Business
Saving lives in maternal cardiac care: A novel approach to safety and excellence
Professor D E Gunatilleke Memorial Oration of the Sri Lanka College of Obstetricians and Gynecologists was delivered by Dr Gamini Galappatthy Senior Consultant Cardiologist at the National Hospital of Sri Lanka.
Dr. Sanath Akmeemana President of the Sri Lanka College of Obstetricians and Gynecologists awards the oration medal to Dr. Gamini Galappatthy Senior Consultant Cardiologist, he delivered the prestigious Professor D E Gunatilaka memorial oration at the Samson Rajapaksha auditorium of the SLCOG House on May 25, 2025. The oration was titled ‘Heart Disease and Pregnancy – The Crossroads Well Signposted Will Prevent Disasters’.
Prof. D.E. Gunatilleke Oration
Prof. D.E. Gunatilleke was a renowned consultant obstetrician and gynecologist and former President of SLCOG 1979-1981 has made invaluable contributions to obstetrics and gynecology in Sri Lanka—his legacy continues to inspire generations. He was born in 1924 and entered Colombo Medical College in 1944 passing MBBS with a brilliant academic record in 1949. He continued to shine both academically and clinically obtaining his membership of the Royal College of Obstetricians and Gynecologists, London as the best student from the British Commonwealth. A pioneer in introducing laparoscopic gynecological surgery, he died in 1983 having served the country for nearly four decades. This prestigious annual oration in memory of late Prof D E Gunatilleke honors his values of meticulous clinical practice, kindness and integrity and was attended by many members of his family.
This year’s Prof. D.E. Gunatilleke Memorial Oration titled “Heart Disease and Pregnancy – the Crossroads Well Signposted Will Prevent Disasters”, was brilliantly delivered by my classmate from Royal College, Dr. Gamini Galappatthy MBBS, MD, MRCP-UK, FRCP London, FCCP, FACC, FESC, FAPSC, Senior Consultant Cardiologist at the National Hospital of Sri Lanka.
A Personal Connection to the Oration
Attending this distinguished oration carried deep personal meaning to me—not only because of my lifelong friendship with Gamini since our early years at Royal College but also due to my late father, Dr.
D.V.H. Silva, who was a fellow member of the Royal College of Obstetricians and Gynecologists (UK) and its Sri Lankan affiliate, SLCOG. Among the audience were many of my late father’s colleagues and former students, adding a sense of both legacy and professional camaraderie to the occasion.
Listening to Dr. Gamini Galappatthy’s oration, I recognized the critical need to elevate awareness of maternal cardiac care, prompting me to contribute through a paper article—exploring the paradigm shift he advocates in obstetric patient care to prevent crises at pivotal junctures.
The ‘crossroads’- learning to navigate safely
The crossroads are real — every pregnant woman with heart disease stands at one. Gamini’s use of the metaphor of a dangerous crossroads between pregnancy and heart disease was appropriate and illustrative. Traveling down either road one encounters many inherent dangers but coming to the junction unprepared could end in disaster!. A maternal death is a tragic and largely preventable disaster at the cross roads, a majority due to heart disease in Sri Lanka. In addition to snatching a woman’s life in the prime, the socio-economic impact of a maternal death is wide and far reaching. With the right signposts, collaboration, and a shift to proactive safety thinking, the obstetric teams can ensure these women navigate the crossroads safely.
Gamini provided novel insights into the ‘Safety-I’ and ‘Safety-II’ frameworks as applicable to maternal cardiac care—emphasizing the importance of learning as done at present, from mistakes, risk identification and error prevention (Safety-I) while also highlighting the need for a broader approach of additionally studying successful practices and successful outcomes (Safety-II) to enhance success in patient care. His emphasized on multidisciplinary collaboration, early risk assessments, and optimized treatment protocols as the cornerstones of proactive maternal healthcare.
The concepts of Safety I and Safety II which Gamini highlighted, were first proposed by Professors Erik Hollnagel [Denmark] in a 2013 paper. These are currently being recognized by the World Health Organization (WHO), the National Institute for Clinical Excellence (NICE) UK and the Royal College of Obstetricians and Gynecologists (RCOG), UK.
The novel Safety II approach proposed by Gamini in his oration for the field of obstetrics and gynecology in Sri Lanka, especially in the context of heart disease management in pregnancy, was well received by the esteemed audience at the oration consisting of consultant obstetricians, physicians, cardiologists and medical administrators.
