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Paediatrics: At some time in the past, I absolutely hated it!

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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.



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Opinion

Sri Lanka’s geopolitical positioning for future prosperity

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Kariyawasam

By Chula Goonasekera
For the LEADS Forum (admin@srilankaleads.com)

Sri Lanka’s future prosperity will depend on how effectively it positions itself within an increasingly complex global environment. At a recent LEADS Forum discussion (https://youtu.be/Bbr3e_qU1Fw), veteran diplomat Prasad Kariyawasam, former Secretary to the Ministry of Foreign Affairs, High Commissioner to India, Ambassador to the United States, Ambassador /Permanent Representative to the UN in New York and Geneva —outlined the strategic choices Sri Lanka must make to secure long term stability and economic advancement. Kariyawasam offered a rare blend of historical perspective, diplomatic experience and practical guidance.

His central message was clear: Sri Lanka must exercise strategic agency—engaging all major partners while safeguarding its national interests.

Foreign Policy as an Extension of National Aspirations

Foreign policy, Kariyawasam emphasised, is inseparable from domestic priorities. As your text notes, “foreign relations often reflect the medium- and long-term aspirations of a country’s people and its leadership.” Governments must therefore craft external relations that reflect the public’s economic and social expectations, avoiding short-term political impulses that undermine long-term national interests.

For a small nation, foreign policy cannot be symbolic or personality driven. It must be purposeful, pragmatic and directed towards the security and prosperity of the people.

A History of Global Connectivity

Sri Lanka’s history demonstrates that the island has never been isolated. From ancient ties with India and Southeast Asia to Arab, Persian and Chinese maritime networks, the island prospered when connected to the wider world. We must realise that “geography creates opportunity, but geography alone does not create prosperity.” Institutions, infrastructure and policy determine whether geographic advantage becomes economic success.

Colombo’s emergence as a cosmopolitan trading hub and Galle’s role as a resupply station for Indian Ocean shipping in colonial times , illustrate how deeply Sri Lanka has been embedded in global commerce for centuries.

Lessons from Asia’s High Performers

Kariyawasam highlighted the experiences of Japan, South Korea, Taiwan, Singapore and Vietnam. Their paths differ, but their success rests on common foundations:

• investment in human capital and infrastructure

• merit based institutions

• integration into global markets

• attraction of investment and technology

• export oriented industries

• strategic engagements with both China and Western economies

The lesson for Sri Lanka is not imitation but continuous adaptation and constructive integration with the global economy.

India: Sri Lanka’s Closest Major Partner

India’s transformation into a global economic power presents Sri Lanka with both opportunity and responsibility. India is already Sri Lanka’s largest source of tourists and a major investor. Kariyawasam states, “The larger question is how effectively Sri Lanka can participate in and benefit from India’s growth.”

A partnership should encompass modern, more open pathways for trade, investment, logistics, energy, technology, digital services, education and professional mobility—And asymmetry between the two economies must be handled with maturity and foresight, seeking special and differential treatment .

China and Other Global Partners

China remains a significant economic partner. Sri Lanka must avoid viewing this relationship through a zero sum lens. The goal should be productive and transparent engagement, ensuring better terms of trade and meaningful technology transfer.

Equally Important relations must be nurtured with the United States, European Union, United Kingdom, Japan, Australia, ASEAN and the Gulf.

All these relationships can be vibrant partnerships that does not lead towards , dependency but mutually beneficial pragmatic arrangements .

A Fragmenting International System

Global geopolitics is becoming more volatile. Trade tensions, wars, sanctions, supply chain disruptions, climate change and technological competition increasingly shape national security. We must realise, “foreign policy cannot be separated from economic policy.”

Sri Lanka’s recent economic crisis demonstrated the importance of international confidence, access to finance and resilient supply chains. Energy security, food security, cybersecurity and digital infrastructure are now core elements of national strategy.

