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Medical negligence or medical error ?

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By Prof. Susirith Mendis

Preamble

The newspapers and social media have been full of news during the last few weeks about incidents in hospitals, which led to the death of patients. Obviously, we are aware of such incidents more now than then due to the feverish activity of social media.

The latest was the untimely and unnecessary death of Chamodi Sandeepani, a 21 year-old girl in the Teaching Hospital, Peradeniya. According to the mother of Chamodi, her daughter’s condition deteriorated and her body turned blue after the administration of two medications by a nurse. One of them had been identified as Ceftriaxone (a Cephalosporine antibiotic).

I was also truly disturbed when a very good friend of mine, a consultant anaesthesiologist – a long-time resident of UK, lost his brother, who was a card-carrying patient on his sensitivity to penicillin. He was injected with ‘Augementin’ (a combination drug of amoxicillin and clavulanic acid) in a major private hospital in Colombo and died immediately afterwards. It was alleged that the emergency tray was not readily available at the time of injection. There was hardly a ripple in the media about this incident.

Both these incidents point to anaphylactic shock. Death by anaphylactic shock occurs in all parts of the world – including the best of centres. But that does not mean that many of those were necessarily fatal. Some patients could have been revived with immediate appropriate response and emergency care. Too many incidents have been exposed in recent times about unexpected and untimely deaths of patients in hospitals. Allegations of negligence abound. These incidents must be investigated by independent investigators to ascertain the facts of each of these cases. The manner in which inquiries have been done in the past by the Ministry of Health leaves much to be desired. Most often, the end result is absolving the medical/health professionals and issues swept under the carpet. As in this case of Chamodi, where the inquiry panel is headed none other than by the DGHS – ‘a home and home affair’.

Nonetheless, as a medical professional, a medical teacher for over 40 years and a medical ethicist of some standing within and without our profession, I am most troubled by the responses and reactions I see in social media posted by doctors. There is a uniform response of criticising the victims and a myriad of excuses. There is not even a remote consideration of whether there has been negligence on the part of the medical/health professionals directly involved in the incident. There was a very recent case where a daughter who posted a bitter experience she had at the Nagoda Hospital of indifference and lack of concern and care in a facebook post. She was hounded and harassed by the police on a complaint from the hospital authorities. She was coerced by the Police to delete her post. A case of the combined effect of medical and police muscle.

A more conciliatory and introspective approach by the doctors will in the log run be more fruitful in improving the quality and standards of healthcare in the hospitals. Exuding arrogance, intimidatory self-defence and a mindset of ‘attack is the best form of defence’ is without doubt, counterproductive.My objective in this article is to look at the issues of medical negligence and medical errors in general and how they pertain to our perspective of the recent events that have taken hold of our attention during the last few weeks.

What I will not delve into in this article are the existent economic crisis that has lead to shortage of drugs, inferior drugs imported without due diligence to quality and standards, short-circuiting the due process and regulatory oversight of the National Medicines Regulatory Authority (NMRA) and the role played by the Minister of Health and the Ministry of Health. The last, but importantly, ‘clinician burnout’ due to the difficulties faced by medical and health professionals struggling to provide minimal patient care under dismal supply conditions. Collectively or singularly all of the above have directly or indirectly been responsible for these unfortunate deaths.

My comments herein, are issues related to medical negligence and medical error that are systemic as well as global.Let me start with a comment in a book that happened to catch my eye at the University of Georgetown Medical School Medical Ethics Library over 2 decades ago:

The book was “Examining your doctor: A patient’s guide to avoiding harmful medical care.” by Timothy B. McCall, MD (Carol Publishing Group, New York, 1995). This is the personal experience/confession of a doctor when he was training as a medical student in a University Hospital in te USA.

“My first experience taking care of patients as a medical student changed forever the way I viewed doctors. I was appalled. In the university hospital I was assigned, we treated one patient after another transferred from hospitals where they had received medical care that had nearly killed them. We saved some of them, though many of those we saved ended up disabled. We didn’t tell these patients or their families that they had been victims of poor medical care; we intentionally misled them. Covering up malpractice is just one example of the systematic way that doctors withhold information from their patients.”

