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How to minimise medical negligence or error

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by Dr K. M. Wasantha Bandara

This is a humble effort to build up on the article titled, ‘Medical negligence or error’, published in The Island on 18th July. The author of the article, Professor Susirith Mendis, who is a well reputed medical professional and an academic, has drawn our insight into unfortunate events taking place in the health system. That is very important at this time, because certain sections in the society are trying to insult and disintegrate our health system, obviously for narrow, political gains. As Prof. Mendis has emphasised it is an accepted fact worldwide that medical errors and negligence do occur in any system, although there is lack of information except for emblematic cases like the death of a young girl. However, in my opinion, any citizen may have a right to criticize any undesirable event, taking place in the process of delivery of healthcare to people, but it is very unfair to undermine the public confidence in the system. That is because our health system is considered to be Noble in terms of equity and geographical and financial access, when compared with so-called systems in most parts of the world.

I am sure there will be no one in our country to challenge the credentials of Professor Mendis to give a learned opinion on the issue. While being very much grateful and thankful to him, I must apologise to him for presenting my credentials to add some thoughts to his work as to how to minimise such incidents in the future. I am a dental surgeon who has postgraduate qualifications in three different fields, namely, Health Systems Management, Financial Management and Quality Management. I was certified as a quality manager in health care in New Zealand, and also have more than eight years of experience as a health programme manager overseas, including in certain projects funded by WHO and UNICEF. I also have participated in a number of international workshops designed to train “economic hit men” who are used to promote subtle strategies to expand the healthcare market in the name of improving the quality of care.

As such, I have personally experienced sinister attempts to disintegrate public funded health systems in favour of markets. There was one thing common in those attempts, which is what we see in our country today. These days, the attack on healthcare systems is much easier because of Zuckerberg’s army of mental slaves who can be used for the purpose free of charge. We also have experienced the role played by them to pave the way for regime change in the name of system change in Sri Lanka. The other feature which is common in these sinister attempts in exaggeration of undesired outcomes is willful cover-up of actual reasons for poor performance of the system. However, in my opinion unethical, unaccounted and corrupt practices of doctors and medical administrators do more harm to the system than errors or negligence. For example, prescribing habits of the majority of doctors are influenced by commercial interests of pharmaceutical companies, leading to over use and irrational use which is a cost to the patient as well as the nation. The corrupt practices of medical administrators in the procurement process of pharmaceuticals have undermined public confidence in the system.

I also have contributed to a research project where legal frameworks governing the healthcare delivery systems in 40 countries, including Sri Lanka, were studied. That was about more than 25 years back, and I was proud to be a Sri Lankan among western colleagues, because our system was considered to be one of the best, in terms of equity, geographical and financial access, responsiveness and relative cost of care or in other words efficiency versus effectiveness. It was also understood that remarkable performances in our health system can be attributed to free education, and civilizational inheritance, where empathy and kindness are guiding principles in social interaction in our country. Anyway, it is a fact that our people have enjoyed free healthcare, and free education ever since the origins of our civilisation.

It is obvious that we as a nation were able to achieve excellence in key aspects in our system, because of the national policy of free healthcare and hard work of health administration we had in the 70s and 80s. When compared with today’s administrative structure and the administrators themselves, the excellence of the old generation is well proved, although at that time they had no postgraduate qualifications in management, but professionalism and humanism. They took great pain amidst all constraints, especially lack of available resources, to build a system that was so effective and efficient to a level to be admired in international forums. Unfortunately, today’s generation of administrators, having postgraduate qualifications, training, and a comfortable lifestyle, have failed to uphold what their Predecessors built at difficult times than today in terms of resources. Anyway, one must be fair by accepting the fact that generational gap or deterioration of social and professional values in our society may have contributed to overall degeneration of the values in the health system.

As Professor Mendis has mentioned, and I have pointed out above, Zuckerberg’s army contributes to further deterioration of the system by posting irresponsible and indiscriminate comments in social media. In our country, although we have 6 million households, there are 8 million social media accounts and as such, there is a reasonable leverage to manipulate social opinion, and thereby social systems by a centralised system operated by external forces.

