Opinion
‘Why we should forgive debt for poorer countries – and medical students’
The above caption is the title of an article written by Dr. Kamran Abbasi, Editor-in-Chief of the BMJ. In it, he laments the extremely high cost of medical training, with young UK medical students burdened by an unbearable debt of around £100,000 by the time they qualify—often before they’ve earned a single penny.”
Dr. B. J. C. Perera responded to the article on 12 April 2025 by e-mail, and his response was published promptly. (doi: https://doi.org/10.1136/bmj.r744/rapid-responses).
His response is as follows:
Re: Why we should forgive debt for poorer countries—and medical students: Another perspective from Sri Lanka
Dear Editor,
The BMJ article “Why we should forgive debt for poorer countries—and medical students” certainly gives food for thought.
The real problem is that the students have to pay for everything in Western countries. Nothing really is free. There is also the cultural norm that instigates young people to leave the homes of their parents and be independent. There is a very real cost to getting educated, and this continues with post-graduation as well.
As for our country, Sri Lanka, hardly any young doctor who qualifies is saddled with an unbearable financial burden in the form of a repayable loan. Almost the vast majority of them operate as medical students from the homes of their parents, and the latter attend to the expenses. The university education is totally free, and there are no tuition fees or any other payments to be attended to. Only a very small minority of medical students take Bank Loans, and even in those, the amounts are not even remotely close to Stg pounds 100,000 which figure was quoted in the paper.
We may have our faults, but we do look after the primary, Secondary and Tertiary education of our young people. I am also a product of our free education system. If my parents had to pay for my education or I needed to get a massive bank loan, I would not be what I am today. In return, I have stayed back in Sri Lanka and repaid in full the debt I owe to our people by providing my services in our free National Health Service.
Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed,
FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of
Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
Past President, Colombo Medical School Alumni Association (CoMSAA) – 2015
Past President, Sri Lanka Medical Association (2013).
Founder President, Sri Lanka College of Paediatricians (1996-97)
Opinion
Dengue: Who will guard the state?
I am writing to draw public attention to a serious health hazard regarding a property located at elvitigala mawatha, belonging to the national housing development authority (NHDA)
As seen in the attached photographs, the site is filled with waste that traps water and provides shelter for mosquitoes. Despite repeated complaints, no action has been taken to clean the premises.
This is extremely concerning given the current dengue situation. As of July 18, the National Dengue Control Unit reported over 73,500 dengue cases and 50 deaths nationwide this year, with Colombo being one of the worst affected districts. Residents, including children and the elderly living nearby, are now at direct risk.
PHIs have previously noted that legal action against government premises for dengue breeding is often blocked. If this continues, we are essentially allowing a government property to endanger public health.
I therefore urge the Colombo Municipal Council, the Ministry of Health, and the National Dengue Operations Centre to intervene immediately, clean this property, and hold the authorities concerned accountable before it leads to more dengue cases in our community.
Concerned Citizen
Opinion
Lucille Amarasuriya
(Written by the late Lakshmi Nimalasuriya in July 1986 and published to mark Lucille’s 40th death anniversary)
She was a special friend. We first met when she was president and I was honorary secretary of a voluntary organization. We worked together in great harmony. She was a person of outstanding merit and enmeshed in dreams and goals which she pursued with unflagging zeal.
Her wealth and position made no impact of exclusiveness, nor the advantages she had as a politician’s wife make her dominating.
She was intelligent, receptive and warm hearted and an indispensable member of the All-Ceylon Buddhist Women’s Association and the All-Ceylon Buddhist Congress. She had the ability to respond to any situation and act with confidence – the criterion of leadership.
She was invited to serve on national councils sponsored by the government and was successful in redistributing the allocation of grants which had continued to be unequal and favoured. She was an active member of the Inner Wheel Club adept at fund-raising and was in great demand. She worked long hours in preparation and enlisted all she knew to make the Flag Days successful. She wooed the wives of diplomats for charity performances and the press for publicity. By her tireless efforts she enriched the ever-depleting coffers of these voluntary organizations.
The spiritual growth of young people was a subject close to her heart. She initiated the Youth Forum of the ACBC. She was indeed a happy mother at the time of her death as all her children had grown up to become good citizens.
She was a gifted and versatile person who could sing, write, draw, paint, design, sew and make lovely handicrafts with effortless ease. So, be it an important occasion like her children’s weddings, or mundane functions, fetes, annual general meetings, or at a simple pinkama in the temple or nunnery, or on a sacred day, her lovely creations which she spent hours in making in silent enjoyment would add that splash of gaiety and festivity which delighted us. She told me she learnt this love of decoration from her father who was an eminent Buddhist worker. Underlying all her work was her dedication to the Buddha Sasana.
The death of her teenage daughter early in life, and the death of her husband, who pre-deceased her by a few years, left her inconsolable and she with great difficulty reconciled herself to their loss.
She relives again in memory – Here she comes, a winsome smile on her lovely face, of graceful stature, her wavy hair drawn back, her favourite throatlet around her neck; with friendly charm, her hand out-stretched to help and bound to a generous heart, so she rightly claimed her name of endearment – she was to all Lucilla akka, sister Lucille.
May she soon attain her goal – the end of suffering – Nibbana.
Opinion
Ukraine’s power struggle spills on to the streets
A leadership crisis that exposes the strategic fault lines of Ukraine’s war effort—and the competing imperatives of domestic command, Western pressure, and battlefield reality.
