Opinion

The College of General Practitioners of Sri Lanka celebrates 50 years – 1

Published

2 years ago

2024/08/5

Thilina Walpola

‘Look forward to knowledge but do not forget to lookback for wisdom’

By Dr. Ruvaiz haniffa

A western medical doctor, who has undergone further training to deliver medical care at primary care level, based on concepts and principles of Family Medicine/General Practice, is a General Practitioner/Family Physician. Family Medicine/General practice is the medical specialty which provides continuing and comprehensive care for the individual and the family. General Practitioners – now commonly referred to as Family Physicians – deal with physical, mental and social signs and symptoms in individuals, their families and the community to deliver quality promotive, preventive, curative, rehabilitative and palliative care in an ethical and professional manner, based on the principles of family medicine which is the academic discipline which underpins general practice. Though, in essence being a ‘generalist’ discipline it is classified as a ‘specialty’ of breath which integrates biological, clinical and behavioural sciences to deliver healthcare in holistic manner.

The Family Physician of today is rooted in the historical ‘generalist’ commonly referred to simply as ‘A DOCTOR’. The reader is encouraged to reflect on who or what a medical doctor means to him/her at an individual, family and community level. In Sri Lanka, the terms general practitioner, private practitioner or family physician is synonymously used to identify a western medical practitioner who may or may not deliver primary curative medical care, based on the principles of family medicine. This directly and indirectly implies that anyone with a medical degree (or not) is deemed fit by the medical regulators of Sri Lanka, in particular, and the Sri Lankan public, in general, as qualified, trained and competent to deliver care to patients based on the concepts and principles of family medicine.

This basically allows every Tom, Dick and Harry (or to contextualize it to a Sri Lankan scenario every Silva, Perera and Fernando!!!) (or put another way every Community Physician, Oncologist and Cardiovascular surgeon!!!) to engage in General Practice. This puts patients in harm’s way and gives genuine general practitioners a bad name and image, professionally. This creates a vicious cycle which leads to the academic discipline of family medicine to be looked down upon as an ‘inferior’ or even ‘incompetent’ medical discipline as compared to other medical specialties. This in turn leads to unnecessary medicalization of health issues and leads to a disease-based approach to healthcare at an exorbitant cost for the individual and society. The outcome of this is patients expecting and doctors complicitly delivering disease care as opposed to healthcare when often it is clearly unnecessary. There are many within the disease care industry who directly and indirectly benefit financially and otherwise from this philosophy.

BACKGROUND

The concepts and principles of family medicine are as old as the field of medicine itself. Family medicine as an academic discipline is comparatively new. It was accepted as a distinct academic branch of medicine in the UK in 1952 and in the USA in 1969 and In Sri Lanka, it was recognized as a distinct clinical discipline in May 1979.

In Sri Lanka there is no historical record of self-employed western medical practitioners during the colonial occupations by the Portuguese or even the Dutch. One of the earliest references to self-employed western medical practitioners is in the year 1835 during the British colonial occupation. These records state that a western medical practitioner, named Dr Misso, ‘opened an exceedingly well-furnished dispensary in Pettah after spending 20 years in public service’.

Towards the end of the 19^th century, many Ceylonese doctors, who were products of the Ceylon Medical College (presently the Faculty of Medicine, University of Colombo) took to private practice and established independent clinics outside the state healthcare system in Colombo and Kandy gradually moving to other major towns and villages.

With the increase in their numbers, by the early part of the 20^th century, there were quite a few general practitioners all over Ceylon. A logical development of the proliferation of those engaged in general practice was the formation of an association to look after their interest and ensure their continuous professional development. This led to the formation in 1929 of The Independent Medical Practitioners Association (IMPA) vibrantly existing even today. Dr E.V. Ratnam (founder of one of the first private hospitals in Sri Lanka – The Ratnam’s Hospital – established in 1907) was the prime mover in the formation of the IMPA and was its first President until 1950.

