Features
Patient-centred care and CKDu
Some observations on the occasion of World Kidney Day
By Prof. M.W. Amarasiri de Silva
(Inaugural Fellow, International Society of Nephrology 2018, Adjunct Professor at the University of Pittsburgh, USA, and Professor Emeritus, University of Peradeniya)
Today is World Kidney Day, and this year the principal focus is on patient-centred care for people living with kidney disease. This theme highlights the increasing recognition of the need to identify and address patients’ priorities, values, and goals in order to advance the research, practice, and policy designed to improve the quality of life of people suffering from chronic kidney disease. Regardless of the type of kidney disease or the approach to treatment adopted, patients want to live well, retain their social place, maintain some semblance of normality, and have a sense of control over their health and wellbeing.
A patient-centred approach is one where the patients are treated as social individuals and enabled to take control of and improve their health. Thus, they become active participants in their care. Their biology becomes secondary in this process. Members of patients’ families and communities can continue to focus on them as people, rather than on their illness or disability. Support should concentrate on achieving the patients’ aspirations and be tailored to their needs and unique circumstances.
A patient-centred approach to health requires building public policy, creating supportive environments, facilitating community action, and developing and improving patients’ skills and knowledge of disease management. Overall, any such programme requires a complete reorientation of the treatment system. Those who work directly with patients at the District Secretariat (DS) Division level – the public health inspectors, public health nurses, nurses, hospital attendants, community workers, health educators, rural development officers, childcare officers, and others – should be directed towards a patient-centred approach, and trained in good communication skills and to address patient needs effectively. A patient-centred approach should address those with chronic disease of unknown aetiology (CKDu) within their family and community, and become an integral part of everyday life in the family and community. If CKDu sufferers are uprooted from their social setting and placed in a clinic-based environment, the treatment system becomes an artificial one with no link to the patient’s cultural milieu. Such treatment systems do not work satisfactorily.
In western societies, community health workers, working in communities, facilitate this process by assisting the medical specialists in hospitals. They visit the homes of patients and help their families to overcome problems through counselling. In Sri Lanka, such a link between the community/family and the hospital, focusing on the patient, is missing. Especially with regards to CKDu patients, establishing a connection between the community and the hospital is crucial. Such a link would help to alleviate the stigma attached to CKDu patients in the community and the neglect and isolation that many have to endure. Visits by hospital staff and paramedics to patients in their homes can improve the understanding of hospital staff about how patients live at home, what problems do they face at home and in the community. It would improve the commitment of patients towards their treatment. This would also improve their compliance with their medical regimen. A change in the treatment procedures from a hospital-based system to a patient-centred one is necessary, as the existing approach has had little impact in assisting CKDu patients in addressing their grievances and improving their quality of life, or in reducing the incidence of and death rates from the disease.
In a patient-centred approach to the treatment and care of CKDu patients, essential elements are community engagement and empowerment. Educating the patients and their families on disease risk factors and treatments is a prerequisite. In Sri Lanka, government programmes have invested in developing people’s understanding of the risk factors for CKDu but have not paid much attention to improving people’s knowledge of treatments and testing procedures. Therefore, most people in CKDu-affected areas have knowledge of the causes of CKDu, but have limited understanding of treatments. As a result, patients are not able to make an informed decision on the type of treatment that they should undergo or to discuss the subject with their medical professionals. They blindly accept (or reject) the type of treatment recommended by the doctors.
In Sri Lanka, people’s knowledge of treatments for kidney disease is fragmentary. Their knowledge of things like blood transfusion is limited and is very hospital centred. Experience in other countries shows that patients on a home therapy or haemodialysis at home were more satisfied than those with in-centre haemodialysis. In Sri Lanka, haemodialysis at home has not been promoted.
Most CKDu patients undergo harrowing experiences in their communities and at home. They report a substantial drop in their quality of life. Their illness means that they cannot draw water from the dug well to wash or use the toilets with squatting pans. They are advised to install commodes in their toilets, but most CKDu patients cannot afford to do this. Many say that they cannot cultivate their rice paddy land, so they don’t get any income from agriculture. Although they are paid Rs. 5,000 by the government each month, that is not adequate for a family of five people to live an ordinary life. As CKDu patients find it difficult to use public transport, they have to hire a vehicle at a significant cost each time they visit the clinic. In many families, children have dropped out of school because their parents cannot afford to provide for their education. About 15% of CKDu patients in the villages live alone, with, in many cases, their wives having left them and gone to the Middle East for employment. Family members say that the CKDu patients have become demanding. Many CKDu patients and their family members display signs of depression and uneasiness.
