Opinion
Paediatrics: At some time in the past, I absolutely hated it!
By Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
This must surely be quite a resounding bombshell—from the computer keyboard of a Specialist Consultant Paediatrician. What I have written in this article is most definitely from the past, quite a bit of it from over 50 years ago. I have to qualify the title of this article with the caveat that it should not be misinterpreted as hating children. I loved children with no reservations whatsoever, and still do. Witnesses to that statement are my daughter, three grandchildren, a large number of nieces and nephews, and even grandnieces and grandnephews as well as a very large cohort of little ones that I have seen and treated over many a decade. I have unconditionally loved children; period. Now then, one might wonder, quite justifiably perhaps, what on earth is this character talking about? How is it that the word ‘hate’ has come into the picture?
The term “Paediatrician”, is derived from two Greek words; pais meaning “child” and iatros meaning “healer”. Paediatrics is the science, which deals with the medical care of infants, children, and adolescents. Child healthcare has a legacy as old as any other constituent of medicine. It is also held in the highest esteem because of the notion that children are the jewels of our future, and consequently, their health and well-being are a matter of broad social concern. Of course, if you are a healer of children, you cannot hate children!
At the very outset, I have to explain why I hated paediatrics over five decades ago. At that time, as a late-teenaged medical student and a young junior doctor, I had the bitter experience of seeing scores of children succumbing to many different diseases for which we had very few answers. At the Lady Ridgeway Hospital for Children, it was not an uncommon sight to see bodies of innocent little children being wheeled out of the wards as a regular occurrence. As a young man, I could not come to terms with these frightening manifestations of a branch of medicine which was somewhat unsuccessful in saving children. Hence the intense dislike for paediatrics and a firm determination to avoid getting into the field of paediatrics at any cost.
In that era, the newborn death rate was around 40 per 1000 live births, meaning around 40 newborns out of 1000 did not live beyond 28 days. The Infant Mortality Rate was around 55 per 1000 live births, meaning 55 of 1000 did not reach their first birthday and the Under 5-year Mortality rate was around 70 per 1000 live births meaning 70 out of 1000 live births did not survive up to their 5th birthday. These were horrendous statistics that accounted for significant numbers of child deaths, year in and year out. What killed these children were prematurity, congenital defects including heart malformations, many types of major infectious diseases, malnutrition, acquired heart problems, accidents, and a whole host of a multiplicity of other childhood maladies. To make matters worse, some diseases that affected the brain and others like polio which affected the peripheral nervous system, left the afflicted children maimed for life with cruel disabilities. As a medical student and a young junior doctor, I felt helpless in not being able to do something, or anything worthwhile at all, to try and stem the tide and the slide. Hence my intense dislike for paediatrics. I desperately wanted to be a Consultant Physician who treats adults. At that time, it was quite a glamorous speciality.
Yet for all this, destiny dictated otherwise. I was forced to do paediatrics for the second six months of the internship. I went to work as a very junior House Officer at the Lady Ridgeway Hospital for Children and quite honestly took up that position with the greatest reluctance and very serious concerns about my abilities to treat children. It was extremely hard work as large numbers of children were admitted to the ward with all kinds of diseases. It was a matter of working day and night, even foregoing meals, to try and save children.
As time went by, something struck me very strongly and ever so forcefully as well, while working with children. Of course, the deaths were there and that was the worst scenario that one could ever imagine. But there were a considerable number of children who recovered and went home as well. We managed to even save many desperately ill children. We were sending back those who recovered, into a full life of many decades to be spent as useful citizens of our Motherland.
As it happened, when you work with children, they kind of ‘grow on you’. At the end of my internship, my feelings towards paediatrics were a bit mollified and somewhat neutral. At the end of the internship, fate decreed for me to be posted to the Out-Patients Department of the Lady Ridgeway Hospital for Children as a Medical Officer in the OPD. That was a most rewarding experience as we treated and cured quite a large number of children who came with various illnesses to be treated in the OPD. By the end of one year in the OPD, I had secured a postgraduate qualification that enabled me to get a position in the Faculty of Medicine of the University of Peradeniya. I spent a year there doing adult medicine and teaching pharmacology.