Other key figures who served as Presidents of the IMPA were Sir Frank Gunasekera (1950-51. Served as personal Physician to the British Governor), Dr M C M Kaleel (1952-63. Founder Member of the UNP, Cabinet Minister and Chairman of the UNP), Dr A D P A Wijegoonawaredne (1963-68. President of the Commonwealth Medical Association and Ceylon Medical Association), Dr A M Fernando (1969 -70 Founder Chairman of the Board of Study in Family Medicine at the PGIM), Dr R. P Wijeratne (1970-71) and Dr M P M Cooray (1971-75. First President of the College of General Practitioners of Sri Lanka)

The IMPA was a medico-political body with academic general practice as a subsidiary interest amidst the many professionally related issues it had to deal with at its inception and formative years. Nevertheless, in the 1960s the leaders of the IMPA identified the need for a separate entity to spearhead and dedicate itself as an organization to the academic discipline of General Practice. This idea was the embryo which, over the years, developed into the College of General Practitioners of Sri Lanka, the apex professional and academic body of all grades of general practitioner in the private, state and academic sectors in Sri Lanka. In 1969, Dr A M Fernando, attended the convention of the General Practitioners of Australia, in Sydney.

During this visit, he experienced firsthand the benefits of a formal organization dedicated to GPs and how it played a role in the continuous professional development of its members which, in turn, led to quality primary curative care to patients. He shared his experience with the IMPA membership who, too, were convinced of the benefits of such organization and its advantages to the healthcare system of the country. Dr C E S Weeratunge, a General Practitioner and member of IMPA, was appointed Secretary to the Ministry of Health in 1970 and having been convinced of the idea for the need of a organization for academic family medicine he lost no time in facilitating the idea of a College for General Practitioners and converted it in to reality along with a team of colleagues spearheaded by Dr G M Heennilame.

The procedural and legal aspect of this venture commenced in 1972 and culminated on the 19^th of August 1974 when, under the able guidance of the Speaker of the House Mr. Stanley Thilakaratne and the Clerk of the House Mr. Sam Wijesinghe, Mr. Ronnie de Mel Member of Parliament for Dondra (later Finance Minister) presented the Bill which was approved and brough in to existence the College of General Practitioners of Sri Lanka (CGPSL) by an act of Parliament.

For the record the CGPSL came into legal existence by way of Parliament Bill No. 26 of 19^th August 1974. The inaugural meeting of the founder members of the College was held on 6^th September 1974 at SLMA House. The first general meeting was held on 18^th February 1975. At this meeting all qualified doctors, who were eligible for membership, according to the Bill, were enrolled, subject to the confirmation of the Council. In all 118 members were enrolled on that day.

I take this opportunity to place on record my eternal gratitude to the Independent Medical Practitioners Association of Sri Lanka for having the vision and courage to create the CGPSL as an independent entity and for all the guidance and support it gave the CGPSL in its formative years.

MAJOR ACHIEVMENTS

Since 1975 the CGPSL has taken giant strides to firmly establish Family Medicine as a distinct clinical, specialty in Sri Lanka, amidst a myriad of hurdles. On this momentous occasion of our 50^th Anniversary please permit me to share with you a brief list of unique achievements we have made as a college over the years.

* Establishment of the Board of Study in Family Medicine, at the Post Graduate Institute of Medicine (PGIM) of the University of Colombo

Through this academic activity the College laid the post graduate educational foundation for every single trainee in family medicine who went through the Diploma in Family Medicine Programme and all those who have gone through, are going through and will go through the MD in Family Medicine programme in Sri Lanka.

It must not be forgotten that the entire effort in creating this Board of Study was shouldered by Members of the CGPSL. Of the initial 10-member board five were Members of the CGPSL, including the Chairman and Secretary of the founding Board. The stewardship of this pioneering Board is considered the Golden Era which ushered Family Medicine as an academic disciple into the medical and postgraduate medical education spheres in Sri Lanka and beyond. The CGPSL, through the BoS, successfully conducted the Diploma in Family Medicine (DFM) exam in Chennai, India, in collaboration with the College of General Practitioners of the Indian Medical Association (CGPIMA). As such there are quite a few Indian Doctors with the DFM-Colombo qualification in Indian even today. To date this remains the only post graduate medical examination conducted in a foreign county by the PGIM.