Those patients on dialysis need to attend the clinic once every three days. Many patients do not attend the clinics as required due to financial difficulties. Each visit to the clinic requires Rs. 2,000 to 3,000 for transportation, which is beyond many patients’ means, and therefore, after a few visits, they drop out of the dialysis programme. A patient told me, ‘the doctor told me that I have to get a kidney transplant. I am on the waiting list like many thousands of patients. I have no great hopes anyway. I undergo blood transfusion. I was asked to come to the clinic every third day, but I don’t have money to pay for a vehicle every time. I mortgaged my two acres of rice paddy two years ago, and the money has been spent on my treatment and food for the family’.
A patient-centred approach should highlight how to improve the quality of life of CKDu patients and families. The quality of life for patients should become the dominant preoccupation in health promotion in CKDu communities. Essential health professionals, such as health educators, public health inspectors, and public health midwives, should take the lead in educating the CKDu-affected population about the management of patients at home and in their communities. They should discuss how behavioural changes could improve health, for example identifying the adverse effects of smoking and chewing tobacco. Referring to her husband, a CKDu patient, a woman said, ‘My husband smokes a lot. He smokes a bundle of beedi a day. One bundle of beedi is Rs. 100 and contains 25 beedis. He smokes them at night, early in the morning, and at work… However much I tell him to, he doesn’t stop’. Many patients do not regularly take the medication given by the clinic or attend their appointments as scheduled.
People surveyed during the course of my research were not very aware of the difference between CKD and CKDu. Most CKDu patients identified having diabetes and high blood pressure as risk factors for CKDu. They are risk factors for CKD, and CKDu develops due to other factors in the absence of diabetes and hypertension. Most end-stage patients did not know what treatment options were available for them, and preferred to stay and die at home. Compared to affluent families in the CKDu-affected communities, the paddy farmers who own less than two acres of rice paddy are less educated and lacking in CKDu-related health knowledge.
Any community empowerment programme, focusing on CKDu patients, should discuss the basics of kidney function, CKDu testing procedures, and the management of CKDu at home and in the community.
Recommendations:
A reorientation of the hospital-centred approach to a patient-centred one. This requires training local officers at the DS Division level. A programme for this has to be identified and discussed at ministerial level with the participation of Community Based Organisations in the area, patients, carers, medical and paramedical practitioners. A sociologist/anthropologist working in the area of community empowerment and participation would also be an asset.
The introduction of home dialysis should be considered as a measure to enhance the community/family role in CKDu disease management. Home dialysis needs a cleanroom, which is hard to find in farmer households in CKDu-endemic areas. Therefore, for each Grama Niladhari Division, the government should consider building a spacious room in a central location and constructing all the facilities for patients to come and undergo dialysis. A community member should be trained to handle the procedures.
To effectively address the increasing incidence of CKDu in the epidemic regions in Sri Lanka, a well-developed intervention and a community education programme, focusing on behavioural change, should be aimed at lower socioeconomic groups.
The government should strengthen the patient-centred approach to treatment and care. Although medical education programmes in the universities prioritize medical professionals’ role in treatment, patient-centred approaches are seldom discussed. The universities should focus on CKDu-affected districts when selecting villages for students’ intervention and training on a patient-centred approach. Departments of Community Medicine should take the lead in this direction.
A programme to address depression among CKDu patients, needs to be established. DS Division level officers appointed for community work should be trained to handle the psychological issues afflicting CKDu patients. The education and counselling of end-stage kidney patients are essential as many such people have refused to undergo dialysis or kidney transplants.
The basics of kidney function and the risk factors for CKDu should be taught to school pupils in areas where CKDu is endemic.
Features
Why spill water and reject sunlight while burning imported fuel?
Sri Lanka needs a fairer and more transparent approach to renewable energy
by K R Pushparanjan
Sri Lanka has spent several decades encouraging private investment in renewable energy. Small hydropower was among the earliest successes of this policy while rooftop solar has more recently enabled thousands of ordinary households and businesses to become electricity producers. These developments have reduced the country’s dependence on imported fuel, mobilised private capital for electricity generation and contributed towards a cleaner and more diversified energy system.
