they also want the development of the two provinces which are below the average standard in the country.
REJECTING PAST
The massive vote for the NPP is as much an expression of trust and positive expectations from the government as it is a rejection of the other political parties that have governed the country in the past and brought it to the bottom in 2022. The stabilisation of the free fall by former President Ranil Wickremesinghe from May 2022 until his defeat at the presidential election of November 2024 did not receive the appreciation his supporters anticipated. This was because a section of the population was continuing to prosper through relationships with those in positions of power while the main burden of the economic collapse was thrust on the majority of people. It was also due to the former president’s failure to seek the causes of the economic collapse and deal with the associated corruption, even though that was not the only cause.
The fact that the main political parties that had dominated national politics continued to give nominations to those widely believed to be corrupt was one of the main reasons for the flight of voters away from those political parties. Indeed, some of these tarnished politicians managed to win seats in parliament probably due to the patronage they had extended to the electorates they nursed. However, the party leadership needs to keep in mind that the consequence of such nominations was to alienate a much larger segment of the electorate and thereby serve to erode their voter banks.
In the north and east, the failure of the political leadership of the political parties that represented minority interests to show any significant results over the past decades was a factor that alienated the electorate away from them. It is largely these negative factors that have caused the minority voters to move away from continuing to support them. The government needs to seize the opportunity that its landslide victory provides to engage in the necessary discussions, negotiations and accommodations to bring about a political, and long lasting constitutional, solution to the ethnic conflict. Such a solution would require the 2/3 majority that the NPP has obtained to amend the constitution and to entrench the political solution in law.
QUICK CHANGE
However, unlike the people in the rest of the country who may be willing to give the new government more time to reform the system, those in the north and east who have been let down time and again by the promises of successive governments, may not be willing to wait. There is much that can and should be done without needing constitutional amendment but by simply implementing existing laws, to resolve problems regarding land, memorialization use of the Tamil language, appointment of Tamil officers as heads of units and department, and so on. The government has an incentive to act speedily in this regard to hold on to the support that they have received from the ethnic and religious minorities. It will be easier to show speedy results in dealing with ethnic and religious grievances than in reviving the economy, given the constraints the national economy is under.
Due to the prevalent economic conditions, which are at “knife’s edge” if the IMF is to be believed, the new government will be hard pressed to show quick fixes, just as the previous government under President Wickremesinghe also could not show quick fixes. The fiscal realities give the government little room to manoeuver on the economy. However, in the case of resolving the ethnic conflict there is no reason for the government to delay. Unlike in the case of economic recovery for which there are no short-term panaceas, the solution to the ethnic conflict is one that can be resolved soon as it has been discussed, negotiated and publicised on several occasions, but not implemented due to the failure of leadership.
A solution to the ethnic problem will be welcomed not only by the ethnic and religious minorities within the country but also by those living outside in the diaspora and by the international community, most notably India which has always been promoting it as good for Sri Lanka and good for India. A successful resolution of this problem will gain international recognition in a world that is looking for success stories and can induce foreign investors to come in due to the assurance of peace. The NPP government has the opportunity to set a precedent by engaging with all stakeholders, including civil society and opposition parties, to craft a sustainable political solution that ensures lasting peace and reconciliation. It cannot be overemphasised that achieving a sustainable political solution that will last the test of time will require the participation and consent of all communities and collaboration with opposition parties.
Features
Coming up…dance of the year!
As we get closer to the month of December, I’m reminded of the Beatles hit song, ‘It Won’t Be Long’.
Yes, of course, it won’t be long before we start experiencing the festive atmosphere, the dawning of Christmas, and then the New Year, 2025.
This year, the festive season should turn out be a brighter scene, with 31st night being extra special at most venues.
One particular event that got my attention is the New Year’s Eve dance that is being put together by the folks at Cinnamon Lakeside, ably led by Nazoomi Azar, the hotel’s new General Manager.
With his experience, having worked in London, Nazoomi is determined to make the hotel’s NYE happening the dance of the year.
According to Nazoomi, it’s going to be an awesome event, aptly titled ‘James Bond Gala Dinner Dance.’
I’m told guests will be given VIP status at the ‘James Bond Gala Dinner Dance’ and will experience a totally different scene as they head into 2025.
To create the kind of music that would be best suited for such a prestigious happening, the hotel has signed up the well-known 31st night music makers in town, Sohan & The X-Periments, along with the band AROH, and guest stars Judy De Silva, Falan Andrea, Geoffrey Fernando and J-Pal.
Last 31st night (2023) and in 2022, Sohan performed in Australia and London, respectively, so, he says, he is going to make this 31st night happening at Cinnamon Lakeside King’s Court Ballroom, a truly memorable event.
Sohan went on to say that it will be an exciting fun-filled night and the guests coming from abroad, especially Sri Lankans, can expect a very special performance from the galaxy of stars who will light up the scene with their music.
“Yes, with two bands in attendance, we will provide non-stop entertainment, and the dance will end with a traditional Sri Lankan breakfast.”
Guests, at this event, will also be able to enjoy all the New Year activities in the entire hotel, which will include a foreign DJ operating under a marquee, a mini dance in the Library, as well as check out the longest 5-star buffet in town.
No doubt, this ‘James Bond Gala Dinner Dance’ is going to be a memorable, exciting, fun-filled affair.