Well, that says many things that most doctors in Sri Lanka would refuse to accept or even consider. Their arrogance ensures that they are never wrong. They can ever be wrong.

But, it is ironical that with better technology in healthcare available today, even in Sri Lanka, doctors are more likely to be found negligent. Is this because (i) medical standards have deteriorated? (ii) more doctors are now less skillful? (iii) they are now more careless? (iv) lawyers have realised that there is good money to make from ligigation against doctors? (v) patients have become more aware of their conditions (thanks to the internet) and therefore, more litigious? (vi) Insurance companies are paying good compensation? Or is it a relative permutation and combination of all of the above? I have not seen any serious scientific study done to ascertain the real situation in our country.

Let us now, look at a non-binding classification.

Medcal Negligence

It is an act of commission or omission by a healthcare provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. To establish negligence, it is necessary to first establsih ‘duty of care’. A reasonable, foreseeable and actual loss or injury caused by or materially contributed to by a breach of duty of care will lead to an accusation of negligence.

This can be of two basic types: Criminal Negligence and Medical (or Clinical) Negligence. Criminal negligence is such that the negligence is grave enough for a police investigation and a prosecution by the Attorney General. It can lead to judicial sentencing and even imprisonment. Medical negligence, on the other hand, is a civil procedure, that could lead to damages being awarded by a Court of Law.

But prior to legal measures in a Court of Law, it is possible to pursue a lesser path of ‘pre-litigation’. This entails a departmental inquiry (Ministry of Health) which can lead from warning, transfer, punishment, reporting the the Sri Lanka Medical Council (SLMC) to even dismissal from service. A complaint to the SLMC can lead to periods of temporary suspension of registration. And in extreme instances, to complete erasure from the Medical Register.

There are even less serious avenues in instances where pateinet or their next of kin, can seek redress through a process of ‘conflict resolution’. Mediation is one of them. It has to be a voluntary process. There cannot be coercion on either parties – i.e., the doctors concerned or the patient. The parties meet privately with a neutral mediator who facilitates a negotiated agreement. This then binds the parties to that mutualyy agreed conditions of resolution of the conflict. This could be an unqualified apology to a meagre financial compensation for losses incurred. It is seen as a much more constructive and less adversarial process than conventional litigation. If agreement is not reached, the parties are free to initiate or continue with litigation.

Another non-litigious option for patients is to make a formal complaint to the Parliamentary Commissioner for Administration (better known as the Ombudsman). The present Ombudsman is a former Judge of the High Court of Sri Lanka. The former Secretary-General of Parliament, Sam Wijesinghe was the first – if my memory serves me right.

The positives of a non-litigious process is that it is (i) a non-threatening environment; (ii) it may give an increased sense of ‘fairness’ and justice for doctors; (iii) the legal and other costs are minimal and affordable to most.

The negatives are: (i) Will it give justice to the grievances of patients or their next of kin? (ii) Will the whole process be transparent and devoid of obvious bias? (iii) Will the process retain the confidence of both patients and doctors that justice has been done?

To ensure that the process is transparent and devoid of bias, there would be a need for non-medical or legal representation. Would it not be ideal, as in the Court process of ‘trial by a jury’, to have a committee of inquiry made up of competent civilians?

We, in Sri Lanka have no estimates of negligence. But, if we go by the many anecdotes of serious events of gross negligence we hear, and the number of litigation that have failed in a court f law or settled out of court, they are still a matter of very serious concern.

There are other conditions that I will not dwell at any length here. That is ‘medical misadventure’ where there is error or unexpected outcome during medical intervention leading to serious deleterious effect on patient. This happends most often in surgical and anaesthetic practice. An ‘adverse event’ is defined as an undesirable and unintentional, though not necessarily unexpected, result of medical treatment. Examples of an adverse event is discomfort in an artificial joint that continues after the expected recovery period, painful cheloids developing after open-heart surgery or a chronic headache following a spinal tap.

Medical Error

Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome; the failure of a planned action to be completed as intended (an error of execution); the use of a wrong plan to achieve an aim (an error of planning); or a deviation from the process of care that may or may not cause harm to the patient. Patient harm from medical error can occur at the individual or system level.