It is therefore difficult to reconcile these objectives with reports that renewable generators are increasingly being required to curtail production during periods of low electricity demand, particularly on Sundays, Poya days and other holidays. The question is especially relevant to run-of-river mini-hydropower, where naturally available water may simply pass downstream when generation is stopped, and to rooftop solar, where abundant midday sunshine cannot be postponed until the evening peak.
There are, of course, legitimate technical reasons why the Ceylon Electricity Board (CEB), as system operator, may occasionally have to curtail renewable generation. An electricity system must maintain a continuous balance between generation and consumption. On Sundays and holidays, industrial and commercial demand can fall considerably while solar, hydro and wind generation remain available. Certain conventional generating units may sometimes have to remain connected to provide frequency control, voltage support, operating reserves and other services essential for grid stability. Transmission constraints can also make it impossible to substitute generation in one part of the country directly for generation elsewhere.
No responsible renewable-energy producer would suggest that grid security should be compromised merely to accept every available unit of renewable electricity. However, legitimate engineering considerations should not become a blanket explanation that places curtailment decisions beyond public scrutiny.
The CEB itself describes the economic principle underlying electricity dispatch as merit-order dispatch, under which lower-cost generation is normally utilised before progressively more expensive generation. Consequently, whenever inexpensive renewable electricity is deliberately curtailed while substantially more expensive oil-fired generation continues, electricity consumers and renewable producers are entitled to ask why. If a particular thermal generating unit must remain online for frequency stability, voltage support, network security or some other technical requirement, that can be explained. If transmission congestion requires renewable generation in a particular area to be reduced, that too can be demonstrated. Transparency should strengthen technically sound decisions, not threaten them.
Mini-hydro and an unequal contractual relationship
Run-of-river mini-hydropower deserves particular consideration. Unlike reservoir hydro, most such plants have limited ability to store water. When sufficient water is available, but the plant is instructed not to generate, that water may simply bypass the turbines and continue downstream. The opportunity to produce that electricity is then lost. No imported diesel, furnace oil or coal is required to allow that water to turn a turbine, and there is no corresponding fuel-related foreign-exchange expenditure.
Sri Lanka’s mini-hydropower industry was developed largely through private investment. The CEB currently records 219 commissioned mini-hydro projects with an aggregate capacity of approximately 430 MW and acknowledges the role of government policy in encouraging private-sector development of this indigenous renewable resource.
Yet, there has always been a fundamental imbalance in the commercial relationship between the small power producer and the national purchaser. Mini-hydro projects have historically sold their electricity through the Standardised Power Purchase Agreement (SPPA). The very nature of a standardised agreement substantially limits the individual developer’s negotiating position. Published material concerning Sri Lanka’s small-power-producer framework has described the SPPA as standardized and non-negotiable.
This is hardly a negotiation between parties of equal bargaining strength. A mini-hydro developer cannot realistically reject an unfavorable provision and offer the electricity to another national grid. For much of the industry’s history there has effectively been one purchaser, leaving the developer with little practical alternative but to accept the terms offered.
The weakness of that position becomes particularly evident when curtailment occurs. A PUCSL-commissioned study has recorded that under the original SPPA there was no penalty on the CEB for not purchasing energy. The developer may have invested the capital, borrowed the money, undertaken the construction and hydrological risks, maintained the machinery and had both water and generating equipment available, yet still carry the financial loss when electricity cannot be accepted for reasons originating within the national system.
If curtailment is genuinely necessary for grid security, the plant operator may have to accept the technical instruction. It does not logically follow, however, that the entire financial consequence should automatically be imposed upon the weaker contracting party.
Germany curtails renewables too – but differently
Germany provides a useful comparison precisely because it demonstrates that renewable curtailment is sometimes unavoidable even in an advanced electricity system. With very large quantities of wind and solar generation, Germany regularly experiences transmission congestion and occasions when all available renewable electricity cannot immediately be transported to consumers.
The important difference lies in how the problem is managed. Germany operates a regulated redispatch system. European electricity-market rules require redispatch to be undertaken according to objective, transparent and non-discriminatory criteria. Conventional generation, renewable generation and storage can all form part of the process, with interventions determined by what is required to relieve network constraints safely and economically.
