Although the dust has settled on the matters raised by Dr. A.H. Sheriffdeen’s letter to the President of the College of Surgeons of Sri Lanka (CSSL) and the heat generated by the issue has now cooled, it is worth reflecting on this matter. Emeritus Professor Sheriffdeen has acquired a well deserved reputation as an excellent surgeon and teacher of the highest calibe and it was natural that what he had to say struck a resonant chord among a wide section of society not only because of what he said but also the way he said it. Anybody who read his letter, widely publicized by both the mainstream and social media, would have clearly seen the anguish with what he wrote and empathized with the reality that things were much better in times that are now long past.
Both Dr. Sheriffdeen, in a subsequent letter, and Dr. Jayaindra Fernando, President of CSSL, have expressed dismay about the original letter being publicized the way it was. Fernando has said that the College of Surgeons “were surprised and dismayed” by the publication of what they termed was a “private letter” intended to be read by its members. Sheriffdeen has said that he is appalled that an “internal email” to the President of CSSL had been published as it was. Given the excellent tone and tenor of of what followed, we do not wish to strike a discordant note but want to say in defence of the publication, that the letter did not say it was private and confidential or meant only for the reading of a select audience. Also, at least the mainstream editors (we can’t speak for the social media), would not have seen it as a ‘plant’ – something not common in our line of work. We might add our belief that is was a good thing that a matter as important as this was widely disseminated and provoked extensive discussion among those who matter – both in the medical profession and elsewhere.
The response to the original missive by the paediatric surgeons working at the Lady Ridgeway Children’s Hospital (LRH) deserves the highest commendation by all for the way in which it was worded. This letter was formally released to the press by the President of CSSL and although published elsewhere earlier, is republished in this issue of our newspaper both for the reason that we ran the original story as well as the need for the widest possible dissemination of what for the lack of a better word be styled as the “rejoinder.” The LRH surgeons who called themselves a “Paediatric Surgeon’s Collective” wrote in lighter vein that “it is said in jest that every story has three sides – your side, our side and the truth.” We professional journalists are trained to investigate both sides of what we write in the hope that the truth lies in-between your side and my side and would hopefully be discerned by the readers.
The rejoinder was a model of the best diplomacy which conveyed what the writers had to say with no offense to anybody. It called Prof. Sheriffdeen “one of our beloved and respected teachers” who had striven during his career to impress upon his students the ideals of being a good doctor. They did not try in the slightest way to criticize Sheriffdeen for what he wrote saying “the exasperation of a man who feels betrayed and thwarted is understandable (and) if his impassioned communication…..did help to restore his equilibrium, as he expected, then we will somehow try to take in stride the damage done to our reputation and that of the hospital.” Most letter writers would have socked in the words with which that sentence ended, “even though the events that had taken place are misrepresented.” There was no strident accusation of misrepresentation or any kind of fault finding.
In essence the LRH surgeons made the point that standards of care for any condition is ever-evolving and they are guided by what is appropriate at that point of time. Presently, acute appendicitis in children, does not have to be rushed into the theatre in the night (unlike in Sheriffdeen’s heyday they did not say to their eternal credit). They explained that in the contentious case under discussion, it had been decided to do the appendectomy after fluid resuscitation and antibiotics. It had been planned to operate on the child as the first case the next morning, successful surgery performed and the patient who was fully recovered had been discharged. They agreed that the consultant surgeon does not stay in after normal working hours “but is only a telephone call away.”
All’s well that ends well we are tempted to say with no two-fisted attack on anybody. But there is no escaping the reality that there are great deal of deficiencies in the state healthcare system and that most people in the country have a perception that private healthcare, despite the enormous and in most cases unaffordable cost, is preferable to going to a government hospital. Knowledgeable people know that the finest and most skilled services are present in the state sector. But it is also true that healthcare is today a lucrative business not only for the private hospitals but also for specialist consultants permitted private practice despite being employees of the state health service. We do not think that all these doctors can place their hand their hearts and swear that they put in the necessary hours at their government jobs at the cost of their private practice. There are many who do and perhaps many more that do not. Hopefully the wide discussion of all the issues arising from Prof. Sheriffdeen’s letter will be a healing touch on the country’s healthcare system.
Free-market and socialism
Friday 16th April, 2021
Former Finance Minister and newsmaker, Ronnie de Mel, has attracted media attention, again, at the age of 96. He is reported to have said, during a recent conversation with Opposition Leader Sajith Premadasa, that the Sri Lankan economy should be repositioned with a tilt towards socialism. He has also stressed the need for equitable growth, and other such pro-poor measures in keeping with the tenets of Buddhism.