There are many ways that medical care can go wrong. Errors can occur around the administration of medications (including adverse drug events/reactions), during laboratory testing, pathology reports, hospital infections, as a result of surgery or even in documentation or data entry tasks.

Medication error are the leading cause of negligence, error and adverse events. They include; (i) prescribing errors; (ii) failure to prescribe, administer, or dispense a medication; (iii) a patient receiving a medication too late or too early; (iv) a patient receiving a drug not authorized for them; (v) improper use of a medication; (vi) wrong dose prescription or preparation; (vii) administration errors; (viii) failure to take into account a patient’s medical conditions or potential drug interactions; and (ix) not following proper dispensing/prescribing rules for a medication.

“To err is human”

An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a study of 37 million patient records. (The Health Grades Patient Safety in American Hospitals study (2000-02).

According to Dr. Lucien Leape, lead the author of a Harvard study, the number of deaths from medical errors in hospitals account for the equivalent to the death toll from three jumbo jet crashes every two days.( Public Health Reports , 1999; 114: 302-317 July/August, 1999).More people die each year in the United States from medical errors than from highway accidents, breast cancer or AIDS, a federal advisory panel has reported.

The report from the National Academy of Sciences’ Institute of Medicine cited studies showing between 44,000 and 98,000 people die each year because of mistakes by medical professionals. “That’s probably an underestimate for two reasons, one is, there are many different kinds of errors we never learn about — even in retrospective studies — because they are never written down. Second, these studies did not include other areas of care like home care, nursing homes and ambulatory care centers.” (Dr. Donald Berwick of the National Academic of Medicine, Washington DC). Medical error is the third leading cause of death in the US according to a BMJ article (BMJ 2016;353:i2139).

Here are some more statistics from the USA. The FDA receives more than 100,000 reports every year that are associated with medication errors (FDA, 2019). Forty-one percent of Americans report having been involved with a medical error either personally or secondhand (Institute for Healthcare Improvement/NORC at the University of Chicago, 2017). More than 7 million patients in the U.S. are impacted by medication errors every year (Journal of Community Hospital Internal Medicine Perspectives, 2016). Ten percent of hospital patients will be subject to a medication error (NCBI, 2019).By 2023, medication errors in the US has been tied to $40 billion in spending and up to 9000 deaths each year.

What about Sri Lanka?

To my knowledge, there are neither records of ‘medical error’ nor surveys or audits done for us to have an understanding, or even estimates, of medical negligence or errors in Sri Lanka. I am open to correction, if there are. The only record I know of is Professor Carlo Fonseka’s seminal article in the BMJ (Volume 313 21-28 December 1996) titled “To Err was Fatal”. In it he writes of five fatal errors he made that caused the death of five patient. I think it is compulsory reading for all doctors who have not yet read it. In it he makes five important and profound observations: (i) All doctors are fallible; (ii) The natural reaction of doctors to errors is to hide them or to rationalise them away; (iii) It is unscientific and unethical to refuse to face our errors; (iv) There is no cathartic ritual in our profession to expiate the sense of guilt generated by our errors; (v) Since knowledge grows mainly by error recognition, facing our errors squarely is the path to medical wisdom.

As Prof. Carlo Fonseka stated, doctors are not infallible, no matter how much patients would like them to be. While doctors’ mistakes are not usually intentional, they are often preventable and typically occur when doctors fail to exercise the proper level of care and skill. Hence, it is not difficult to accept that doctor errors occur more frequently than patients realise. The recent events are the tip of the proverbial iceberg.

Unfortunately, when doctors’ mistakes do happen, the consequences can be disastrous – even fatal. In which direction should we in Sri Lanka tread? The path traced by the West? Or go back to our own traditions and culture? Our social relations are based on the ‘Eastern Philosophical Tradition’. The Sri Lankan social milieu is predominantly based on Buddhist Philosophy – ‘The Four Noble Truths’ and ‘The Eightfold Path’ and the values of Meththa, Karuna, Muditha and Upeksha.