Equally important is the recognition that curtailment has financial consequences. Germany’s Federal Network Agency explains that affected generators and storage operators have statutory entitlements to appropriate financial compensation within the redispatch framework. Depending upon the circumstances, relevant arrangements can take account of generation expenditure, lost revenue opportunities, readiness costs, maintenance implications and costs avoided because generation was reduced. The German framework also provides balancing mechanisms intended to address the commercial position of installations affected by redispatch, including renewable generators.
The principle is worth considering in Sri Lanka. When a privately financed generator is required to sacrifice otherwise available production for the security and benefit of the national electricity system, why should that cost automatically and entirely be borne by the generator?
Germany offers another lesson that may be even more important: transparency. Through the Federal Network Agency and its SMARD electricity-market information platform, information on congestion management, renewable curtailment and conventional redispatch is publicly available. Official German figures show that renewable curtailment amounted to approximately 3.5 percent of renewable generation in 2025, meaning that more than 96 percent of renewable electricity generated reached the system and consumers.
Sri Lanka cannot simply copy Germany. The two electricity systems differ enormously in size, resources, interconnections and market structure. What can be adopted, however, are the principles of transparency, non-discrimination, accountability and fair treatment of generators affected by decisions taken for the benefit of the wider system.
What generation remained online?
Whenever significant renewable curtailment occurs in Sri Lanka, sufficient information should therefore be made publicly available to answer some straightforward questions. How many megawatts were curtailed, for how many hours, and how many megawatt-hours of renewable electricity were consequently lost? Which thermal generating units remained operational during those hours? What fuel were they using and what was their approximate generation cost? Why was each of those units technically required to remain online? Was the curtailment caused by system-wide oversupply, a local transmission constraint, frequency considerations or some other identifiable requirement? These are not unreasonable questions. If the decisions are technically and economically sound, the answers should vindicate the system operator.
The issue assumes particular importance because Sri Lanka has historically spent enormous sums purchasing thermal electricity. An Auditor General’s special audit concerning ACE Power Embilipitiya reported expenditure of approximately Rs. 59.454 billion on electricity purchased from that plant between 2016 and 2021. The audit also drew attention to transmission-system problems and the consequences of permanent solutions not being implemented in a timely manner.
This does not establish that thermal generation is unnecessary or that private thermal producers have acted improperly. Nor should allegations of corruption be made against particular parties without evidence. Nevertheless, Sri Lanka’s long history of public concern regarding procurement, governance and major public expenditure makes transparency particularly important. Large thermal power contracts, fuel purchases and capacity arrangements involve substantial sums of money. The best protection against suspicion is not secrecy but disclosure.
If expensive thermal generation genuinely has to remain online while inexpensive renewable generation is curtailed, publish the technical reason. Publish the quantities. Publish the relevant costs. Allow engineers, economists, regulators, investors and electricity consumers to examine the decision for themselves.
Rooftop solar must not become the next casualty
The same argument now applies to rooftop solar. Sri Lanka successfully encouraged households and businesses to invest their own money in solar installations. Net Metering, Net Accounting and related arrangements helped transform consumers into small-scale electricity producers and contributed substantially to the growth of distributed renewable energy. PUCSL continues to recognise Net Metering, Net Accounting and Net Plus within Sri Lanka’s rooftop-solar framework.
The rapid expansion of rooftop solar undoubtedly creates genuine technical difficulties. Solar production is concentrated around daytime hours, while Sri Lanka’s major electricity demand peak occurs later. On a sunny Sunday or holiday, solar production can therefore be substantial precisely when commercial and industrial demand is low. Distribution networks designed for one-way electricity flows may also encounter voltage and hosting-capacity limitations as increasing quantities of electricity flow back from consumers towards the grid.
But it would be fundamentally unfair to encourage citizens to invest their savings in solar energy and subsequently treat their electricity as a problem simply because the national grid has not developed quickly enough to accommodate it.
Battery energy storage offers an important part of the eventual solution. A household battery can capture surplus solar energy around midday and release it during the evening, when both the household and the national system need electricity most. PUCSL has already recognized the value of combining rooftop solar with battery storage in its evolving regulatory arrangements.