* Introduction of Family Medicine to the undergraduate medical curriculum

At the request of the CGPSL the Faculty of Medicine, University of Colombo, began sending its students to General Practitioners in the Colombo area for three half-day sessions in 1980 to expose them to the discipline. The NCMC, which was established in 1981, had a Department Family Medicine in 1983 where students were given formal theoretical and practical inputs into Family Medicine for the first time in Sri Lanka. Subsequently the Universities of Sri Jayewardenepura and Kelaniya established Departments of Family Medicine in the years 1993 and 1994, respectively. The University of Colombo established a Family Medicine Unit in 2002 and converted it to a Department of Family Medicine in 2018. The Universities of Jaffna, Rajarata, Eastern and Ruhuna have either commenced or are in the process of establishing either Departments or Units to teach Family Medicine.

International Partnerships and Collaborations*

World Organization of National Colleges Academies and Academic Associations of General Practice – WONCA

WONCA commenced in the year 1972 and the CGPSL formally joined in 1978 at its 8^th meeting held in Geneva, Switzerland, though professional and academic contacts had been going on since 1976.

Earlier this year in conjunction with the 50^th anniversary of celebrations of the CGPSL, the WONCA South Asia Regional meeting was hosted by the CGPSL in Colombo 3^rd to 5^th May 2024 at the Shangri-La Hotel. Sri Lanka. They had twice previously hosted this conference (2005 and 2016),

This event was marked by the Philatelic Bureau of Sri Lanka issuing a commemorative stamp and first day cover marking the event.

Many members of the CGPSL play active roles in WONCA with great distinction.

* Royal College of General Practitioners of the United Kingdom

The CGPSL established formal links with the Royal College of General Practitioners of the UK in March 1978 with the visit to Sri Lanka of the Dean of Studies of the RCGP, Dr J S Norell. He was able to give technical inputs in to organization of educational programmes for the membership. This link was renewed in 2003 with the CGPSL taking a lead role negotiating with the RCGP to conduct the Membership exam of the RCGP in the South Asia region. Many CGPSL members underwent training to function as examiners at this exam. The first MRCGP[INT]-South Asia exam was held in 2007 in Colombo. This exam is now held three times a year in rotation in Colombo, Chennai and Karachi. A Past President and Senior Member of the CGPSL Dr. Preethi Wijegoonawardene was elected as the Chair of the MRCGP[INT]-South Asia Examination Board in 2016.

Establishment of the North Colombo Medical College

The CGPSL initiated the creation and establishment of a private medical college, called North Colombo Medical College, which now carries on as the Faculty of Medicine, University of Kelaniya. The NCMC produced about 300 Sri Lanka and overseas nationals as doctors who serve their patients in Sri Lanka and throughout the world.

When Dr G M Heennilame first brought up the proposal of a private medical school in 1975 at a Council meeting of the CGPSL, he was ridiculed and had to face raucous laughter and cynical comments from his colleagues in the Council who did not allow him to continue his presentation. He re-presented his proposal in 1980 at the AGM having further refined it. The proposal won unanimous support from the general membership. Following this, a memorandum was submitted to His Excellency J R Jayawardene, ihe President of Sri Lanka at the time.

The Health Minster Mr. Gamini Jayasuriya was instructed by the President to follow the matter up with the CGPSL along with Secretary Health (Mr. B C Perera) and the Director General of Health Services. A series of logistical, medical educational, health service delivery and financial meetings with relevant officials took place and the President, on the recommendation of his officials, approved the long lease of the Thalagolla convalescent home with 5 to 10 acres of surrounding land in Ragama and designated the North Colombo General Hospital as the teaching hospital for the proposed private medical college.

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Opinion

Could Sri Lanka once again face an economic crisis similar to 2022?

Published

12 hours ago

2026/06/9

Sahan Weerasooriya

This article examines whether Sri Lanka faces the risk of once again moving towards a situation similar to the 2022 economic crisis. The 2022 crisis was not the result of a single cause, but a multidimensional crisis created by the combined effects of fiscal weaknesses, foreign exchange shortages, debt burdens, policy mistakes, and the weakening of the productive economy. Although foreign exchange reserves, the exchange rate, and the fiscal position have now stabilized to some extent, that stability remains fragile.