Strategic Agency: The Guiding Principle

Sri Lanka must avoid becoming an arena for great power competition. Strategic agency means making decisions based on national interest, expanding Sri Lanka’s choices, not restricting them.

India is essential. China is important. The United States, Europe, Japan, Australia, ASEAN and the Gulf are important. The objective is a web of partnerships that strengthens resilience and autonomy.

Sri Lanka’s Strategic Assets

1. Location: Sri Lanka’s geography is a long standing advantage. Ports such as Colombo, Hambantota, Trincomalee and Galle can become specialised hubs—if connected to logistics, manufacturing, services and exports.

2. Digital Connectivity: Submarine cables, data centres, cloud services and cybersecurity are now as important as physical geography. Sri Lanka can turn its location into both a maritime and digital advantage.

3. Tourism and Natural Heritage: The focus should shift from tourist numbers to value creation—wellness, heritage, ecotourism, cruise tourism, education and MICE tourism.

4. Human Resources and Demographics: High literacy is no longer enough. Skills in technology, engineering, AI, logistics and advanced manufacturing are essential, especially with an ageing population.

5. Migrant Workforce: Migrant workers are a strategic asset, not merely a source of remittances. Bilateral labour agreements, skills recognition and diaspora engagement should be central to foreign policy.

Requirements for Sustained Prosperity

Sri Lanka’s future depends on:

• peace and security

• access to international markets

• productive investment

• a skilled, productive workforce

• modernised agriculture

• higher value tourism

• demographic preparedness

• climate resilience

• strong, predictable institutions

Please note that “foreign policy can open doors. Domestic institutions determine whether we can walk through them.”

The Role of the State

Sri Lanka does not need a larger state—only a more capable one. Policy continuity, professional institutions, predictable regulation and reduced corruption are essential. Geography does not change; long-term national interests do not change. Intentional relationships built over decades should not be reinvented with each election cycle.

Building Trust Internationally

Trust is a strategic asset. Sri Lanka must be known as a country that honours commitments and maintains predictable policies. This is vital not only for diplomacy but also for investment and long term partnerships.

Avoiding Zero Sum Geopolitics

Sri Lanka does not need to choose between India and China, or between Asia and the West. The task is to identify what each relationship can contribute to national development while protecting sovereignty and freedom of decision making.

Sri Lanka’s geography is an inheritance, but prosperity is not guaranteed. The world is changing rapidly—great-power competition, technological disruption, and climate vulnerability demand a foreign policy that is pragmatic, adaptive, and anchored in national interest.

Sri Lanka must build partnerships without dependencies, maintain strategic agency without isolation, and integrate with the global economy while strengthening domestic capacity.

“We cannot change where Sri Lanka is. We can, however, determine what Sri Lanka becomes because of where it is”

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Opinion

A tariff deal with the US? Make haste slowly

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by Gomi Senadhira

Sri Lanka’s former ambassador to the United States Mahinda Samarasinghe is back in Sri Lanka lobbying for speedier finalisation of a new tariff deal with the United States. According to news reports, delivering the keynote address at the Sri Lanka Institute of Directors’ Annual Meeting last week, he stated, “I have recommended very strongly to the government that we need to conclude the agreement so that we can lock in the very favourable tariff rate that Sri Lanka has got up to now“.

I do not understand why the former ambassador is urging the government to expedite the finalisation of a new tariff deal or what is “the very favourable tariff rate” he refers to in his speech. However, given the ongoing terrible tariff turbulence in the United States and the fragile economic situation in Sri Lanka, I believe, this is not the right time to rush into finalising any trade agreement with the United States. I am also of the opinion that at this juncture Sri Lanka should maintain strategic patience and explore all available options.