The oration was spread out as below proposing a paradigm shift in thinking to enhance maternal cardiac care in Sri Lanka by applying the Safety-I and Safety-II Frameworks
Maternal cardiac care in Sri Lanka is of particular importance, as preventable cardiovascular complications during pregnancy remain a leading cause of maternal mortality. To enhance patient outcomes, healthcare providers must shift from the retrospective focus of Safety-I—centered on failures, risk identification, and error prevention—to the proactive principles of Safety-II, which emphasize successful practices, positive outcomes, and the implementation of guideline recommendations. Shifting to Safety-II framework could enhance patient safety by minimizing risks while optimizing best practices.
Gamini shared maternal mortality statistics and heart disease in pregnancy statistics for Sri Lanka and described outcomes and trends over the past several decades to the present day and compared SL statistics with global and regional benchmarks. He also emphasized key aspects of the WHO maternal heart disease risk stratification and European Society of Cardiology guidelines on managing heart diseases in pregnancy.
The Safety-I and novel Safety-II concept Gamini described is as follows-
Safety-I: Learning from failures
Sri Lanka’s maternal healthcare system, recognized as one of the best globally, still faces several challenges, including a relatively high maternal mortality ratio compared to the best in the world largely due to late diagnoses of heart conditions and limited access to specialized cardiac care.
Safety-I principles aim to address these risks by conducting WHO initiated Maternal Death Surveillance Response [MDSR] meetings at national level after a maternal death to arrive at the cause of maternal deaths. Such data are analyzed by the Ministry of Health to derive a set of globally accepted and comparable statistical parameters such as the maternal mortality ratio and causes of maternal mortality.
In Sri Lanka 2001-2020 a leading cause of maternal mortality was heart disease. Of these, rheumatic valvular heart disease, mainly mitral valve stenosis, was the leading cause. It is estimated that 60% of these deaths are preventable by early diagnosis.
Learning from failures, these statistics allow healthcare providers to identify and eliminate future hazards before they escalate and put in place measures to reduce future preventable complications such as-
Improved Screening Protocols – Strengthening early detection of cardiac conditions in pregnant women.
Standardized Emergency Response – Training medical personnel to recognize warning signs and react swiftly.
Medication and Treatment Guidelines – Ensuring consistency in prescribing safe drugs for cardiac patients.
Safety-II: Learning from Successes
To improve patient outcomes, healthcare providers must transition from the current Safety-I framework to the Safety-II approach, which enhances patient outcomes by building upon Safety-I and incorporating proactive measures. It is estimated from a recent analysis in USA that 1-4% of pregnant women have heart disease. In Sri Lanka this would account for around 2500 pregnant mothers annually with heart disease, a large majority of whom undergo successful pregnancies and who are delivered through the crossroads safely by their obstetrics teams.
Learning from the successful outcomes includes:
Analyzing Successful Case Studies – Understanding how hospitals with lower maternal mortality rates manage cardiac emergencies.
Encouraging Interdisciplinary Collaboration – Strengthening teamwork between cardiologists, obstetricians, and anesthetists for more integrated care.
Leveraging Community-Based Healthcare – Expanding maternal cardiac monitoring at primary healthcare centers for early interventions.
Sharing the success of implementing evidence-based guidelines for managing heart disease in pregnancy by international cardiology societies.
By shifting focus from avoiding mistakes to replicating successful practices, Sri Lanka can create a resilient maternal cardiac care system that improves survival rates and overall healthcare effectiveness.
In summary Dr. Gamini Galappatthy in his oration said that,
A globally recognized paradigm shift from the present Safety-I to a Safety-II approach which builds upon Safety-I by integrating additional proactive measures to enhance patient outcomes, would ensure that Sri Lanka’s maternal cardiac care system is both reactive to failures and proactive in promoting success. By integrating ‘signposts’ such as early risk identification, evidence-based successful strategies and a multi-disciplinary approach, disasters at the Heart Disease and Pregnancy ‘crossroads’ can be prevented and the crossroads navigated safely.
By Dharshan Silva ✍️
Business
Sri Lanka’s recovery reveals a ‘numerical puzzle’ in employment stats
Factory output rises, but many remain outside the labour market
Sri Lanka’s latest economic indicators point to a curious numerical puzzle as industrial production is rising while labour force participation has not moved in tandem.Data for January 2026 show that the Index of Industrial Production (IIP) rose 4.4% year-on-year to 99.3, signalling a modest improvement in manufacturing activity compared with January 2025. The expansion was led mainly by food products, which grew 10.6%, wearing apparel which increased 12.5%, and other non-metallic mineral products, which recorded 3.6% growth.