Ukrainian President Volodymyr Zelensky’s abrupt dismissal of Defence Minister Mykhailo Fedorov and his broader cabinet reshuffle have exposed a deep fracture within Ukraine’s wartime power structure. This extends far beyond personalities and into the strategic orientation of the state itself. What is unfolding is not merely a bureaucratic dispute but a crisis of command in a country prosecuting a high intensity, NATO-supported war against Russia.
On 16 July, protests broke out in Kyiv demanding the removal of Commander in Chief Oleksandr Syrskyi and the reinstatement of Fedorov. Smaller demonstrations occurred in Odessa, Lviv, Kharkiv, Lutsk, Dnipro, and other cities. These protests, which have continued for a week, signal a rupture within the prowar bloc that has sustained the Zelensky administration since 2022.
Antiwar sentiment did not drive the demonstrations, in which the “usual suspects” of US-backed “Colour Revolutions” took part. In this case, veterans, territorial defence networks, and upper middleclass “civil society” actors, who remain committed to the war’s continuation. Their demand for Fedorov’s reinstatement reflects a belief that Zelensky has lost operational coherence and strategic clarity. Placards bearing Fedorov’s name were, in effect, endorsements of escalating long range warfare against Russia, despite the catastrophic human toll already borne by both sides.
The political shock waves have reverberated through Ukraine’s Western patrons. The Mayor of Kyiv, Vitaly Klitschko, a major player in the 2014 “Maidan Coup” who is aligned with German strategic interests, condemned the firing publicly as a “big mistake,” while major Western media outlets described the move as “destabilising.” Behind the scenes, officials in Washington and Brussels viewed the sudden change with alarm. Such reactions reveal the degree to which Fedorov had become embedded in Western military technical planning, particularly in the domain of drone warfare, where Ukraine’s operations increasingly intersect with NATO intelligence and logistical support.
This conflict has emerged precisely as Ukraine intensifies drone strikes deep inside Russian territory and escalates operations against Crimea. Fedorov, appointed only six months ago, became the face of this strategy, celebrated by Western media as a “drone warfare mastermind” and criticised domestically for sidelining artillery procurement. His approach aligned closely with NATO’s interest in testing and refining asymmetric strike capabilities against Russia.
Zelensky’s subsequent hints that he may reconsider the decision underscore the precariousness of his position. His authority now rests on a fragile balance between Western expectations, domestic military factions, and a society exhausted by mobilisation. His consultations with both Syrskyi and Fedorov suggest an attempt to reassert control over a command structure that is no longer unified.
Fedorov’s postdismissal revelations sharpen the picture. His claim that Syrskyi and Chief of the General Staff Andrii Hnatov blocked reform initiatives systematically, and that Syrskyi enabled corruption, points to a structural clash between two models of warfare. The Western media has analysed the row as one in which Fedorov represents a Westernaligned, technologydriven paradigm emphasising drones, automation, and longrange strikes. It portrays Syrskyi as embodying an entrenched Sovietera command culture, reliant on artillery, mass mobilisation, and hierarchical control. Zelensky’s decision to side with Syrskyi is presented as a political calculation, preserving the loyalty of the traditional military establishment at the expense of the “reformist” faction.
However, Fedorov’s political alliances complicate this narrative. His cultivation of farright networks, including neo Nazi blogger Serhii Sternenko, reveals the darker undercurrents of Ukraine’s wartime coalition. Sternenko’s role in the 2014 Odessa massacre underscores how extremist actors continue to intersect with state structures, especially in moments of institutional fragmentation.
In actual fact, the power struggle reflects a contradiction between two elite strategies for managing subordination. Ukraine is a subaltern national state embedded in a wider hierarchy of imperialist power. Fedorov is tied to global centi-billionaires and Western technology platforms. His camp can look “more Western” because it is more integrated into transnational circuits of capital and war-tech. The apparent modernity of that model still carries dependency: it improves efficiency while deepening reliance on external monopolies. The war state becomes dependent on foreign-owned infrastructure, satellite systems, software, and elite relationships, which gives external capital leverage over military coordination and political priorities.
Syrskyi, by contrast, is closer to an older form of domestic elite power: the military-bureaucratic order linked to native oligarchic interests, procurement channels, and patronage. This is a more nationally rooted fraction of the bourgeois bloc, but not necessarily a more independent one, because Ukrainian oligarchic power has long been intertwined with Western finance, arms flows, and state restructuring.
The struggle between Syrskyi and Fedorov therefore reflects competing modes of dependency, and (although clearly the Western establishment favours the latter) not a clean split between “national” and “Western” camps. One route passes through transnational tech capital and managerial reform; the other through entrenched oligarchic-military command and domestic networks of influence. The clash is therefore not an isolated dispute but a symptom of an intra-elite struggle over how Ukraine should be governed as a dependent war economy. Neither side points beyond bourgeois rule; they are different management styles of the same subordinated state form.
Taken together, the crisis reflects a deeper geopolitical reality: Ukraine’s war effort is no longer anchored by a unified elite consensus. Instead, it is being pulled apart by competing military doctrines, Western strategic pressures, corruption scandals, and the exhaustion of a society asked to sustain indefinite mobilisation.
Vinod Moonesinghe, formerly chair of the Ceylon German Technical Training Institute and of the National Institute for Language Education and Training, serves as Convenor of the Asia Progress Forum.
By Vinod Moonesinghe ✍️
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