It is being argued in some quarters that de Mel, who presented 11 budgets consecutively under the better-dead-than-red J. R. Jayewardene government, has faced about, but going by what he is heard saying in a video clip of the aforesaid conversation, which is accessible on the Internet, one can see that he only opines how capitalism can emerge stronger and remain relevant, especially in this country. Speaking boastfully about the epochal economic change the country underwent in 1977, he says there is a pressing need for another such momentous event for the Sri Lankan economy to come out of the doldrums.
Ironically, there was no love lost between de Mel and the late President Ranasinghe Premadasa, while they were in the JRJ government as the Finance Minister and the Prime Minister respectively, but the former is now of the view that the latter’s son, Sajith, is the only hope for the country!
We had two epoch-defining elections as regards the national economy. In 1970, the SLFP-led United Front (UF) government, which secured a two-thirds majority in Parliament, adopted a statist approach to economic management and threw in its lot with the socialist bloc in a bipolar world. It took things to an extreme in experimenting with its autochthonous politico-economic model. The state’s vise-like grip on the economy retarded the growth of the private sector much to the resentment of the capitalist bloc. Many arguments have been put forth in defence of this kind of state control over the economy, stringent regulations, etc., under that regime; they are not without merit, but the UF government became hugely unpopular, as a result. In 1977, the UNP, made a stunning comeback and formed a government with a five-sixths majority in the House with de Mel as the Finance Minister and upended the UF’s economy policies, triggering an open-market tsunami as it were; that revolutionary change led to the evisceration of many vital state institutions. Both regimes failed to maintain a balance, and their economic reforms, therefore, did not yield the desired benefits for the country. If only they had heeded the classical, oxymoronic adage, festina lente (‘make haste slowly’).
Those who expected capitalism to flourish following the collapse of the Soviet Union (1991) only cherished a delusion. Capitalism has been in crisis; this situation is mostly due to the fact that the capitalist state has to carry out two mutually contradictory functions—accumulation and legitimisation. The process of legitimisation basically requires maintaining social harmony, which cannot be achieved unless the ill-effects of the unbridled capital accumulation are mitigated for the benefit of the ordinary people. Hence attempts by the capitalist state to give its policies a socialist flavour with social welfare and pro-poor schemes. (The JRJ government went so far as to call this country a ‘Democratic Socialist Republic’, in the Constitution it introduced. (Emphasis added.) It is against this backdrop that former Finance Minister de Mel’s aforesaid advice to the Opposition leader should be viewed.
Besides, critics of capitalism inform us that the current free-market model has led to a triple crisis for capitalism—financial instability, lack of environmental sustainability and political unpopularity. “Adapt or perish, now as ever, is nature’s inexorable imperative,” H. G. Wells has said. This aphorism applies to economic models as well. Even the US has had to make dramatic course corrections over the decades. Some of these measures run counter to its unsolicited advice to the rest of the world; Washington opted for a massive bailout package to save the American banks, etc., during the 2008 financial meltdown, which marked a turning point in capitalism and modern economic theories. The Occupy Wall Street movement, which emerged in 2011, was another manifestation of the crisis of the capitalist state; the protesters who took to the streets were young Americans enraged by intolerable economic inequalities.
President Donald Trump had no qualms about openly practising protectionism to boost the US industries at the expense of other nations, especially China, through controversial tariff hikes. His successor, Joe Biden continues with, more or less, the same policy. All US Presidents have been closet protectionists.
Biden has recently got a 1.9-trillion-dollar stimulus package approved by the Congress to jump-start the economy, facilitate the ongoing Covid-19 vaccination drive, and grant relief to the pandemic-hit Americans. These measures are part of the legitimisation process aimed at bringing about social harmony.
One can only hope that the present-day political leaders and economic policymakers will take note of the fact that one of the main architects of the Sri Lankan version of market economy has owned that things are far from copacetic for capitalism in its present form; the key takeaway for the incumbent government from de Mel’s advice to Sajith, in our book, is the need to ensure equitable growth, which, however, is not attainable through occasional cash handouts and politically-motivated poverty alleviation projects.
Happy New Year!
Tuesday 13th April, 2021
The Sinhala and Tamil New Year is the time when ordinary people have their fill of merrymaking, and traders and pawnbrokers laugh all the way to the bank. The much-talked-about need to preserve traditions associated with the national festival for posterity is only an excuse for the annual splurge.
What is being celebrated is essentially a harvest festival. In days of yore, people toiled away for months and produced a surplus, part of which was set aside for the New Year festivities. They did not have to worry about the rest of the year as they had enough food stocks. Today, there is no such surplus production, and most people spend borrowed money on New Year celebrations only to regret later when the festive hangover gives way to sobering reality.