Ordinarily, such growth in factory output would be expected to draw more people into the workforce. Yet Sri Lanka’s labour market statistics tell a slightly different story.
The labour force participation rate has been in the high 40% range in recent years. Latest estimates show it at around 46.9%, compared with about 49.9% in an earlier period, suggesting that a noticeable segment of the working-age population has remained outside the labour market even as production has begun to pick up.
In other words, factories appear to be producing more, but the pool of workers actively participating in the labour market has not expanded at the same pace.
Meanwhile, the unemployment rate has remained relatively low, just above 4%, indicating that those who are actively seeking employment are generally able to find work.
Business sentiment indicators also point to continued momentum in the real economy. The Purchasing Managers’ Index (PMI) for manufacturing has remained above the 50 point threshold, signalling expansion in factory activity, though slightly less than the stronger readings recorded toward the end of last year. The services sector PMI, meanwhile, continues to reflect steady business activity.
An economic analyst told The Island that taken together, the numbers suggest that Sri Lanka’s productive sectors are slowly regaining their footing after the severe economic stresses of recent years, but the gap between rising industrial output and subdued labour force participation would raise a question for economists and policymakers if they put their mind to the matter,
“If factories are producing more, where are the workers? Where is more hiring?”, he asked.
“One could argue that workers who exited the labour market during the economic crisis through migration or shifts to informal activity may not yet have fully returned. And the gap is unlikely to be explained by automation in factories. If that is the case, a sustained revival in export-oriented industries such as apparel and food processing should gradually draw more people back into the workforce,” he explained.
“So, the numbers underline a simple but important challenge for policymakers to ensure that improvements in industrial production are matched by broader participation in the labour market. Until more people return to the workforce, Sri Lanka’s recovery may continue to show this curious numerical puzzle of factories producing more, but fewer people showing up in the labour statistics,” he argued.
By Sanath Nanayakkare
Business
Plant-based tourism could be Sri Lanka’s overlooked growth opportunity: Andrea Diaz
As Sri Lanka searches for new sources of foreign exchange and sustainable economic reform, an unexpected opportunity may lie in something as simple as the food on its plate. According to Andrea Diaz, Executive Director of Dharma Voices for Animals (DVA), Sri Lanka could strengthen tourism revenue, improve public health and advance environmental resilience by positioning itself as a vegetarian- and vegan-friendly destination rooted in its Buddhist heritage.
“Compassion is not only a moral value,” Diaz says. “It can also be an economic strategy.”
Sri Lanka occupies a unique place in the global Buddhist world, having preserved the Theravada tradition for more than two millennia. Diaz believes this heritage gives the island a distinctive moral authority to demonstrate how Buddhist principles such as non-harming and compassion can shape modern policy and everyday life. Dharma Voices for Animals promotes plant-based food systems that protect animals, safeguard the environment and support human health. In Sri Lanka, the organisation frames its work as an effort to reconnect contemporary lifestyles with longstanding cultural values.
Historically, many Sri Lankan communities relied heavily on plant-based diets before colonial influences altered food systems. Even today, much of the island’s traditional cuisine – dhal curry, mallung, jackfruit dishes and coconut-based preparations – remains naturally vegetarian or easily adaptable. Diaz argues that this culinary foundation gives Sri Lanka an advantage that many countries struggle to build.
Rather than reinventing its food culture, she says, Sri Lanka could highlight its existing culinary traditions and present them to the world as part of a compassionate and sustainable national identity.
DVA’s work on the ground focuses on translating these ideas into practical change. A network of volunteer regional coordinators conducts educational programmes at temples, Sunday schools, community centres, women’s groups, medical clinics and even army facilities, encouraging people to reflect on how daily food choices align with Buddhist ethics. According to Diaz, the organisation’s outreach in 2025 alone reached more than 146,000 individuals through lectures, discussions and community events.
Education is paired with practical tools aimed at making plant-based eating accessible. The organisation has published Sri Lanka’s first vegan cookbook using locally available ingredients, while cooking classes broadcast on cable television and community cooking competitions demonstrate that plant-based meals can be affordable, nutritious and culturally familiar.
By highlighting that many rice-and-curry combinations already meet nutritional needs, advocates hope to dispel the perception that dietary change requires dramatic lifestyle adjustments.
The economic implications extend beyond cuisine. Diaz notes that global tourism trends are shifting toward values-driven travel. Visitors from Europe, North America and Australia increasingly seek destinations where vegetarian and vegan food is readily available and clearly labelled. Countries that accommodate this demand often benefit from longer stays and strong word-of-mouth promotion among conscious travel communities.