However, domestic battery storage still represents a considerable additional investment for an ordinary household. Public policy should therefore be careful not to make battery ownership an economic prerequisite for participating in rooftop solar before such systems become reasonably affordable.
Until domestic battery storage becomes economically accessible to the average household, Net Metering and Net Accounting should be preserved, strengthened and made genuinely accessible. They provide a practical bridge between today’s rapidly growing distributed solar generation and tomorrow’s electricity system in which affordable batteries, utility-scale storage, pumped hydro and sophisticated demand management can shift much more renewable energy from periods of surplus to periods of high demand.
The national grid should, during this transition, continue to perform an important balancing function. Meanwhile, policy should encourage rather than compel household batteries through appropriate time-of-use tariffs and incentives. As battery prices decline, consumers will increasingly adopt them voluntarily because the economics make sense.
The grid must evolve with renewable energy
The longer-term answer is therefore not to choose between renewable energy and grid stability. Sri Lanka needs both.
Investment is required in battery storage, pumped-storage hydro, stronger transmission and distribution networks, better renewable forecasting, modern inverter technology, sophisticated system-control facilities and demand-response programmes. Electricity tariffs can also be designed to encourage industries, commercial establishments, water pumping, electric-vehicle charging and other flexible loads to consume more electricity during periods of abundant solar production.
The electricity system must gradually become capable of moving energy not merely geographically but also across time—storing electricity when nature provides more than consumers require and releasing it when demand rises.
This is also essential for maintaining investor confidence. Private investors make renewable-energy decisions according to expected annual generation, financing costs and anticipated revenue. If a developer can spend substantial capital constructing a renewable project only to face unpredictable curtailment outside his control and without adequate compensation or contractual recourse, the investment risk increases. Eventually that risk translates into higher financing costs, higher required returns and fewer projects.
A country cannot credibly invite private investors to finance renewable energy infrastructure while retaining an overwhelmingly one-sided contractual ability to discard their output and transfer the resulting financial loss back to them.
Transparency should not frighten the CEB
Nobody should expect the CEB to compromise national grid security merely to accommodate a mini-hydro plant or rooftop-solar producer. Where curtailment is technically unavoidable, it should occur.
But “system stability” should never become a phrase that ends the discussion.
Where synchronous generation must remain operating, explain why. Where transmission congestion requires renewable curtailment, identify the constraint. Where renewable producers sacrifice available generation for the benefit of the national system, develop a fair compensation mechanism. Where expensive thermal generation remains operational while naturally available water bypasses turbines, disclose why that was the technically necessary and economically preferable decision.
Germany demonstrates that renewable curtailment and renewable-energy development are not contradictory. Even sophisticated electricity systems sometimes have to discard renewable electricity. The difference is that a mature system attempts to minimize curtailment, operates under transparent rules, publishes relevant information and recognizes the financial consequences imposed upon generators.
Sri Lanka should aspire to the same principles.
We should not encourage private investors to build mini-hydropower plants and then place them against the wall through contracts over which they have little negotiating power. We should not encourage households to spend their savings installing solar panels and later make them bear the cost of deficiencies in the electricity network. And we should certainly not discard economically usable indigenous renewable energy without a convincing explanation while scarce foreign exchange is being spent importing fuel.
Sri Lanka should not spill usable water, reject available sunlight and then burn imported fuel to produce electricity that nature was prepared to provide without a fuel bill.
The issue is not whether every unit of renewable electricity can always be accepted. Clearly it cannot. The real test is whether every unit curtailed was genuinely necessary, whether the least-cost and least-wasteful solution was chosen, whether affected producers were treated fairly, and whether the public is permitted to see the evidence.
That is not an unreasonable demand from renewable-energy producers. It is the standard of transparency, accountability and economic discipline that Sri Lanka’s electricity consumers should expect from a modern national power system.
Features
‘Career of Evil’
Tales of Mystery and Suspense 22
by Prof. Rajiva Wijesinha
I return now to J K Rowling of Harry Potter fame, writing under the pseudonym Robert Galbraith about Cormoran Strike. There are several books in this series of off-beat detective stories, featuring a private investigator who lost a leg while serving in the army, and his assistant Robin Ellacott, who had been raped when a student, with lasting psychological effects. Strike himself was the child of a rock band groupie, who had lived a sordid life, her last attachment being to a failed rock star of relatively aristocratic provenance and brutal habits.