Lessons from the countries that rushed for trade deals

To better comprehend this, let’s look at experiences of the countries that rushed to conclude tariff deals with the United States after President Donald Trump declared his “reciprocal tariffs” under the International Emergency Economic Powers Act (IEEPA) in April 2025. As Samarasinghe stated in his keynote, “The bottom line on all these negotiations was that every country that finally agreed to sign the agreement had to give either complete duty-free access for American exports into those markets, or near complete duty-free access.” In exchange for these tariff concessions and other market access commitments these countries managed to get the newly introduced country specific “reciprocal tariffs” reduced.

However, in February 2026, the Supreme Court of the United States (SCOTUS) struck down these “reciprocal tariffs” under the IEEPA. With that, the market access gains these countries received in exchange for complete duty-free access for American exports into their markets evaporated under U.S. domestic law. By moving too fast to conclude bilateral tariff agreements with the United States these countries are now bound to strict obligations whereas the benefits they bargained from the U.S. administration are not worth the paper those were written on.

Sri Lanka’s experience

In April 2025, President Trump declared his “reciprocal tariffs” and labelled Sri Lanka as the worst offender, imposing one of the highest additional duties at 44%. Since then, Ambassador Samarasinghe and other negotiators have managed to negotiate this down to 20%. I do not know what the deal was through which Sri Lanka managed to reduce the 44% tariff to 20% or what we gave in return for this “concession.” However, what we received in return has absolutely no value after the decision by the SCOTUS.

Current state of US tariffs

After the decision by SCOTUS, the U.S. administration introduced a temporary 10% additional tariff on all countries for 150 days. At the end of that period, this 10% tariff was replaced by a new “forced labor tariff ” of 10% to 12.5% on all trading partners under Section 301 of U.S. trade law. Twenty-five U.S. states and several small businesses have already filed lawsuits against these tariffs in U.S. courts. This new “forced labour tariff ” on Sri Lanka was first fixed at 12.5%. Later, after President Anura Kumara Dissanayake issued a gazette notice prohibiting the importation of goods produced using forced labour, it was reduced to 10%. That means Sri Lanka has already made a substantial commitment to receive this “tariff concession,” and I presume our negotiators understand the implications of this commitment.

Make haste slowly

After President Trump imposed 44% “reciprocal tariffs” on Sri Lanka, through an article published in The Island on 25th April 2026 (), I urged the government to engage immediately with the US administration on these tariffs. However, I also emphasised that the best way to move forward was to make haste slowly.

Two millennia ago, Augustus Caesar, the first emperor of Rome, frequently used the phrase, “make haste slowly”, because he detested rashness and haste in his military commanders. It was the recurring guiding maxim that he emphasised throughout his 40-year imperial rule. After 2000 years, this classical oxymoron remains a definitive golden rule for professional trade negotiators. More importantly it is the exact blueprint required when navigating turbulence in trade negotiations with the Trump administration.

The endgame – The most dangerous moment in trade negotiation

Samarasinghe has also stated the agreement is 90% complete. Any experienced trade negotiator should know that the final 10% contains high-stakes provisions and is the most dangerous moment in a trade negotiation. A single misplaced comma or ambiguous product description in a tariff schedule can cost millions through unintended loopholes. Rushing this last stretch to secure a deal can permanently expose Sri Lanka to sudden shifts in American trade policy, heavy compliance costs, or strict enforcement under Section 301 regarding supply-chain labour standards. Hence, this is the time for strategic patience.

(The writer can be reached at senadhiragomi@gmail.com)

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Opinion

Buddhist law and constitutional amendments

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Upon reading the article titled “Prof. Pieris says Buddha Dhamma recognized as source of law under Constitution” (Island, September 12, 2026), the classical Sinhala idiom “Yanne Koheda? Malle Pol” immediately comes to mind. The expression, translating literally to answering “I have coconuts in my bag” when asked “Where are you going?”, underscores a complete disconnect in logic. Because it is uncertain whether the article accurately represents the professor’s precise words, the following critique addresses the contents of the report rather than the speaker himself.