Sri Lanka, she suggests, could tap into this market with relatively modest policy steps – clearer menu labelling, plant-based certifications for hotels and targeted marketing highlighting the island’s naturally vegetarian culinary traditions.
Positioning Sri Lanka as a compassionate culinary destination could also strengthen its broader tourism brand. Modern travellers increasingly consider sustainability, ethics and wellness when choosing destinations. A national identity linking Buddhist values with environmentally responsible food culture could help differentiate Sri Lanka from competing tropical tourism destinations while supporting farmers who produce rice, lentils, vegetables, spices and coconuts.
Beyond tourism, Diaz believes dietary shifts could contribute to climate resilience and food security. Animal agriculture requires significant land, water and grain while producing comparatively high greenhouse gas emissions. Redirecting more crops directly to human consumption improves efficiency and allows more people to be fed from the same land base.
For a country already rich in plant-based staples, strengthening these agricultural systems could reduce reliance on imported animal feed while supporting smallholder farmers and protecting natural resources.
Public health represents another potential benefit. Many of the world’s most costly diseases including cardiovascular disease, diabetes and hypertension are strongly linked to diet. Diets rich in legumes, vegetables, fruits and whole grains are associated with lower rates of these conditions. Encouraging plant-forward diets, Diaz argues, could help governments reduce long-term healthcare costs while improving workforce productivity.
Dietary change, she emphasises, does not require universal adoption to produce meaningful social impact. Research on social movements suggests that when roughly 3.5 percent of a population actively supports a cause, broader cultural and political change can begin. In Sri Lanka’s case, that would mean about 800,000 people visibly committing to compassionate food choices and discussing the values behind them.
Yet while discussions about compassion and sustainability are gaining attention, Sri Lanka’s legal framework for animal protection remains outdated. The country still operates under a law dating back to 1907, a colonial-era statute widely viewed as inadequate for modern welfare standards. A proposed Animal Welfare Bill – developed through years of consultation and legal drafting – has twice received Cabinet approval but has never been presented to Parliament.
If enacted, the legislation would replace the colonial-era statute with modern welfare standards, establishing clearer definitions of cruelty and neglect, stronger penalties and improved investigative powers. It would also formalise internationally recognised welfare principles such as adequate food, shelter, medical care and humane handling of animals.
Advocates also emphasise that the growth of plant-based industries need not threaten farmers currently involved in livestock production. Instead, they see opportunities for gradual diversification. With appropriate training and policy support, farmers could transition toward crops central to plant-based diets or participate in value-added food production, strengthening rural livelihoods while reducing environmental strain.
For Sri Lanka, the broader message is that compassion, sustainability and economic development need not be competing priorities. A food system that emphasises plant-based traditions already embedded in local culture could simultaneously strengthen tourism, improve public health, enhance climate resilience and support rural agriculture.
Seen through that lens, the humble rice-and-curry meal may represent more than a culinary tradition. In a world searching for more sustainable ways to live and travel, Sri Lanka’s oldest food traditions may yet become one of its most modern economic opportunities.
by Sanath Nanayakkare
Business
City of Dreams partners with FitsAir for direct Ahmedabad-Colombo flights
City of Dreams Sri Lanka has partnered with FitsAir and Cinnamon Hotels & Resorts to launch direct scheduled passenger flights connecting Ahmedabad and Colombo, enhancing connectivity for Indian travellers to South Asia’s first integrated resort.
Sri Lanka’s first private international airline, FitsAir, will operate the service three times weekly from May 15, catering to Gujarat’s growing outbound travel market. The route positions Colombo as an attractive luxury getaway for Indian travellers while strengthening ties between the regions.
Guests can stay at Cinnamon Life at City of Dreams or explore other Cinnamon properties in Colombo, with curated holiday packages combining the resort experience with multi-destination itineraries across the island, including cultural experiences in Kandy and beach stays.
Kamal Munasinghe, Senior Vice President at Cinnamon Hotels & Resorts, noted India remains one of their most important markets, with Gujarat showing strong interest in Colombo as a leisure destination.
FitsAir Director Ammar Kassim added that the overnight departure from Colombo arrives early morning in Ahmedabad, giving travellers a full day ahead and opening smooth onward connections through Colombo across their growing international network.
Packages start from INR 55,555, including return airfare, two nights’ accommodation with breakfast at Cinnamon Life, and private airport transfers.
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