At the end of that year, as was decreed ever so firmly by providence, I applied for a position and came back to the Lady Ridgeway Hospital for Children as a Paediatric Registrar, the second-in-command of a Children’s Ward. By that time the die had been cast; firmly and forever more. I was going into a lifetime career in paediatrics and there was no turning back from then onwards. A 3-year training period in the UK ensued where I did adult medicine simply because the mandatory MRCP examination was in adult medicine. Then I came back to Sri Lanka and at the rather early age of 31 years, I was posted as the Specialist Consultant Paediatrician to General Hospital Badulla; the only paediatrician for 70 to 80 kilometres around. I was thrown unceremoniously, into the deep end.
The rest is history. Over a stint as a Consultant Paediatrician spanning 46 years, right up to the present time, I have seen it all. I served in Badulla, Ratnapura, Kurunegala and Colombo. More than anything, I have seen the tremendous advances made by the incessant forward march of child healthcare. We are now able to handle quite successfully a lot of the diseases that killed children 50 years ago. Many of the killer infectious diseases are practically eliminated from our country. Loads of congenital malformations including major heart problems are now being effectively treated. We save many lives of children who would have succumbed to all those major diseases just 50 years ago. Many people do not believe it but the Cardinal Health Statistics of Sri Lankan children are now on par with the developed Western World. Currently, the newborn mortality rate is around 4 per 1000 live births, the infant mortality rate is around 7 per 1000 live births and the under 5-year mortality rate is around 6.5 per 1000 live births; ALL IN SINGLE DIGITS. When compared to the really high values of the 1960s and 1970s, the extremely significant fall of these parameters is nothing but miraculous. People all over the entire world are really in wonder about this little island nation which has achieved so much with so few resources
The success story of paediatrics in Sri Lanka is not only due to the dedication and clinical acumen of Consultant Paediatricians but also to the untiring efforts of all other grades of child healthcare staff, in hospitals as well as in the field over many a grassroots level. The way the paediatric scenario has developed in Sri Lanka is most definitely due to a team effort of absolute splendour. We now see only very few deaths of children in our hospitals. We have collectively turned the tide for the better.
As for me, to have worked in and given my all in a branch of medicine that I originally tried hard to avoid, practically loathed and intensely detested, is perhaps the kind of thing that dreams are made of. It has very definitely warmed the cockles of my heart to be a witness to the vast strides that have been made in child healthcare over the last few decades. Today, to see a little child recovering and going home is akin to a precious gift that nothing else could even remotely match. My attitude and perceptions towards child healthcare have gone through a complete 180-degree swing, quite early in my career as a practising doctor. For me, quite thankfully and over the years, the practice of paediatrics has become not only a matter of doing what I love, but most clearly and persistently loving what I do; daily. I believe that I have adequately given back to this country, even more than what I owe, for the most beautiful things that it has given me, including free education.
Opinion
War with Iran and unravelling of the global order – II
Broader Strategic Consequences
One of the most significant strategic consequences of the war is the accelerated erosion of U.S. political and moral hegemony. This is not a sudden phenomenon precipitated solely by the present conflict; rather, the war has served to illuminate an already evolving global reality—that the era of uncontested U.S. dominance is in decline. The resurgence of Donald Trump and the reassertion of his “America First” doctrine reflect deep-seated domestic economic and political challenges within the United States. These internal pressures have, in turn, shaped a more unilateral and inward-looking foreign policy posture, further constraining Washington’s capacity to exercise global leadership.
Moreover, the conduct of the war has significantly undermined the political and moral authority of the United States. Perceived violations of international humanitarian law, coupled with the selective application of international norms, have weakened the credibility of U.S. advocacy for a “rules-based international order.” Such inconsistencies have reinforced perceptions of double standards, particularly among states in the Global South. Skepticism toward Western normative leadership is expected to deepen, contributing to the gradual fragmentation of the international system. In this broader context, the ongoing crisis can be seen as symptomatic of a more fundamental transformation: the progressive waning of a global order historically anchored in U.S. hegemony and the emergence of a more contested and pluralistic international landscape.
The regional implications of the crisis are likely to be profound, particularly given the centrality of the Persian Gulf to the global political economy. As a critical hub of energy production and maritime trade, instability in this region carries systemic consequences that extend far beyond its immediate geography. Whatever may be the outcome, whether through the decisive weakening of Iran or the inability of external powers to dismantle its leadership and strategic capabilities, the post-conflict regional order will differ markedly from its pre-war configuration. In this evolving context, traditional power hierarchies, alliance structures, and deterrence dynamics are likely to undergo significant recalibration.