We are ‘serendipitously’ placed. We are a nation where all 4 major religions are practiced. Do we need to follow or abide by the Western medical ethical tradition coming down from Aesclepius and Hippocrates ?

We practice Modern Western Scientific Medicine in a socio-cultural milieu seeped in ancient Eastern traditions. Can we take inspiration from those traditions and synthesise a ‘New Medical ethical tradition’ by bridging this philosophical divide?

Do we have both the creativity and the courage to do so? If we have, we can in all probability avoid the pitfalls that the practice of medicine has fallen in the West (and in particular, the USA).Let these recent unfortunate and possible unavoidable deaths open us as medical professionals to a more humane and humanistic approach to patient care in Sri Lanka.



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End of ‘Western Civilisation’?

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Carney at Davos

“All animals are equal, but some animals are more equal than others” ––George Orwell, Animal Farm

When I wrote in this column an essay on 4th February 2026 titled, the ‘Beginning of Another ‘White Supremacist’ World Order?’, my focus was on the hypocrisy of Canadian Prime Minister Mark Carney’s Davos address on 20 January 2026 to the World Economic Forum. It was embraced like the gospel by liberal types and the naïve international relations ‘experts’ in our country and elsewhere. My suspicion of Carney’s words stemmed from the consistent role played by countries like Canada and others which he called ‘middle powers’ or ‘intermediate powers’ in the world order he critiqued in Davos. He wanted such countries, particularly Canada, “to live the truth?” which meant “naming reality” as it exists; “acting consistently” towards all in the world; “applying the same standards to allies and rivals” and “building what we claim to believe in, rather than waiting for the old order to be restored.” These are some memorable pieces of Carney’s mantra.

Yet unsurprisingly, it only took the Trump-Netanyahu illegal war against Iran to prove the hollowness in Carney’s words. If he placed any premium on his own words, he should have at least voiced his concern against the continuing atrocities in the Middle East unilaterally initiated by the US and Israel. But his concern is only about Iran’s seemingly indiscriminate attacks across the region targeting US and Israeli installations and even civilian locations in countries allied with the Us-Israel coalition.

Issuing a statement on 3 March 2026 from Sydney he noted, “Canada has long seen Iran as the principal source of instability and terror in the Middle East” and “despite more than two decades of negotiations and diplomatic efforts, Iran has not dismantled its nuclear programme, nor halted its enrichment activities.” A sensible observer would note how the same statement would also apply to Israel. In fact, Israel has been the bigger force of instability in the Middle East surpassing Iran. After all, it has exiled an entire population of people — the Palestinians — from their country to absolute statelessness has not halted its genocide of the same people unfortunate enough to find themselves in Gaza after their homeland was taken over to create Israel in 1948 and their properties to build illegal Jewish settlements in more recent times. And then there is the matter of nuclear weapons. Israel has never been hounded to stop its nuclear programme unlike Iran. There is, in the world order Carney criticixed and the one in his fantasy, a fundamental difference between a ‘Jewish bomb’ and a ‘Muslim bomb’ in the ‘clash of civilisations’ as imagined by Samuel P. Huntington and put into practice by the likes of Messers Trump, Netanyahu, and Carney. That is, the Jewish bomb is legitimate, and the Muslim one is not, which to me evokes the commandments in the dystopian novella Animal Farm.

But Carney, in his new rhetoric closely echoing those of the leaders of Germany, UK and France, did not completely forget his Davos words too. He noted, in the same statement, “we take this position with regret, because the current conflict is another example of the failure of the international order.” But in reality, it is not the failure of the current international order, but its reinforcement by the likes of Mr Carney, reiterating why it will not change.

Coming back to the US-Israel attack on Iran, anyone even remotely versatile in the craft of warfare should have known, sooner or later, the rapidly expanding theatre of devastation in the Middle East was likely to happen for two obvious reasons. One, Iran had warned of this outcome if attacked as it considered those countries hosting US and Israeli bases or facilities as enemies. This is military common sense. Two, this was also likely because it is the only option available for a country under attack when faced with superior technology, firepower and the silence of much of the world. I cannot but feel deep shame about the lukewarm and generic statements urging restraint issued by our political leaders notwithstanding the support of Iran to our country in many times of difficulty at the hands of this very same world order.