The continuity of the IMF programme, debt sustainability, investor confidence, and policy discipline are decisive factors in this regard. At the same time, poverty, the quality of employment, pressures on the SME sector, price levels, and income inequalities remain serious socio-economic challenges. Therefore, while it may not be accurate to say that the 2022 crisis will immediately recur, abandoning the reform path and failing to correct structural weaknesses could once again push Sri Lanka towards a crisis-prone path.

Recently, the Chief Executive Officer of the Advocata Institute issued an important warning regarding Sri Lanka’s economic future. That statement also received wide attention across various media platforms. His central argument was that if Sri Lanka moves away from the current path of economic reforms, there is a risk that a situation similar to the severe economic crisis experienced in 2022 could re-emerge.

This statement cannot be dismissed merely as a political or ideological remark. It is an important warning that deserves deeper consideration in relation to the country’s economic stability, policy continuity, and the future of the reform process. Therefore, the purpose of this note is to examine the strength and validity of that statement through selected macroeconomic indicators and structural economic factors.

A particularly important point to remember is that the 2022 economic crisis was not caused by a single factor or a single policy mistake. It was a complex economic crisis created by the accumulation of fiscal imbalances, excessive debt, foreign exchange shortages, weak export and investment growth, the decline of the productive economy, policy uncertainty, and weak institutional governance over many years.

Therefore, in assessing whether Sri Lanka could once again move towards such a situation, it is not sufficient to rely on a single indicator or a short-term trend. Instead, it is essential to consider a broad macroeconomic range, including the fiscal position, foreign exchange reserves, debt sustainability, investment and export performance, unemployment, poverty levels, the condition of small and medium-sized enterprises, price levels, interest rates, and the overall path of economic growth.

Our main question should not be whether the 2022 crisis will return tomorrow. The more important question is whether the fundamental structural weaknesses that caused that crisis have truly been corrected, or whether they have only been temporarily managed. Sri Lanka’s economic future will be determined by the answer to this question.

1. Foreign Exchange Reserves

By early 2022, Sri Lanka’s usable foreign exchange reserves had fallen to extremely low levels, making even payments for fuel, medicine, and other essential imports a serious challenge.

At present, foreign exchange reserves have recovered significantly, providing a stronger protective buffer compared with the situation in 2022. However, this stability could once again be weakened by a breakdown in the continuity of the IMF programme, a slowdown in foreign direct investment flows, a decline in tourism earnings or remittances, or disruptions to the debt restructuring process.

2. Exchange Rate Stability

In 2022, the rapid depreciation of the rupee was a major factor that increased import prices, production costs, and the cost of living.

Today, the exchange rate shows relative stability, but that stability depends on foreign exchange inflows, market confidence, and policy credibility. Therefore, if the IMF programme is disrupted, foreign exchange earnings decline, or investor confidence weakens, the rupee could once again come under severe pressure.

3. Fiscal Position

Among the root causes of the 2022 crisis were the collapse of government revenue, dependence on excessive borrowing, and the long-term weakening of fiscal discipline.

Under the IMF programme, the fiscal position has been strengthened to some extent through increased tax revenue and expenditure control. However, reversing tax reforms for political popularity, failing to reform loss-making state-owned enterprises, or losing control over public expenditure could once again widen fiscal imbalances.

4. Debt Sustainability

In 2022, Sri Lanka was forced to suspend external debt servicing for the first time in its history.

Although the debt restructuring process has now made considerable progress, debt sustainability depends on continuous economic growth, maintaining a primary budget surplus, and policy discipline. If these conditions weaken, concerns over debt stability could re-emerge.

5. Employment Conditions

Although the official unemployment rate appears to be under some control, problems relating to the quality of the labour market remain unresolved.

Many people have moved into low-income informal employment, while the shortage of employment opportunities among educated youth remains significant. In addition, the migration of skilled and educated workers has placed pressure on the country’s human capital and long-term productive capacity.