A key lesson underscored by the war is the deep interconnectivity of the contemporary global economic order. In an era of highly integrated production networks and supply chains, disruptions in a single strategic node can generate cascading effects across the global system. As such, regional conflicts increasingly assume global significance. The structural realities of globalisation make it difficult to contain economic and strategic shocks within regional boundaries, as impacts rapidly transmit through trade, energy, and financial networks. In this context, peace and stability are no longer purely regional concerns but global public goods, essential to the functioning and resilience of the international system
The conflict highlights the emergence of a new paradigm of warfare shaped by the integration of artificial intelligence, cyber capabilities, and unmanned systems. The extensive use of unmanned combat aerial vehicles (UCAVs)—a trend previously demonstrated in the Russia–Ukraine War—has been further validated in this theatre. However, unlike the Ukraine conflict, where Western powers have provided sustained military, technological, and financial backing, the present confrontation reflects a more direct asymmetry between a dominant global hegemon and a Global South state. Iran’s deployment of drone swarms and AI-enabled targeting systems illustrates that key elements of Fourth Industrial Revolution (4IR) warfare are no longer confined to technologically advanced Western states. These capabilities are increasingly accessible to Global South actors, lowering barriers to entry and significantly enhancing their capacity to wage effective asymmetric warfare. In this evolving context, technological diffusion is reshaping the strategic landscape, challenging traditional military hierarchies and altering the balance between conventional superiority and innovative, cost-effective combat strategies.
The war further exposed and deepened the weakening of global governance institutions, particularly the United Nations. Many of these institutions were established in 1945, reflecting the balance of power and geopolitical realities of the immediate post-Second World War era. However, the profound transformations in the international system since then have rendered aspects of this institutional architecture increasingly outdated and less effective.
The war has underscored the urgent need for comprehensive international governance reforms to ensure that international institutions remain credible, representative, and capable of addressing contemporary security challenges. The perceived ineffectiveness of UN human rights mechanisms in responding to violations of international humanitarian law—particularly in contexts such as the West Bank and the Gaza Strip, and more recently in Iran—has amplified calls for institutional renewal or the development of alternative frameworks for maintaining international peace and security. Moreover, the selective enforcement of international law and the persistent paralysis in conflict resolution mechanisms risk accelerating the fragmentation of global norms. If sustained, this trajectory would signal not merely the weakening but the possible demise of the so-called liberal international order, accelerating the erosion of both the legitimacy and the effective authority of existing multilateral institutions, and deepening the crisis of global governance.
Historically, major wars have often served as harbingers of new eras in international politics, marking painful yet decisive transitions from one order to another. Periods of systemic decline are typically accompanied by instability, uncertainty, and profound disruption; yet, it is through such crises that the contours of an emerging order begin to take shape. The present conflict appears to reflect such a moment of transition, where the strains within the existing global system are becoming increasingly visible.
Notably, key European powers are exhibiting a gradual shift away from exclusive reliance on the U.S. security umbrella, seeking instead a more autonomous and assertive role in global affairs. At the same time, the war is likely to create strategic space for China to expand its influence. As the United States becomes more deeply entangled militarily and politically, China may consolidate its position as a stabilising economic actor and an alternative strategic partner. This could be reflected in intensified energy diplomacy, expanded infrastructure investments, and a more proactive role in regional conflict management, advancing Beijing’s long-term objective of reshaping global governance structures.
However, this transition does not imply a simple replacement of Pax Americana with Pax Sinica. Rather, the emerging global order is likely to be more diffuse, pluralistic, and multilateral in character. In this sense, the ongoing transformation aligns with broader narratives of an “Asian Century,” in which power is redistributed across multiple centers rather than concentrated in a single hegemon. The war, therefore, may ultimately be understood not merely as a geopolitical crisis, but as a defining inflection point in the reconfiguration of the global order.
Conclusion: A New Era on the Horizon
History shows that major wars often signal the birth of new eras—painful, disruptive, yet transformative. The present conflict is no exception. It has exposed the vulnerabilities of the existing world order, challenged U.S. dominance, and revealed the limits of established global governance.