Career of Evil is the third in the Strike series, and markedly different from the two books I read previously, the first and the fifth. Those were relatively speaking classic whodunnits, with a range of possible murderers, the solution in the end being quite unexpected but also convincing. The murderers in both cases are unhinged, but this does not become obvious until Strike has put two and two together and revealed a history of aberrant behaviour.
This novel has just a few suspects, all of them bizarre, as is made clear from the moment they are introduced. The case begins with Robin being sent a severed leg from a dead body, or rather it begins with the thoughts of the murderer who seeks revenge from Strike, which it seems he intends to achieve by first terrifying and then killing the woman he calls Strike’s Secretary. He also evinces a horrid desire to mutilate women after abusing them.
The first person Strike thinks of as a possible suspect is a member of a crime syndicate known to have sent body parts through the post, but Strike soon decides that he cannot be the perpetrator, in part because he is not likely to have known that Strike was responsible for his conviction earlier. Rather Strike is convinced it is one of three people who hate him, two of them individuals he helped to prosecute when he was in the investigating unit of the army, the third his step-father whom he suspected had killed his mother.
Unfortunately, Wardle, the policeman assigned to the case, who gets on well with Strike, is convinced it is the first person Strike had suggested, and does not seem interested in the rest, so Strike sets about trying to find out what they are up to.
They are not easy to trace, but Strike eventually tracks them down. He finds Laing’s mother in Scotland, although she is no longer able to provide any useful information. He then tracks down the mother of Laing’s first wife, Rona, whom Strike had found tied up and tortured. It was this incident that led to Laing’s conviction and imprisonment, and ultimately fuelled his hatred of Strike.
He finds the sister of the second suspect, Noel Brockbank, and learns that she and her brother were both abused as children by their stepfather. Brockbank later went on to abuse young girls himself. When Strike went to arrest him over the abuse of his stepdaughter, Brockbank attacked him with a broken bottle, and Strike knocked him out. Brockbank subsequently suffered seizures and was found to have a serious brain injury. Although Strike was initially blamed for the injury, it was later established that Brockbank had fractured his skull in a rugby match before the confrontation. Brockbank was therefore never convicted of the abuse allegations, while Strike was cleared of responsibility for his brain injury.
Strike’s third suspect is his former stepfather, Jeff Whittaker, whom he describes as unutterably filthy and abusive, yet strangely attractive to women. When Strike tracks him down, he finds Whittaker living with Stephanie, a woman who supports him with what she earns as a sex worker. Despite being abused by Whittaker, she remains devoted to him.
In his musings, the killer refers to the woman he lives with as “It”, suggesting that he could be Whittaker, who lives off Stephanie’s earnings. But when Robin is attacked by a man dressed differently from Whittaker, whom she had seen shortly before, it becomes clear that Whittaker is not the killer. Laing, the first of Strike’s three suspects, is also apparently ruled out when Robin sees him on crutches and learns that he is claiming disability benefits. Strike and Robin therefore concentrate on the third suspect, Noel Brockbank, whom they eventually trace to a home he shares with his girlfriend, Alyssa, and her two young daughters. Robin has seen the younger girl and becomes increasingly worried about what Brockbank might do to her. Although Strike has ordered her to leave Brockbank alone, Robin continues investigating because of her concern for the child. She eventually discovers that Brockbank has been sexually abusing the older of the two girls.
Meanwhile, Strike and Robin manage to identify the girl whose leg was sent to the agency. Among the bizarre letters Strike had received in the past was one from a young woman who fantasizes about having her healthy leg amputated and believed that Strike had deliberately had his own leg removed. Robin realises that the girl was suffering from a condition known as body integrity identity disorder, or BIID, in which a person has a persistent desire to have a healthy limb or other body part removed. Strike simply ignored the letter, unaware that the girl was suffering from a recognised condition and that her request was serious. The girl, Kelsey Platt, is subsequently found to have been murdered, and the police discover forged letters apparently written by Strike in response to her.
Wardle has his suspicions of the man married to the girl’s sister, with whom she had lived. Strike thinks this absurd, and it turns out that the man has an alibi for the time of the murder, but Strike does go along when the sister asks to see him and is overwhelmed by the sense of grief she and her husband evince.