When I say this, I am not naïvely embracing Iran as a shining example of democracy. I am cognizant of the Iranian regime’s maltreatment of some of its own citizens, stifling of dissent within the country and its proxy support for armed groups in the region. But in real terms, this is no different from similar actions of Israel and the US. The difference is, the actions of these countries, particularly of the US, have been far more devastating for the world than anything Iran has done or could do. US’s misadventures in Vietnam, Iraq, Syria, and Afghanistan come to mind — to take only a handful of examples.

But it is no longer about Carney and the hollowness of his liberal verbal diarrhoea in Davos. What is of concern now is twofold. One is the unravelling fiction of what he called the ‘new world order’ in which he located countries like Canada at the helm. And the second is the reality of continuing to live in the same old world order where countries like Canada and other middle and intermediate powers will continue to do the bidding of powerful aggressors like the US and Israel as they have done since the 20th century.

Yet, one must certainly thank Trump and Mr Natenyahu for one thing. That is, they have effectively exposed the myth of what used to be euphemistically called the ‘western civilisation.’ Despite its euphemism, the notion and its reality were omnipresent and omnipotent, because of the devastating long term and lingering consequences of its tools of operation, which were initially colonialism and later postcolonial and neocolonial forms of control to which all of us continue to be subjected.

One thing that was clearly lacking in the long and devastating history of the ‘western civilisation’ in so far as it affected the lives of people like us is its lack of ‘civilisation’ and civility at all times. Therefore, Trump and Mr Netanyahu must be credited for exposing this reality in no uncertain terms.

But what does illegal and unprovoked military action and the absence so far of accountability mean in real terms? It simply means that rules no longer matter. If Israel and the US can bomb and murder heads of state of a sovereign country, its citizens including children, cause massive destruction claiming a non-existent imminent threat violating both domestic and international law, it opens a wide playing field for the powerful and the greedy. Hypothetically, in this free-for-all, China can invade India through Arunachal Pradesh and occupy that Indian state which it calls Zangnan simply because it has been claiming the territory of itself for a very long time and also simply because it can. India can invade and occupy Sri Lanka, if it so wishes because this can so easily be done and also because it is part of the extended neighbourhood of the Ramayana and India’s ‘Akhand Bharat’ political logic. Sri Lanka can perhaps invade and occupy the Maldives if it wants a free and perennial supply of Maldive Fish. Incidentally, the Sri Lankan Tamil guerrilla group, People’s Liberation Organization of Tamil Eelam nearly succeeded in doing so 1988.

Sarcasm aside, even more dangerous is the very real possibility of this situation opening the doors for small, violent and mobile militant groups to target citizens of these aggressor countries and their allies as we saw in the late 1960s and 1970s. This will occur because in this kind of situation, many people would likely believe this form of asymmetric warfare is the only avenue of resistance open to them. It is precisely under similar conditions that the many Palestinian armed factions and Lebanese militia groups emerged in the first place. If this happens, the victims will not be the fathers and the vociferous supporters of the present aggression but all of us including those who had nothing to do with the atrocities or even opposed it in their weak and inaudible voices.

If I may go back to Carney’s Davos words, what would “to live the truth?”, “naming reality”, “acting consistently” and “applying the same standards to allies and rivals” mean in the emerging situation in the Middle East? Would this kind of hypocrisy, hyperbole, choreographed silence and selective accusations only end if a US invasion of Greenland, an integral part of the ‘White Supremacist’ World Order’ takes place? By then, however, all of us would have been well-trained in the art of feeling numb. By that time, we too would have forgotten yet another important line in Animal Farm: “No animal shall kill any other animal without cause.”

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Silence is not protection: Rethinking sexual education in Sri Lanka

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Sexual education is a vital component of holistic education, contributing to physical health, emotional well-being, gender equality, and social responsibility. Despite its importance, sexual education remains a sensitive and often controversial subject in many societies, particularly in culturally conservative contexts. In Sri Lanka, discussions around sexuality are frequently avoided in formal and informal settings, leaving young people to rely on peers, social media, or misinformation. This silence creates serious social, health, and psychological consequences. By examining the Sri Lankan context alongside international examples, the importance of comprehensive and age-appropriate sexual education becomes clear.