European powers are beginning to chart a more independent course, reducing reliance on the U.S. security umbrella, while China is poised to expand its influence as an economic stabiliser and strategic partner. Through energy diplomacy, infrastructure investments, and active engagement in regional conflicts, Beijing is quietly shaping the contours of a more multipolar world. Yet this is not the rise of Pax Sinica replacing Pax Americana. The emerging order is likely to be multilateral, fluid, and competitive—a world in which multiple powers, old and new, share the stage. The war, in all its turbulence, may therefore mark the dawn of a genuinely new global era, one where uncertainty coexists with opportunity, and where the next chapter of international politics is being written before our eyes.
by Gamini Keerawella
(First part of this article appeared yesterday (08 April)
Opinion
University admission crisis: Academics must lead the way
130,000 students are left out each year—academics hold the key
Each year, Sri Lanka’s G.C.E. Advanced Level examination produces a wave of hope—this year, nearly 175,000 students qualified for university entrance. Yet only 45,000 will be admitted to state universities. That leaves more than 130,000 young people stranded—qualified, ambitious, but excluded. This is not just a statistic; it is a national crisis. And while policymakers debate infrastructure and funding, the country’s academics must step forward as catalysts of change.
Beyond the Numbers: A National Responsibility
Education is the backbone of Sri Lanka’s development. Denying access to tens of thousands of qualified students risks wasting talent, fueling inequality, and undermining national progress. The gap is not simply about seats in lecture halls—it is about the future of a generation. Academics, as custodians of knowledge, cannot remain passive observers. They must reimagine the delivery of higher education to ensure opportunity is not a privilege for the few.
Expanding Pathways, Not Just Campuses
The traditional model of four-year degrees in brick-and-mortar universities cannot absorb the demand. Academics can design short-term diplomas and certificate programmes that provide immediate access to learning. These programmes, focused on employable skills, would allow thousands to continue their education while easing pressure on degree programmes. Equally important is the digital transformation of education. Online and blended learning modules can extend access to rural students, breaking the monopoly of physical campuses. With academic leadership, Sri Lanka can build a reliable system of credit transfers, enabling students to begin their studies at affiliated institutions and later transfer to state universities.
Partnerships That Protect Quality
Private universities and vocational institutes already absorb many students who miss out on state admissions. But concerns about quality and recognition persist. Academics can bridge this divide by providing quality assurance and standardised curricula, supervising joint degree programmes, and expanding the Open University system. These partnerships would ensure that students outside the state system receive affordable, credible, and internationally recognised education.
Research and Advocacy: Shaping Policy
Academics are not only teachers—they are researchers and thought leaders. By conducting labour market studies, they can align higher education expansion with employability. Evidence-based recommendations to the University Grants Commission (UGC) can guide strategic intake increases, regional university expansion, and government investment in digital infrastructure. In this way, academics can ensure reforms are not reactive, but visionary.
Industry Engagement: Learning Beyond the Classroom
Sri Lanka’s universities must become entrepreneurship hubs and innovation labs. Academics can design programmes that connect students directly with industries, offering internship-based learning and applied research opportunities. This approach reduces reliance on classroom capacity while equipping students with practical skills. It also reframes education as a partnership between universities and the economy, rather than a closed system.
Making the Most of What We Have
Even within existing constraints, academics can expand capacity. Training junior lecturers and adjunct faculty, sharing facilities across universities, and building international collaborations for joint programmes and scholarships are practical steps. These measures maximise resources while opening new avenues for students.
A Call to Action
Sri Lanka’s university admission crisis is not just about numbers—it is about fairness, opportunity, and national development. Academics must lead the way in transforming exclusion into empowerment. By expanding pathways, strengthening partnerships, advocating for policy reform, engaging with industry, and optimizing resources, they can ensure that qualified students are not left behind.
“Education for all, not just the fortunate few.”
Dr. Arosh Bandula (Ph.D. Nottingham), Senior Lecturer, Department of Agricultural Economics & Agribusiness, Faculty of Agriculture, University of Ruhuna
by Dr. Arosh Bandula
Opinion
Post-Easter Sri Lanka: Between memory, narrative, and National security
As Sri Lanka approaches the seventh commemoration of the Easter Sunday attacks, the national mood is once again marked by grief, reflection, and an enduring sense of incompleteness. Nearly seven years later, the tragedy continues to cast a long shadow not only over the victims and their families, but over the institutions and narratives that have since emerged.
Commemoration, however, must go beyond ritual. It must be anchored in clarity, accountability, and restraint. What is increasingly evident in the post-Easter landscape is not merely a search for truth, but a contest over how that truth is framed, interpreted, and presented to the public.