The girl is evidently a godsend to the murderer, whose desire to remove body parts could not be controlled. He chops fingers off a girl he almost kills, and then removes the nose and ears of a girl he kills soon afterwards. And previously he had sent Robin the toe of the girl whose leg had been sent earlier.
All this horror can seem over the top, and one may wonder how Rowling could bring herself to wallow in such grim material. But perhaps she felt very strongly about the abuse women were subject to, and though her depiction of the way women played into the hands of abusive men seems excessive, she feels that awareness of that increases the need for support groups and other mechanisms to provide safety nets.
But there is also another side to the novel, namely the relationship between Strike and his partner Robin, which verges on the romantic though neither wishes to move on the matter. Strike feels diffident about taking advantage of his position as her employer, while Robin is engaged to a young man she has known for years, and whom she was virtually engaged to while at university. He has stood by her after the rape, when she could barely face society, and she finally decides to accept him and they are planning their wedding at the beginning of this book. But she finds that he is jealous of Strike, and hence his resentment of her commitment to her work, she breaks off the relationship when they are staying with her parents to finalize arrangements for the wedding.
But they still share a flat, and given the threat looming over her she cannot really move to live by herself. And gradually his misery wears her determination down, and she agrees again to marry him. The novel ends with their wedding, which Strike just manages to get to, causing her to beam, though she ‘had not once smiled in the entire service’.
But they still share a flat, and with the threat hanging over her, Robin cannot really move out and live by herself. Gradually, Matthew’s misery wears down her determination, and she agrees to marry him after all. The novel ends with their wedding. Strike arrives just in time, battered and bloodied after his confrontation with the killer. Robin has not smiled once during the ceremony, but when she sees Strike, she suddenly beams.
Before that, in the kerfuffle caused by Robin’s attempt to rescue the children of the woman Brockbank was living with, Strike sacks her. This turns out to be useful to him, because he subsequently enlists the children’s mother, Alyssa, to help trap the killer, whom he has by then identified as Donald Laing. With Shanker’s help, Strike arranges for Alyssa to pose as his new secretary and lure Laing into the open while he gains access to the flat Laing has been using as a hideout. There he discovers the evidence of the murders, including the severed body parts kept in a refrigerator.
This leads to a dramatic climax in which the murderer turns up. Strike has difficulty subduing him, partly because of his missing leg, but he is helped by Shanker, a man whom his mother, Leda, had taken in as a neglected and
badly beaten boy and who has remained deeply grateful to the family. With the murderer captured and the case effectively wrapped up, Strike asks Shanker to drive him to Yorkshire, where Robin’s wedding is taking place. They arrive while the ceremony is still in progress, and Strike manages to get into the church just as Robin is making her vows. When she sees him, she beams and says “I do” while looking at him rather than at Matthew.
Clearly, this suggests that the relationship between Strike and Robin is far from settled. Indeed, as I discovered when I read the fifth book in the series, the story certainly does run and run.
Features
Ananda Ganegoda: Pioneer in popularising Sinhala music
by Dr Upul Wijayawardhana
It was with a great sense of sadness that I received the news about the death of Ananda Ganegoda at the age of 80 years; the last of the famous industrialist Ganegoda brothers to depart. Ananada was a businessman par excellence but he ought to be remembered specially for his outstanding contribution to popularising Sinhala music by founding the music label Singlanka in 1980. Unfortunately, I lost touch with him, having seen him only once since I left Sri Lanka in May 1988. As I mentioned in my article on statins (Cholesterol lowering statins: Scope for use widens – The Island; 18 September) I have met some remarkable people in my practice of medicine and Ananda was certainly one of them.
The Ganegoda brothers were actually two sets of first cousins though they worked as a single family. Nandajeewa, Sumanalatha, Wimalajeeva, Karunajeewa and Ratnajeeva were the children of Jineris Ganegoda whilst Chandrasiri, Jinadri and Ananda were the children of Jineris’ younger brother Johanis. Sadly, it seems to have been forgotten by many that the Ganegoda brothers were instrumental in changing our export economy by starting garment factories in 1954, one of the first groups of non-traditional exports. According to a family post on Facebook, the visionary leader was Wimalajeewa, who started Noortex, Mayura, GIL and Eurolanka garment factories. Others followed suit and they presided over a vast business empire.