However, I will not go into details of how medical negligence or errors take place in the system, since Professor Mendis has dealt extensively on that aspect, I would like to draw the attention of the administrators and the public on the aspects of how to prevent or minimise them. Irrespective of the fact, whether the issue is negligence, error, or a kind of contributory, negligence or error, for which patients are also responsible partly or unpredictable mishap, medication error, Or poor reconciliation of medications prescribed by multiple specialists independently of each other or whatever other undesired outcome; definitely there will be a certain degree of dispute between the provider of the service and the recipient.

If the dispute is not managed properly, a minor negligence can be interpreted as criminal negligence will lead to litigation, creating more problems in the system. In the USA, it is well known that there are legal firms spying on undesirable events, taking place in hospitals and offering litigation services on the basis of sharing the compensation equally. This situation has led to unnecessary investigations and other defensive actions by the medical professionals and finally extra cost to the patient as well as the nation. That is the main reason why the US is classified as the highest spender on healthcare with poor outcomes. Healthcare spending in the US is amounting to 13.5% of the GDP, although 20 million people have no insurance cover at all for healthcare and for those who have insurance the overhead or the cost of insurance is 35%, which does not cover the cost of care.

To cut it short to be fair with The Island newspaper, which is always open for discussion, on issues of national importance, I would like to present in point form as to how to prevent or minimise undesirable outcomes in a system. Irrespective of the underlying cause of the poor outcome in the system, we could categorise those remedial measures into threefold. The first and foremost is protection of the noble fundamentals of the system, where equity, geographical and financial access is guaranteed and cost of care is contained to have justifiable balance between the efficiency and the effectiveness. People must be aware of subtle strategies, introduced to address the issue of being responsive to the expectations of the people, and finally how they facilitate expansion of the healthcare market, depriving sections of the society of basic care.

One of those subtle strategies recommended by international funders, is to divide or split the funder and provider. For example, at present, both the funder and the provider are department health, whereas if those functions are separated public and private providers have equal access to the public funds. If that is facilitated by insurance, 35% of the funds will be wasted as insurance admin cost or overhead. However, there is a need and an opportunity to improve the system further, mainly by addressing interconnected issues in the present system. One is the continuity of care and the other is a referral mechanism for specialist care, both of which can be addressed by establishing a General Practice sub system integrating the public and private out patient care.

The second approach to minimize undesirable outcomes is strengthening of legal frameworks to regulate medications, devices-etc., and to improve the accountability of medical manpower, as well as prevention and settlement of disputes. It is obvious that doctors individually cannot guarantee the safety and efficacy of medications and medical devices they are supposed to use and as such the NMRA act should provide for that. But in the present wave of allegations and counter allegations, the need to amend and strengthen the legal framework is not highlighted.

Although the draft of the amended act is in the drawers without being presented to cabinet and Parliament. Obviously, it is a well-known fact that the so -called pharmaceutical mafia takes decisions over and above the politicians and officials. That is the very reason as to why state pharmaceutical corporation is reluctant to intervene in the market to bring down the prices of essential drugs, which is contrary to principles of its founder Prof. Senaka Bibile. Also, countries like New Zealand have an independent body called health and liability commissioner established by law to intervene and settle the disputes as a mediator and to improve the accountability of medical personnel. But unfortunately, that kind of third-party approach to minimize disputes and public unrest as well as need for litigation is not discussed in the noise created by various interested parties. When there is a permanent independent mechanism established by law, it is not easy for interested parties to undermine the confidence of the people in the system.

The third approach is to improve, modify or optimize the knowledge, skills and behavioral aspects of the key healthcare personnel, for which multiple strategies can be used, including strengthening of clinical processes and practices as well as changing of management culture. There is a long list of interventions to that effect with evidence which can be easily applied in our system. Even simple measures like multidisciplinary ‘grand ward rounds’, case reviews, death reviews, medical audits in emblematic cases, and related clinical or process audits to identify common weaknesses would make a big change in the minds of the medical manpower. There is very remarkable evidence of improvements achieved by way of introducing complaint and incident registers with transparent inquiry and reporting mechanisms. Also, introducing protocols and practice guidelines to guide and unify practices that can lead to questionable outcomes have shown remarkable results.