The central premise of the report concerns a statement delivered by the Chief Justice regarding a petition filed against the 22nd Amendment to the Constitution. According to the report, the Chief Justice’s observation that the determination would be made strictly on the basis of established law rather than Buddhist teachings was characterised as a “cavalier dismissal” of the Buddha Dhamma. This assertion carries a host of unexamined assumptions. Had the writer specified precisely which tenets of the Buddha Dhamma were violated, a direct legal or philosophical evaluation could take place. However, no specific Buddhist tenet or law was identified as having been transgressed, and for good reason: no such statutory legal framework exists within the Buddha’s teachings.

To understand the flaw in this argument, one must examine the constitutional context alongside the canonical meaning of the terms involved. Article 9 of the 1978 Constitution of Sri Lanka mandates that the Republic shall give Buddhism the foremost place and that it shall be the duty of the State to protect and foster the Buddha Sasana, while guaranteeing the fundamental rights of all religions under Articles 10 and 14(1)(e).

While “Buddhism” and “Buddha Dhamma” are frequently used as interchangeable terms in casual dialogue, they represent distinct concepts. “Buddhism” is an umbrella term coined by 19th-century Western scholars to classify the global institutionalised religion, incorporating its diverse sects, cultural traditions, rituals, and socio-political histories. Conversely, Sasana is the ancient term designating the structural framework established by the Buddha to preserve and transmit his teachings, comprising the monastic order (Sangha) and its supporting institutions.

In classical Theravada commentarial literature, the Sasana operates as a functional three-tiered structure. It encompasses Pariyatti Sasana, the preservation and study of sacred texts; Paṭipatti Sasana, the practical execution of the doctrine through ethical conduct and meditation; and Paṭivedha Sasana, the direct experiential realization of ultimate truth, or enlightenment. This structural breakdown raises fundamental questions about state capacity. While a state can readily support Pariyatti Sasana through academic institutions, textual preservation, and educational funding, it cannot legislate or enforce Paṭipatti or Paṭivedha. Practical engagement and spiritual realisation are inherently internal, first-person experiences. Expecting the state to codify or guarantee enlightenment is a conceptual impossibility.

Furthermore, the Buddha Dhamma refers specifically to the unconditioned truths of existence and the teachings imparted to realize them, including the Four Noble Truths, the Eightfold Path, and Dependent Origination. As the late Venerable Professor Kotagama Wachissara Thera observed, there is no rigid ideologue or “ism” in the core Dhamma. The teachings do not constitute a system of divine commandments or a legal statute enforced through reward and punishment. Rather, Buddhist ethics function as self-directed guidelines for psychological clarity and moral inquiry. Even the Vinaya Pitaka, which contains explicit rules of conduct, functions as an internal monastic code rather than a civil or criminal law intended for the laity.

Throughout the Pali Canon, guidance regarding governance focuses on the moral character of leadership and the social duties of statecraft rather than rigid legal codification. In discourses such as the Cakkavatti Sihanada Sutta (DN 26), the Buddha observes that social instability and crime cannot be eliminated solely through punitive measures, emphasising instead that states must provide economic opportunities, fair wages, and resource distribution to maintain societal balance. Crucially, in the Maha Parinibbana Sutta (DN 16), the Buddha explicitly highlights the importance of respecting established laws and traditions rather than enacting arbitrary regulations.

The natural laws articulated in the Dhamma, such as the law of cause and effect or the three characteristics of existence, govern all phenomena universally, regardless of legal statutes or personal belief. They are not human laws to be applied or suspended by a court of law. Therefore, characterizing the Chief Justice’s adherence to constitutional jurisprudence over religious doctrine as a “cavalier dismissal” lacks logical and textual foundation. Framing the judiciary’s adherence to legal precedent as an attack on the Dhamma distracts from fundamental constitutional principles and risks misguiding the public for political ends.

Geewananda
Gunawardana,
Ph.D.

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