In recent times, public discourse has been shaped by book launches, panel discussions, and media interventions that claim to offer new insights into the attacks. While such contributions are not inherently problematic, the manner in which certain narratives are advanced raises legitimate concerns. The selective disclosure of information particularly when it touches on intelligence operations demands careful scrutiny.
Sri Lanka’s legal and institutional framework is clear on the sensitivity of such matters. The Official Secrets Act (No. 32 of 1955) places strict obligations on the handling of information related to national security. Similarly, the Police Ordinance and internal administrative regulations governing intelligence units emphasize confidentiality, chain of command, and the responsible use of information. These are not mere formalities; they exist to safeguard both operational integrity and national interest.
When individual particularly those with prior access to intelligence structures enter the public domain with claims that are not subject to verification, it raises critical questions. Are these disclosures contributing to justice and accountability, or are they inadvertently compromising institutional credibility and future operational capacity?
The challenge lies in distinguishing between constructive transparency and selective exposure.
The Presidential Commission of Inquiry into the Easter Sunday Attacks provided one of the most comprehensive official examinations of the attacks. Its findings highlighted a complex web of failures: lapses in intelligence sharing, breakdowns in inter-agency coordination, and serious deficiencies in political oversight. Importantly, it underscored that the attacks were not the result of a single point of failure, but a systemic collapse across multiple levels of governance.
Yet, despite the existence of such detailed institutional findings, public discourse often gravitates toward simplified narratives. There is a tendency to identify singular “masterminds” or to attribute responsibility in ways that align with prevailing political or ideological positions. While such narratives may be compelling, they risk obscuring the deeper structural issues that enabled the attacks to occur.
Equally significant is the broader socio-political context in which these narratives are unfolding. Sri Lanka today remains a society marked by fragile intercommunal relations. The aftermath of the Easter attacks saw heightened suspicion, polarisation, and, in some instances, collective blame directed at entire communities. Although there have been efforts toward reconciliation, these fault lines have not entirely disappeared.
In this environment, the language and tone of public discourse carry immense weight. The framing of terrorism whether as a localized phenomenon or as part of a broader ideological construct must be handled with precision and responsibility. Overgeneralization or the uncritical use of labels can have far-reaching consequences, including the marginalization of communities and the erosion of social cohesion.
At the same time, it is essential to acknowledge that the global discourse on terrorism is itself contested. Competing narratives, geopolitical interests, and selective historiography often shape how events are interpreted. For Sri Lanka, the challenge is to avoid becoming a passive recipient of external frameworks that may not fully reflect its own realities.
A professional and unbiased approach requires a commitment to evidence-based analysis. This includes:
· Engaging with primary sources, including official reports and judicial findings
·
· Cross-referencing claims with verifiable data
·
· Recognizing the limits of publicly available information, particularly in intelligence matters

It also requires intellectual discipline the willingness to question assumptions, to resist convenient conclusions, and to remain open to complexity.
The role of former officials and subject-matter experts in this discourse is particularly important. Their experience can provide valuable insights, but it also carries a responsibility. Public interventions must be guided by professional ethics, respect for institutional boundaries, and an awareness of the potential impact on national security.
There is a fine balance to be maintained. On one hand, democratic societies require transparency and accountability. On the other, the premature or uncontextualized release of sensitive information can undermine the very systems that are meant to protect the public.
As Sri Lanka reflects on the events of April 2019, it must resist the temptation to reduce a national tragedy into competing narratives or political instruments. The pursuit of truth must be methodical, inclusive, and grounded in law.
Easter is not only a moment of remembrance. It is a test of institutional maturity and societal resilience.
The real question is not whether new narratives will emerge they inevitably will. The question is whether Sri Lanka has the capacity to engage with them critically, responsibly, and in a manner that strengthens, rather than weakens, the foundations of its national security and social harmony.
In the end, justice is not served by noise or conjecture. It is served by patience, rigor, and an unwavering commitment to truth.
Mahil Dole is a former senior law enforcement officer and national security analyst, with over four decades of experience in policing and intelligence, including serving as Head of Counter-Intelligence at the State Intelligence Service of Sri Lanka and a graduate of the Asia Pacific Center for Security Studies in Hawai, USA.
by Mahil Dole
Former Senior Law Enforcement Officer National Security Analyst; Former Head of Counter-Intelligence, State Intelligence Service)
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