6. Poverty and Living Standards

With the 2022 crisis, poverty increased significantly. Although inflation has declined, the cost of living still remains a heavy burden for many families.

A large number of households continue to struggle to meet expenses related to food, transport, education, and health. Therefore, it is still difficult to say that the benefits of macroeconomic stability have adequately reached lower- and middle-income groups.

7. Small and Medium-Sized Enterprises

SMEs, which are a central source of employment and income generation in Sri Lanka, were severely affected by the crisis.

High interest rates, energy costs, raw material prices, and weak consumer demand forced many enterprises to close down, downsize, or become burdened with debt. The pace of economic recovery will depend heavily on the revival of this sector.

8. Weakness of the Productive Economy

A deeper structural cause of the 2022 crisis was the limited base of Sri Lanka’s productive economy.

Even today, the country remains heavily dependent on tourism earnings, remittances, and the services sector. High value-added industries, technology exports, knowledge-based services, and innovation-driven sectors have not grown at the expected pace. Without a structural transformation of the economy, long-term stability cannot be guaranteed.

9. Income and Distributional Inequalities

Although some economic groups recovered quickly after the crisis, a large section of the population has still not escaped economic pressure.

The gap between urban and rural areas, as well as between high- and low-income groups, appears to have widened. If the benefits of economic growth are not distributed more broadly, macroeconomic stability will not translate into social and political stability.

10. Price Levels and Inflation

Inflation has declined, but people are still facing price levels that have already risen and become entrenched.

A decline in inflation does not mean a decline in prices. If income growth does not keep pace with price levels, the real purchasing power and living standards of households will remain weak.

11. Interest Rates and Investment

Although interest rates have declined, private investment and new business activity have not yet grown at the expected pace.

Investment decisions are influenced not only by interest rates, but also by policy stability, legal clarity, the protection of property rights, market expectations, and investor confidence. Therefore, sustained investment growth requires broader institutional and policy stability.

12. What Could Happen If IMF Conditions Are Not Implemented?

The IMF programme is not merely a loan facility. It is a key foundation of the confidence that the international financial community places in Sri Lanka’s economic policies.

programme breaks down:

* IMF disbursements could be suspended.

* Support from development partners, including the World Bank and the Asian Development Bank, could weaken.

* Confidence among creditors and international markets could deteriorate.

* Foreign direct investment could slow down.

* Pressure on the rupee could increase.

* Interest rates could rise.

* Inflation could accelerate again.

* Fiscal crises could re-emerge.

* Economic growth could slow down.

* Jobs, incomes, and living standards could be adversely affected.

This does not mean that Sri Lanka would return to the 2022 situation overnight. However, it could gradually weaken the protective buffers required for economic stability and significantly increase the risk of the country being drawn back into a crisis-prone path.

by Prof. Ranjith Bandara, PhD (Qld.,)

Opinion

Beware of Yanks bearing gifts

Published

2 days ago

2026/06/8

Thilina Walpola

Helicopters from the US. (Pic courtesy SLAF)

The US Government has gifted 10 Bell 206, Sea Ranger Helicopters to the SLAF for Training and Humanitarian Assistance and Disaster Relief (HADR) purposes. The full specifications are as follows.

Contractor:

Bell Helicopter Textron
Date Deployed: First flight: 1961; Operational: 1968
Propulsion: One Allison 250-C20BJ turbofan engine
Length: Fuselage – 31 feet (9.44 meters); Rotors turning – 39 feet (11.9 meters)
Height: 10 feet (3.04 meters)
Rotor Diameter: 35 feet 4 inches (10.78 meters)
Weight: 1595 pounds (725kg) empty, 3200 pounds (1455 kg) maximum take-off
Airspeed: 138 miles (222 km) per hour maximum; 117 miles (188 km) per hour cruising
Ceiling: 18,900 feet (5,761 meters)
Range: 368 nautical miles (420 statute miles, 676 km)
Crew: One pilot, four students

While they are good for training, I have my serious doubts whether these helicopters are ideal for HADR. As they have only a single engine and They can’t even operate into high rise helipads in hospitals and hotels in Colombo. The law requires twin engine helicopters! What happens if there is an engine failure while operating over the sea or in a mountainous area? There will be hell to pay!