Understanding Sexual Education

Sexual education goes beyond biological explanations of reproduction. Comprehensive sexual education includes knowledge about human anatomy, puberty, consent, relationships, emotional health, gender identity, sexual orientation, reproductive rights, contraception, prevention of sexually transmitted infections (STIs), and personal safety. Importantly, it also promotes values such as respect, responsibility, dignity, and mutual understanding. When delivered appropriately, sexual education empowers individuals to make informed decisions rather than encouraging early or risky sexual behavior.

The Sri Lankan Context: Silence and Its Consequences

In Sri Lanka, sexual education is included in school curricula mainly through subjects such as Health Science and Life Competencies, however the content is often limited and taught with hesitation. Many teachers feel uncomfortable discussing sexual topics openly due to cultural norms, religious sensitivities, and fear of parental backlash. As a result, lessons are rushed, skipped, or delivered in a purely biological manner without addressing emotional, social, or ethical dimensions.

This lack of open education has led to several social challenges. Teenage pregnancies, although less visible, remain a significant issue, particularly in rural and estate sectors. Young girls who become pregnant often face school dropouts, social stigma, and limited future opportunities. Many of these pregnancies occur due to lack of knowledge about contraception, consent, and bodily autonomy.

Another serious concern in Sri Lanka is child sexual abuse. Numerous reports indicate that many children do not recognize abusive behaviour or lack the confidence and language to report it. Proper sexual education, especially lessons on body boundaries and consent, can help children identify inappropriate behavior and seek help early. In the Sri Lankan context, where respect for elders often discourages questioning authority, this knowledge is especially crucial.

Furthermore, misinformation about menstruation, nocturnal emissions, and bodily changes during puberty causes anxiety and shame among adolescents. Many Sri Lankan girls experience menarche without prior knowledge, leading to fear and confusion. Similarly, boys often receive no guidance about emotional or physical changes, reinforcing unhealthy notions of masculinity and silence around mental health.

Cultural Resistance and Misconceptions

Opposition to sexual education in Sri Lanka often stems from the belief that it promotes immoral behaviour or encourages premarital sex. However, international research consistently shows the opposite: young people who receive comprehensive sexual education tend to delay sexual initiation and engage in safer behaviours. The resistance is therefore rooted more in cultural fear than empirical evidence.

Religious and cultural values are important, but they need not conflict with sexual education. In fact, sexual education can be framed within moral discussions about responsibility, respect, family values, and care for others principles shared across Sri Lanka’s major religious traditions. Ignoring sexuality does not protect cultural values; rather, it leaves young people vulnerable.

International Evidence: Lessons from Other Countries

Several countries demonstrate how effective sexual education contributes to positive social outcomes.

In the Netherlands, sexual education begins at an early age and is age-appropriate, focusing on respect, relationships, and communication rather than explicit sexual activity. As a result, the Netherlands has one of the lowest rates of teenage pregnancy and STIs in the world. Young people are encouraged to discuss feelings, boundaries, and consent openly, both in schools and at home.

Similarly, Sweden introduced compulsory sexual education as early as the 1950s. Swedish programs emphasise gender equality, reproductive rights, and sexual health. This long-term commitment has contributed to high levels of sexual health awareness, low maternal mortality among young mothers, and strong societal acceptance of gender diversity. Sexual education in Sweden is also closely linked to public health services, ensuring access to counseling and contraception.

In many developing contexts, international organisations have supported sexual education as a tool for social development. UNESCO promotes Comprehensive Sexuality Education (CSE) globally, emphasising that it equips young people with knowledge, skills, attitudes, and values that enable them to protect their health and dignity. Studies supported by UNESCO show that CSE reduces risky behaviours, improves academic outcomes, and supports gender equality.