Features
The slow, inexorable demise of book(store)s
by Panduka Karunanayake
Call me a hopeless nerd or even a worthless pedant, but one of my favourite relaxations is to go book-hunting in the city’s ‘second-hand bookshops’ (or as they are known overseas, ‘used bookstores’). Of late, I have had less occasion to indulge myself in this innocuous pleasure, both because it is becoming harder to find a book that hadn’t attracted my attention before and because there is no more space in my reading room to keep any new acquisitions. And also because, I suppose, I know intuitively that the likelihood of a new book making an impact on me or the world around me now is vanishingly small, since the years have inexorably caught up with me too. Not to forget, there are also quite a few books in my room that are still crying out for my serious attention.
But when I recently found the time and courage to visit my favourite hide-out, namely the Senanayake Book Shop on Galle Road in Wellawatte, I realised that times have indeed changed. It has been gradually folding up for some time, being ‘more closed than usual’ (to rephrase the title of a book that is well known to many of us). It is now closed for good – I was told by a street vendor selling his wares on the pavement in front. That message really drove home hard. It was as though a third parent has passed away. I heard from the shopkeeper next-door that the owners had donated the remaining books to a public library and sold the premises.
Within Colombo itself, there are the hide-outs on (former) McCallum Road, Bookland on Marine Drive and the one in the Narahenpita Economic Centre. Kandy too has its few hide-outs. Whenever I travel overseas and spend more than a few days in a city, I make it a point to find out the city’s used bookstore hide-outs. I used to take pride in my knowledge about these hide-outs in cities such as London, Liverpool, Toronto, Trivandrum and Melbourne – which even the locals didn’t know! I used to say that I can find used bookstores better than an alcoholic can find taverns.
But of late, all these have been folding up gradually. Melbourne has probably only one general used bookstore, the City Basement Bookstore on Flinders Street, and even that is not open as usual. Toronto’s list, which used to be more impressive than those of any other city I had visited, is now all but evaporated. The few remaining serve only specialised, expensive collectors’ items. There is hardly any that can serve a non-specialist reader such as me, like the Senanayake Book Shop which was, quite simply, one of the best in the world.
Second-hand bookshops served two very important purposes in my life as a reader. The first is that it gave me access to good books at an affordable price. For instance, at Senanayake Book Shop an average book would cost less than Rs 500 – a price for which there are no items in most restaurant menus that we visit. Of course, there are the very expensive collectors’ items, but I have always been careful to steer clear of them. The second purpose is that when a person who had been an avid, erudite reader passes away, the family generally has no use for the deceased person’s significant book collection; the whole collection either ends up in a library as a special collection or is bought by a second-hand bookseller for a pittance. Soon afterwards, we would be spending hours in the bookshop devouring over the newly acquired collection therein, enjoying and admiring it and maybe buying a few off it.
This second purpose is very important even to those readers for whom money is no matter, because such book collections, which had been painstakingly put together by the deceased person over decades and after visiting several countries, are truly priceless. No bookstore selling new books, not even online ones, can possibly compete with this. Book collections of that sort have a high proportion of quality reading and rare gems – bookstores selling new books have books across the whole spectrum of quality, with most new books as a rule being worthless.
But is all this of any consequence? In this digital age, when e-books and e-newspapers are replacing the printed word globally and rapidly, can a nerd like me have a good reason to lament? Or, is my kind simply on its way out and just-as-well too?
I think books play an important role in our learning that e-books cannot. Everyone talks about the ephemeral, intangible and unromantic nature of reading an e-book. But that is not the point (although that too is a good point for romantics like me).
A book is a mini-journey of discovery – and it is this journey, not the discovery, that helps us to learn. When we take a book in our hands and start reading it or look for some information in it, we must necessarily go through its contents page, chapters and the layout inside the chapter in order to find what we are looking for. In so doing, we are experiencing something very important, imperceptibly. We are gradually building our mind map: the complex relationships between different quanta of information and how they are arranged in the universe of knowledge. Learning is not merely remembering information – it is being able to relate different quanta of information to each other, determining the significance of one quantum in the light of another and in the bigger scheme.
When we ask an erudite professor an unusual or novel question and the professor answers it dextrously, you will find that the secret of that dexterity is usually the professor’s ability to locate the question in the correct place in the universe of knowledge – which is represented in a miniature form inside the professor’s brain, as a mind map.
An e-book experience does not give us quite the same journey, especially if we located the information that we are looking for by using its search engine (which is akin to locating it in a printed book by using its index).
What is more, sometimes the journey turns up unexpected surprises: we may be looking for Fact A but may stumble upon Fact B, which suddenly captures out attention and we spend the rest of the evening reading – leaving for another day the discovery of Fact A. Those serendipitously acquired collections of knowledge come quite handy – in vivas, interviews, cocktail circles and solving unusual problems needing out-of-the-box solutions. They are often the foundation of what is known as adaptive expertise (in contrast routine expertise). Or to put more simply, such lateral mini-journies promote lateral thinking.
As books go out of use, as second-hand bookstores go out of business, as the reading habit becomes harder to sustain, as information acquisition becomes more crucial to success than knowledge development, as the average attention span reduces in one generation from 20 seconds to 8 seconds (and continues to reduce), what will become of human learning? Am I just mourning the demise of second-hand bookshops, or is this something more serious for humanity? I think you know the answer, which has been rendered even more frightening with the emergence of generative artificial intelligence and open-access chatbots – which have made redundant not only knowledge development but even thinking in itself.
But for now, let me mourn the demise of my favourite ‘used bookstore’. Thank you, Senanayake Book Shop!
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