Besides, in order to restore the public confidence a comprehensive financial and quality audit must be done to identify the weaknesses and corrupt practices in relation to registration and procurement of pharmaceuticals. It should also be mentioned that prices of medicine cannot be reduced only by price controlling mechanisms alone. In the present economic crisis, the US dollar went up by less than 50%, yet the prices of essential medicines went up in a range of 80% to 300%. Those greedy pharmaceutical traders must be countered by adequate market intervention by the state pharmaceutical corporation, which was created by Professor Senaka Bibile, for that purpose.

 But, unfortunately, none of these remedial actions to improve and protect the system is not discussed by the medical associations and trade unions, except for individuals like Professor Mendis. If the fundamentals of discussion on this matter is not corrected, it can be predicted that we would get a “Gota go home – Ranil come back” type of solution to the problem.



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Viktor Orban, Benjamin Netanyahu and Donald Trump: The Terrible Threes of the 21st Century

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Orban (center) Trump and Netanyahu

In the autumn of 1956, Hungary staged the first uprising against the 20th century Soviet behemoth. Seventy years later, in the spring of 2026 Hungary has delivered the first electoral thrashing against 21st century right wing populism in Europe. The 1956 uprising was crushed after seven days. But the opposition scored a landslide victory in Hungary’s parliamentary election held on Sunday, April 12 and. Viktor Orban, Prime Minister since 2010 and the architect of what he proudly called “the illiberal state”, was resoundingly defeated. Orban who has been a pain in the neck for the European Union was a close ally of US President Donald Trump and Israeli Prime Minister Benjamin Netanyahu.

Trump even dispatched his Vice President JD Vance to Budapest to campaign for Orban. After Orban’s defeat, Trump and his MAGA followers may be having nightmares about the US midterm elections in November. Similarly, Orban’s defeat has reportedly caused “great concern in the halls of power in Jerusalem.” Netanyahu has lost his only ally in the European Union and the opposition victory in Hungary does not augur well for his own electoral prospects in the Israeli elections due in October.

Ceasefire Hopes

Trump and Netanyahu have bigger things to worry about in the Middle East and among their own political bases. Trump is going bonkers, blasphemously imitating Christ and badmouthing the Pope, launching a blockade in the Strait of Hormuz and strong arming more talks in Islamabad. Netanyahu has been forced to sit on his hands, pausing his fight against Iran while pursuing peace talks with Lebanon. The leaders and diplomats from Pakistan, Egypt and Turkey are shuttling around drumming up support for another round of talks in Islamabad and a prolonged extension of the ceasefire.

Further talks in Islamabad and potential extension of the ceasefire received a new boost by Trump’s announcement of a new 10-day ceasefire between Israel and Lebanon. The background to this development appears to be Iran’s insistence on having this secondary ceasefire, and Trump insisting on ceasefire abidance by Hezbollah in return for his ordering Netanyahu to stop his brutal ‘lawn mowing’ in Lebanon. All of this might seem to augur well for a potential extension of the primary ceasefire between the US and Iran. There are also reports of the narrowing of gap between the two parties – involving a potential moratorium on Iran’s uranium enrichment, the opening of the Strait of Hormuz, and Iran’s access to its frozen assets estimated to be $100 billion.

Meanwhile the IMF has released its latest World Economic Outlook with a grim forecast. “Once again, says the report, “the global economy is threatened with being thrown off the course – this time by the outbreak of war in the Middle East.” Before the war, the IMF was expected to upgrade its growth forecasts for the global economy. Now it is going to be weaker growth and higher inflation with oil price optimistically stabilizing around $100 a barrel in 2026 and $75 a barrel in 2027. In a worst case scenario, if the oil prices were to hit $110 in 2026 and $125 in 2027, growth everywhere will further weaken and inflation will go further up in countries big and small.

In a joint statement on the Middle East, the Finance Ministers of the United Kingdom, Australia, Japan, Sweden, Netherlands, Finland, Spain, Norway, Republic of Ireland, Poland and New Zealand have called on the IMF and World Bank “to provide a coordinated emergency support offer for countries in need, tailored to country circumstances and drawing on the full range and flexibility of their tool kits.” They have also welcomed “advice on domestic responses that are temporary, targeted, and effective, and encourage work to identify steps needed to protect long-term growth.”