In countries such as Rwanda and South Africa, sexual education has been integrated with HIV/AIDS prevention programs. These initiatives demonstrate that sexual education is not a luxury of developed nations but a necessity for public health and social stability.

Comparing Sri Lanka with International Models

When compared with international examples, Sri Lanka’s challenges are not due to lack of capacity but lack of open dialogue and political will. Sri Lanka has a strong education system, high literacy rates, and an extensive public health network. These strengths provide an excellent foundation for implementing comprehensive sexual education that is culturally sensitive yet scientifically accurate.

Unlike the Netherlands or Sweden, Sri Lanka may not adopt early-age sexuality discussions in the same manner, but age-appropriate education during late primary and secondary school is both feasible and necessary. Topics such as puberty, menstruation, consent, online safety, and respectful relationships can be introduced gradually without violating cultural norms.

Sexual Education in the Digital Era

The urgency of sexual education has increased in the digital age. Sri Lankan adolescents are exposed to sexual content through social media, films, and online platforms, often without guidance. Pornography frequently becomes a primary source of sexual knowledge, leading to unrealistic expectations, objectification, and distorted ideas about consent and relationships.

Sexual education can counter these influences by developing critical thinking, media literacy, and ethical understanding. Teaching young people how to navigate digital relationships, cyber harassment, and online exploitation is now an essential component of sexual education.

Gender Equality and Social Change

Sexual education also plays a crucial role in promoting gender equality. In Sri Lanka, traditional gender roles often limit open discussion about female sexuality while excusing male dominance. Comprehensive sexual education challenges these norms by emphasizing mutual respect, shared responsibility, and equality in relationships.

Educating boys about consent and emotional expression helps reduce gender-based violence, while educating girls about bodily autonomy strengthens empowerment. In the long term, this contributes to healthier families and more equitable social structures.

The Way Forward for Sri Lanka

For sexual education to be effective in Sri Lanka, several steps are necessary. Teachers must receive proper training to handle the subject confidently and sensitively. Parents should be engaged through awareness programs to reduce fear and misconceptions. Curriculum developers must ensure that content is age-appropriate, culturally grounded, and scientifically accurate.

Importantly, sexual education should not be treated as a one-time lesson but as a continuous process integrated into broader life skills education. Collaboration between schools, healthcare providers, religious leaders, and community organisations can help normalise discussions around sexual health while respecting cultural values.

Finally , sexual education is not merely about sex; it is about health, dignity, safety, and responsible citizenship. The Sri Lankan experience demonstrates how silence and taboo can lead to misinformation, vulnerability, and social harm. International examples from the Netherlands, Sweden, and global initiatives supported by UNESCO clearly show that comprehensive sexual education leads to positive individual and societal outcomes.

For Sri Lanka, embracing sexual education does not mean abandoning cultural values. Rather, it means equipping young people with knowledge and ethical understanding to navigate modern social realities responsibly. In an era of rapid social and technological change, sexual education is not optional it is essential for building a healthy, informed, and compassionate society.

by Milinda Mayadunna ✍️

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A long-running identity conflict flares into full-blown war

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Ayatollah Ali Khamenei / President Donald Trump

It was Iran’s first spiritual head of state, the late Ayatollah Khomeini, who singled out and castigated the US as the ‘Great Satan’ in the revolutionary turmoil of the late seventies of the last century that ushered in the Islamic Republic of Iran. The core issue driving the long-running confrontation between Islamic Iran and the West has been religious identity and the seasoned observer cannot be faulted for seeing the explosive emergence of the current war in the Middle East as having the elements of a religious conflict.

The current crisis in the Middle East which was triggered off by the recent killing of Iranian spiritual head of state Ayatollah Ali Khamenei in a combined US-Israel military strike is multi-dimensional and highly complex in nature but when the history of relations between Islamic Iran and the West, read the US, is focused on the religious substratum in the conflict cannot be glossed over.

In fact it is not by accident that US President Donald Trump resorts to Biblical language when describing Iran in his denunciations of the latter. Iran, from Trump’s viewpoint, is a primordial source of ‘evil’ and if the Middle East has collapsed into a full-blown regional war today it is because of the ‘evil’ influence and doings of Iran; so runs Trump’s narrative. It is a language that stands on par with that used by the architects of the Iranian revolution in the crucial seventies decade.