Three twin engine versions would have been better.

How many helicopter pilots does the SLAF require anyway?

Will we be stuck with junk? Like two Russian KA -26’s during the Sirimavo Government and French Aerospatiale Dauphins SLAF acquired. which were not ‘tropicalised’, during the JRJ Government.

Will the Sea Ranger Spares support be available, free of charge?

I doubt it.

There will also be other Geopolitical strings attached. There is no such thing as a free lunch.

Guwan Seeya

Opinion

Will AI kill solar and wind energy?

Published

2 days ago

2026/06/8

Thilina Walpola

Global warming policies were expected to drive a rapid shift toward a renewables-based energy system dominated by wind and solar. While growth in these sources did occur, it has not matched the pace that was widely anticipated. In the United States, the rise of cheap and abundant shale natural gas significantly reshaped the energy mix, displacing coal and limiting the relative share of wind and solar in electricity generation. In China and India, the situation has been different.

Coal remains dominant because it is widely available domestically, while natural gas is more limited or expensive to secure at scale. As a result, coal has retained its central role in both countries’ power systems. Solar and wind always provide intermittent, variable power. It was widely assumed that a cost-effective, utility-scale electricity storage solution would emerge to solve this problem, but that has not yet happened at the scale originally expected. In the pre-AI era, solar and wind were typically integrated into power systems alongside more reliable sources such as coal, natural gas, and nuclear energy.

For example, if the sun was shining on a Monday, electricity demand could be met largely by solar power during the day. At night, coal, natural gas, or nuclear plants would supply the required electricity. If the following Tuesday was cloudy or gloomy, generation would shift back toward coal, gas, or nuclear to maintain supply. AI introduces a new and more demanding challenge. AI data centers require continuous, high-quality, always-on electricity, which solar and wind alone struggle to guarantee without large-scale storage or back-up systems. In addition, they require very large amounts of power.

As a result, the AI industry is now actively searching for new and expanded sources of reliable electricity. One of the major challenges in powering AI systems is electricity transmission. High-voltage transmission lines are expensive, slow to build, and often face regulatory and land-use constraints. As a result, some companies are exploring more localized power solutions, sometimes referred to as microgrids. These are self-contained energy systems that can operate independently from the main electricity grid. Technologies such as small modular nuclear reactors are an example of such microgrids.

In such isolated systems, the focus is on highly reliable, always available power generated close to the point of use. In this context, solar and wind are expected to play a limited role because their output is variable and depends on weather conditions, making them less suited as primary sources in fully self-contained AI-focused microgrids. The pace of AI infrastructure development is extremely rapid in both the United States and China. AI systems are widely seen as transformative technologies that promise significant new wealth creation, which is driving aggressive and sustained investment. As a result, development is moving quickly, without waiting for long-term solutions such as large-scale energy storage to mature alongside renewable energy systems.

In this environment, electricity demand is rising faster than new infrastructure can be built. In the United States, this reinforces the role of natural gas as the dominant source of reliable power. In China and India, where coal remains more established and readily available, it is likely to continue playing a central role in meeting growing demand. In India, AI data centers have not yet been built at the scale seen in the United States and China. When India does reach that stage, it will need to supply large amounts of reliable electricity. India has placed strong emphasis on solar energy in particular and has had some success in meeting the needs of ordinary consumers through renewable expansion. However, the key question is what choices will be made when large-scale AI data centers begin to arrive.

Will India rely more on coal generation, which is relatively cheap, widely available, and highly reliable, or on solar power, which is intermittent, variable, and often more expensive when reliability is taken into account? My view is that India is more likely to turn to coal to meet this demand, given its existing infrastructure and the need for dependable electricity supply. Then there is an overall question. Solar and wind were already struggling in the pre-AI days to displace coal and natural gas at the system level, despite strong expectations that they would become dominant sources of electricity. Now that AI is here and electricity demand is rising rapidly, will they push solar and wind further behind in the energy mix? (The Statesman)

(The writer is an expert on energy and contributes regularly to publications in India and overseas.)

by SUNIL SHARAN