Subversion from the Right

The two men, Trump and Netanyahu, who started the war and precipitated the current crisis are not being held accountable by anyone and they are still free to do what they want and as they please. The third man, Victor Orban, who did not have anything to do with the war but extended wholehearted ideological and political support as a faithful apprentice to the two older sorcerers, has been democratically defeated. Together, they formed the terrible threes of the 21st century, spearheading a subversion from the right of the emerging liberal status quo of the post Cold War world. Orban’s defeat is a significant setback to the illiberal right, but it is not the end of it.

The three emerged in the specific historical contexts of their own polities that are both vastly different and yet share powerful ingredients that have proved to be politically potent. The broader context has been the end of the Cold War and the removal of the perceived external threat which opened up the domestic political space in the US, for locking horns over primarily cultural standpoints and climate politics. This era began with the Clinton presidency in 1992 and the election of Barack Obama 16 years later, in 2008, created the illusion of a post-racial America.

In reality, the right was able to push back – first with the younger Bush presidency (2000-2008) pursuing compassionate conservatism, and later with the foray of Trump (2016-2020) threatening to end what he called the “American Carnage.” Of the 32 years since the election of Bill Clinton, Democrats have controlled the White House for 20 years over five presidential terms (Clinton – two, Obama – two, and Biden -one), while the Republicans won three terms (Bush – two, Trump – one) spanning 12 years.

Trump has since won a second term for another four years, but already in his five+ years in office he has issued executive orders to roll back almost all of the liberal advancements in the realms of civil rights, equality, diversity and inclusion. All that the celebrated acronym DEI (Diversity, Equality and Inclusion) stands for has been executively ordered to be banished from the state, its agencies and its programs.

In Europe, the European Union became the champion and bulwark of liberalism and subsidiarity, which in turn provoked the rise of right wing populism in every member country. Brexit was the loudest manifestation against what was considered to be EU’s overreach, but after Britain’s bitter Brexit experience the populists in the European countries gave up on demanding their own exit and limited themselves to fighting the EU from their national bases.

Viktor Orban became the face and voice of anti-EU nationalists. But he and his political party, the Christian Nationalist Fidesz – Hungarian Civic Alliance, are not the only one. Nigel Farage’s Reform UK in Britain and Marine Le Pen’s National Rally Party in France are becoming real electoral contenders, while right wing presidents have been elected in Argentina and Chile.

The rise and fall of Viktor Orban

Of the three terribles, Orban is the youngest but with the longest involvement in politics. Born in 1963, Viktor Orban became a political activist as a 15-year old high schooler, becoming secretary of a Young Communist League local. He continued his activism while studying law in Budapest, visiting Poland and writing his thesis on the Polish Solidarity movement, giving lectures in West Germany and the US as a potential future Hungarian leader, and undertaking research on European civil society at Pembroke College, Oxford.

At the age of 26, Orban gained national prominence with a speech he delivered on June 16, 1989 in Budapest’s Heroes’ Square to mark the reburial of Imre Nagy and other Hungarians killed in the 1956 uprising. Imre Nagy was the leader of the 1956 Hungarian uprising against the puppet Soviet Union outpost in Budapest.

To digress and make a local connection – the pages of Sri Lanka’s parliamentary Hansard of 1956, contain an impressive record of the political debate in Sri Lanka over the events in Hungary. The LSSP’s Colvin R de Silva eloquently led the Trotskyite prosecution of the Soviet invasion of Hungary and the suppression of its freedoms. Pieter Keuneman of the Communist Party used his wit and debating skills to defend the indefensible. GG Ponnambalam, the unrepentant anti-communist, used the opportunity to take swipes on both sides. Finally, for the government, Prime Minister SWRD Bandaranaike deployed his own oratorical skills to empathize with the uprising without condemning the USSR. The four men were Sri Lanka’s foremost verbal gladiators and they used the occasion to put on quite a display of their talents.

Back to Hungary, where Orban began his political vocation identifying himself with Imre Nagy and demanding the withdrawal of the Soviet army from Hungary and calling for free elections in that country to elect a new government. That same year in 1989, Fidesz was recognized as a political party; Orban became its leader four years later in 1993 and led the party and its allies to their first victory and formed a new government in 1998. At age 35 Orban became the second youngest Prime Minister in Hungary’s history.