My first contact was not with Ananda but Karunajeeva, if my memory serves me right. After a consultation and a friendly chat, he invited me to a factory visit, which I readily agreed to. He took me to one of the factories in Ratmalana and I was very pleasantly surprised with the high standards maintained in the factory including workers’ welfare. I was able to taste the delicious food served to the workers. The icing on the cake was his measuring me out for shirts and trousers which I wore for a very long time!
Maybe around late 1983 or early ‘84, Ananda ‘channelled’ me for a consultation in the Central Hospital for chest pain and was accompanied by his wife, Nandani. I noted that, in addition to the cigarette smell, he had heavy nicotine staining of fingers. After having ensured that his pain was not cardiac, I tore into him stating, “What is wrong with you? You are among the Sri Lankan businessman doing well and you seem determined to commit suicide with chain smoking,” Then I started wondering whether I had been too blunt, but Ananda said “Dr, Thank you very much. I will stop smoking” and his calm response took me by surprise. On a subsequent social occasion, Nandani whispered in my ear that he had an occasional ‘secret smoke’ and when I encountered, Ananda said “Dr, hari amarui” but promised he would give up completely. I do not know whether he did so but the significant reduction of consumption, hopefully, contributed to his longevity.
I met him last in 1995, in the role of a peacemaker when he was in open conflict with a close relative of mine. I pleaded with him to stop the battle, pointing out that one of his nieces was being courted by the son of my relative. Though shocked, he promised to make peace.
Ananda’s crowning achievement was the founding of Singlanka which made Sinhala songs accessible to the masses. Those of us, old enough to remember, know how difficult it was to listen to music. As a child, I had to go to the village Community Centre to listen to the radio, which is in utter contrast to what is happening today. With just a click on the smartphone anyone can listen to music of any choice, anytime, anywhere as long as you are connected to the internet! Recording with the ability to playback, started with the Phonograph invented by Thomas Edison in 1877, Vinyl records being available from the early twentieth century. They came in various speeds and sizes but needed cumbersome players.
The real breakthrough came in 1963, when the Dutch company Philips introduced the Compact Cassette with more convenient players. Singlanka gave everyone the opportunity to listen to their favourite artists on Compact Cassettes. When the Compact Disc format, developed jointly by Philips and Sony, released in 1983, gathered momentum, Singlanka too moved to this format but most of us are still in possession of Singlanka cassettes. I still occasionally listen to Nanda Malini’s “Pavana”, which has become relevant because of the recent death of Nanda Malini and the ascent of JVP to power, but that is another story.
Most of our famous singers, including the greats like Amaradeva and Nanda Malini, owe at least a significant part of their fame and fortune to Singlanka, which was Ananda’s brainchild. Looking at the discography of Singlanka is like looking at a list of all favourite singers. In addition, Ananda gave the opportunity to the less known in the field of music also to showcase their talent, the best example being Carlo Fonseka’s Calochita Gee, which was a compilation of songs sung by various artists to the lyrics and melodies of Carlo. Who would have imagined multi-talented Carlo having musical creativity as well!
As for me, one event illustrated his generosity and his sense of gratitude. When Dr N J Wallooppillai retired, and I succeeded him as Cardiologist, I arranged for an international conference “Cardiology Update”, which was held on 6th and 7th of June 1985 at Galadari Meridien Hotel, culminating in a banquet. When I rang Ananda about this, he immediately offered to sponsor music for the evening and arranged for Patrick Denipitiya Combo to play and Ivor Dennis, Indrani and Sisira Senaratna to sing. It was a memorable evening, with plaudits from attendees, though we did not have an opportunity to rehearse. I compeered and we selected the songs as we went on. When Indrani wanted to sing Gaya Geethayan I had to stop as it was a Hindi tune and Indians were in the audience! My wife Primrose joined Ivor Dennis to duet “Olu Pipila Wela Lela Denawa”. We ended the banquet with Ivor Dennis singing, and the audience joining, the patriotic song Dakuna, Negenahira, Batahira, Uturada, Eka Kodiye Sevene thanks to Ananda. I am eternally grateful to him.
May Ananda attain the Supreme Bliss of Nibbana!
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