In other words, it is a conflict between ‘good’ and ‘evil’ and who is ‘good’ and who is ‘evil’ in the confrontation is determined mainly by the observer’s partialities and loyalties which may not be entirely political in kind. It should not be forgotten that one of President Trump’s support bases is the Christian Right in the US and in the rest of the West and the Trump administration’s policy outlook and actions should not be divorced from the needs of this segment of supporters to be fully made sense of.

The reasons for the strong policy tie-up between Rightist administrations in the US in particular and Israel could be better comprehended when the above religious backdrop is taken into consideration. Israel is the principal actor in the ‘Old Testament’ of the Bible and is seen as ‘the Chosen People of God’ and this characterization of Israel ought to explain the partialities of the Republican Right in particular towards Israel. Among other things, this partiality accounts for the strong defence of Israel by the US.

For the purposes of clarity it needs to be mentioned here that the Bible consists of two parts, an ‘Old’ and ‘New Testament’ , and that the ‘New Testament’ or ‘Message’ embodies the teachings of Jesus Christ and the latter teachings are seen as completing and in a sense giving greater substance to the ‘Old Testament’. However, Judaism is based mainly on ‘Old Testament’ teachings and Judaism is distinct from Christianity.

To be sure, the above theological explanation does not exhaust all the reasons for the war in the Middle East but the observer will be allowing an important dimension to the war to slip past if its importance is underestimated.

It is not sufficiently realized that the Iranian Islamic Revolution of 1979 utterly changed international politics and re-wrote as it were the basic parameters that must be brought to bear in understanding it. So important is the Islamic factor in contemporary world politics that it helped define to a considerable degree the new international political order that came into existence with the collapsing of the Cold War and the disintegration of the USSR .

Since the latter developments ‘political Islam’ could be seen as a chief shaping influence of international politics. For example, it accounts considerably for the 9/11 calamity that led to the emergence of fresh polarities in world politics and ushered in political terrorism of a most destructive kind that is today disquietingly visible the world over.

It does not follow from the foregoing that Islam, correctly understood, inspires terrorism of any kind. Islam proclaims peace but some of its adherents with political aims interpret the religion in misleading, divisive ways that run contrary to the peaceful intents of the faith. This is a matter of the first importance that sincere adherents of the faith need to address.

However, there is no denying that the Islamic Revolution in Iran of 1979 has been over the past decades a great shaper of international politics and needs to be seen as such by those sections that are desirous of changing the course of the world for the better. The revolution’s importance is such that it led to US political scientist Dr. Samuel P. Huntingdon to formulate his historic thesis that a ‘Clash of Civilizations’ is upon the world currently.

If the above thesis is to be adopted in comprehending the principal trends in contemporary world politics it could be said that Islam, misleadingly interpreted by some, is pitting a good part of the Southern hemisphere against the West, which is also misleadingly seen by some, as homogeneously Christian in orientation. Whereas, the truth is otherwise. The West is not necessarily entirely synonymous with Christianity, correctly understood.

Right now, what is immediately needed in the Middle East is a ceasefire, followed up by a negotiated peace based on humanistic principles. Turning ‘Spears into Ploughshares’ is a long gestation project but the warring sides should pay considerable attention to former Iranian President Mohammad Khatami’s memorable thesis that the world needs to transition from a ‘Clash of Civilizations’ to a ‘Dialogue of Civilizations’. Hopefully, there would emerge from the main divides leaders who could courageously take up the latter challenge.

It ought to be plain to see that the current regional war in the Middle East is jeopardising the best interests of the totality of publics. Those Americans who are for peace need to not only stand up and be counted but bring pressure on the Trump administration to make peace and not continue on the present destructive course that will render the world a far more dangerous place than it is now.

In the Middle East region a durable peace could be ushered if only the just needs of all sides to the conflict are constructively considered. The Palestinians and Arabs have their needs, so does Israel. It cannot be stressed enough that unless and until the security needs of the latter are met there could be no enduring peace in the Middle East.

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