During his first term, Orban started well on the economy, reducing inflation and the budget deficit, was welcomed to the White House by President George W. Bush, and led Hungary to join NATO overruling Russian objections. But the slide into authoritarianism and corruption was just as quick, including the attempt to replace the two-thirds parliamentary majority requirement by a simple majority. By the end of the term the ruling coalition disintegrated and Orban lost the 2002 election and became the leader of the opposition over the next two terms till 2010.

Orban returned to power with a two-thirds majority in 2010 and immediately introduced a new constitution that set the stage for ushering in the illiberal state. What had been previously a communist state now became a Christian state where ‘traditional values’ of gender rights, sexuality, and exclusive nationalism were constitutionally enshrined. The electoral system was changed reducing the number parliamentarians from 386 to 199 – with 103 of them directly elected and 93 assigned proportionately. Orban went on to win three more elections over 16 years – in 2014, 2018 and 2022 – each with a two-thirds majority, and used the time and power to transform Hungary into a conservative fortress in Europe.

The new constitution and its frequent amendments were used to centralize legislative and executive power, curb civil liberties, restrict freedom of speech and the media, and to weaken the constitutional court and judiciary. It was his opposition to non-white immigration that made him “the talisman of Europe’s mainstream right”. He described immigration as the West’s answer to its declining population and flatly rejected it as a solution for Hungary. Instead, he told his compatriots, “we need Hungarian children.” His ‘Orbanomics’ policies restricted abortion and encouraged family formation – forgiving student debt for female students having or adopting children, life-long tax holiday for women with four or more children, and sponsoring fixed-rate mortgages for married couples.

Orban wanted to make Hungary an “ideological center for … an international conservative movement”. Orban heaped praise on Jair Bolsonaro for making Brazil the best example of a “modern Christian democracy.” He endorsed Trump in every one of Trump’s three presidential elections, the only European leader to do so. In return, Orban has been described by US MAGA ideologue Steve Bannon as “Trump before Trump.” Orban’s attack on universities for being the citadels of liberalism have found their echoes in Trump’s America and Modi’s India.

For all his efforts in making Hungary a conservative ideological centre, Viktor Orban’s undoing came about because of Hungary’s growing economic crises and the depth of corruption and systemic nepotism that engulfed the government. The economy has tanked over the last three years with rising prices and the national debt reaching 75% of the GDP – the highest among East European countries. Orban’s critics have exposed and the people have experienced systemic corruption that enabled the siphoning of public wealth into private accounts, the creation of a ‘neo-feudal capitalist class’, and the enrichment of family and friends. Orban’s corruption became the central plank of the opposition platform that Peter Magyar and his Tisza Party presented to the voters and caused his ouster after 16 years.

The Prime Minister elect is not a dyed in the wool liberal, but a member of a conservative Budapest family, and a politician cut from the old Orban cloth. Magyar (literally meaning “Hungarian”) was once a “powerful insider” in the Fidesz government – notably active in foreign affairs, while his ex-wife was once the Minister of Justice in Orban’s cabinet. Mr. Magyar may not fully roll back all of Orban’s illiberalism, but he has committed himself to eliminating corruption, increasing social welfare spending, limiting the prime ministerial tenure to two terms, and being more pro-European, EU and NATO.

EU and European leaders have openly welcomed the change in Hungary, and may be looking for the new government to change Orban’s vetoing of a number of EU initiatives, especially those involving assistance to Ukraine. In return, the new government in Hungary will be expecting the unfreezing of as much as $33 billion funds that the EU extraordinarily chose to freeze as punishment for Orban’s illiberal initiatives in Hungary. For Trump and Netanyahu, the defeat of Viktor Orban removes their only ally and supporter in all of Europe.

by Rajan Philips

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ICONS:A Dialogue Across Centuries

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Sky Gallery of the Fareed Uduman Art Forum is dedicated to bringing audiences, cultures, and time periods together through meaningful and accessible art experiences to create the closest possible encounters with the world’s greatest paintings. Previous exhibitions include, Gustav Klimt, Frida Kahlo, Paul Gauguin, Vincent Van Gogh, Salvador Dali.

ICONS is conceived as “a dialogue across centuries” bringing together over a dozen artistic geniuses whose works span the Renaissance to the modern era. These works at their original scales of creation changes the conversation. You can finally stand in front of a life-size Vermeer or a monumental Monet and feel the dialogue between artists who never met but shaped each other across time. Each exhibit is meticulously presented on canvas, hand-framed, and finished at the exact dimensions of the original masterpieces, preserving the integrity of composition, texture, brushwork, color and scale.

At the heart of the exhibition is Jan van Eyck’s ‘Arnolfini Portrait’, a work that epitomizes the detail, symbolism, and human intimacy that have inspired generations of artists. Alongside it, visitors will encounter paintings that shaped the renaissance, impressionism, modernism, and the evolution of visual storytelling by Munch, Matisse, Monet, Degas, Da Vinci, Renoir, Vermeer, Rembrandt, Cézanne, Caravaggio, and more. The exhibition invites audiences to experience a rare conversation across centuries of artistic brilliance.

By bringing together works that are geographically and historically dispersed, ICONS creates a compelling space for comparison, reflection, and discovery. Visitors are invited to move beyond passive viewing into a more engaged encounter—tracing artistic influence, identifying stylistic shifts, and uncovering unexpected connections between artists who never shared the same physical space, yet remain deeply interconnected across time.

Designed and curated for both seasoned art enthusiasts and first-time visitors, ICONS offers an experience that is at once educational, immersive, and accessible—removing many of the traditional barriers associated with global museum-going.

Exhibition Details:

Dates: April 24 – May 3
Time: 10:00 AM – 5:00 PM (Monday – Sunday)
Venue: Sky Gallery Colombo 5

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Our Teardrop

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BOOK REVIEW

Ranoukh Wijesinha (2026)

Published by Jam Fruit Tree Publications.
82 pages. Softcover. ISBN 978-624-6633-81-3

The author is a graduate teacher at St. Thomas’ College, Mount Lavinia; his alma mater. On leaving school he read for a Bachelor of Arts Degree in English Language and English Literature at the University of Nottingham (Malaysia). On graduating, in 2024, he went back to his old school to teach these same disciplines. There seems to be a historic logic to this as his grandfather, a notable Thomian of his day, also started his working career as a teacher at the College before moving on to the world of publishing; as a newspaper journalist and sub-editor.

On his maternal side, Wijesinha’s grandfather was an accomplished journalist, thespian and playwright of his day, and his mother is also a much sought after teacher of English and English Literature and, as acknowledged by him, his first, and foremost, English teacher.

Ranoukh Wijesinha and friends at STC

Though there are some well-written, almost lyrical, pieces of prose in this publication, it is the poetry that dominates. Written with a sensitivity to people and events he has either observed himself, or as described to him by those who did, it also encompasses all genres of poetic verse, from the classical to the modern, including sonnets, acrostics, haiku to free and blank verse, the latter more in vogue today. All in all, it presents as a celebration of English poetry and its ability to, sometimes, express depth of thought and feeling far better than prose.

Dedicated to his mentor at St. Thomas’, his Drama and Singing Master had been a great influence on Wijesinha His sudden, premature, death understandably came as a shock to the still developing student under his tutelage. The poems “The Man who Made Me” and “The Curtain Called” best demonstrate this. In addition, it is apparent that Wijesinha has endured much mental trauma in his young life. Spending much time on his own, the questions these moments have raised are expressed in “When No One is Listening”, “There was a Time”, “Midnight Walks” and the prose “A Ramble through Colombo”.

However, the majority of the poems concern ‘Our Teardrop’, Sri Lanka, for whom the writer has a great love. He explores its history, its natural wonders, its people, its tragedies, its corruption and the hope that things will get better for all its people. “Bala’ and “Dicky” address a time of violence from days gone by when there were few glories, just victims. “Easter Sunday” brings this almost to the present time.

There also is humour. “Ado, Machang, Bro, Dude” celebrates his friends and friendships in a way that will reverberate with all the present and previous generations of those who are, or were once, in their late teens and early twenties.

There is little to criticise in this first of the writer’s forays into published works except, as referred to previously, to re-state that the prose quails in the face of the power of the poetry. It is all well written, filled with passion and compassion, and gives comfort that there still are young Sri Lankan writers who can be this brave, and write so powerfully, and profoundly, in English. It is hoped that this is just the first of many from the pen of this young writer.

L S M Pillai

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