Today, harvesting makes only moneylenders and the middleman happy. The farming community is caught in a debt trap. Loan sharks prey on them with impunity. Harvesting is followed by debt-servicing, and farmers either cannot pay back their loans or are left with little or nothing after debt repayment; they have to borrow more for consumption and cultivation purposes, and never will they be able to break this vicious circle unless the state makes a meaningful intervention. Avurudu provides them with some respite from suffering. The same is true of most other people as well.
The koha is said to be conspicuous by its absence, this year. Is it fed up with looking for trees to perch on, given the rate at which the country is being denuded? Its cry which is considered the herald of the traditional new year is, in fact, a desperate mating call. One wonders whether its cry is not heard these days because it has opted for remaining silent by way of family planning, as it were, on account of serious habitat problems.
Health experts have been trying to knock some sense into the public, but in vain. People have thrown caution to the wind, and are behaving as if the pandemic were a thing of the past. They seem to consider Avurudu to be something worth dying for. Shops are chock-a-block, and nobody cares two hoots about the physical distancing rule. People jostle inside clothing stores as if they had never worn clothes before. They also strip bare the racks of grocery stores as if they had never seen food, all these years. Adult males religiously flock around liquor outlets as though their very survival were dependent on the bottle that cheers.
Yesterday, India reported 168,912 COVID-19 infections overnight and overtook Brazil as the second-worst hit country in the world. Unless precautions are taken during the current festive season, Sri Lanka may find itself in the same predicament as its big neighbour.
Politics has apparently taken precedence over the COVID-19 protocol although the health authorities fear that a surge of infections is on the horizon. The government seems reluctant to have the health regulations strictly enforced lest such action should not find favour with the public, who had to be immured in their homes during the festive season, last year. The Provincial Council elections are also expected before the year end. Hence the distribution of cash handouts by the government, which is playing Santa months ahead of Christmas.
The national economy and productivity will take another severe beating due to holidays. Workplaces will remain closed until early next week. It takes, at least, one whole week to reboot the country after the New Year celebrations. Economists should figure out how much the country loses owing to numerous holidays.
Perhaps, it was only last year that Sri Lankans celebrated Avurudu meaningfully. They confined themselves to their homes due to strictly enforced lockdowns, which may have caused numerous difficulties, financial or otherwise, but members of most families huddled together as never before; this is what Avurudu is all about.
We wish our readers a very happy New Year!
Bridging vaccine divide
Monday 12th April, 2021
Rich nations make a show of their commitment to defending human rights in the world. They harangue their developing counterparts, at every turn, about the need to protect human rights, and even threaten to meet non-compliance with punitive actions such as sanctions. They, however, do not seem keen to promote and protect humans’ right to vaccination vis-a-vis the prevailing global health emergency. The only way to safeguard this right is to ensure an equitable distribution of COVID-19 vaccines across the world, but the World Health Organisation (WHO) has expressed utter dismay at what it calls a ‘shocking imbalance’ in the distribution of vaccines between the rich and the poor.
This kind of vaccine inequality could be attributed to what WHO Director General Dr. Tedros Adhanom Ghebreyesus has rightly called a ‘catastrophic moral failure’. The COVAX initiative, which alone can ensure a well-coordinated global fight against the virus, has suffered a serious setback, with the high-income countries reportedly holding as many as 4.6 billion doses of vaccines, and the low-middle income nations only 670 million. One in four people have been inoculated in the high-income countries as opposed to one in more than 500 in the low-income countries, according to the WHO.
Unless the COVAX scheme, the most efficacious antidote to what has come to be dubbed ‘vaccine nationalism’, which has put the poorer countries at a distinct disadvantage, goes ahead as planned, a vast majority of the global population, in the developing countries, will be badly hit, and in the long-term, the world’s fight against the virus will be in jeopardy because the pandemic is no respecter of geographical boundaries; no country, however rich and powerful, will be safe in today’s interconnected world dependent on international trade and travel.
‘Vaccine nationalism’ may give the rich nations a sense of security in the short-term, but it will be counterproductive in the long-term, for no vaccine is believed to be able to ensure life-time immunity against COVID-19. The pandemic continues to throw up new challenges. Even if the rich nations achieve their vaccination goals while their poor counterparts are lagging far behind, they will be at the risk of being affected by new variants, against which, the currently available jabs might not be effective. This is why Dr. Ghebreyesus has said no country will be safe until every country is safe.
Some Asian nations are struggling to beat the virus despite some initial success in their battle against the pandemic, according to an Asia News Network article we publish today. The report informs us that India, which is grappling with its second wave of infections, has seen record increases of new cases, with more than 100,000 daily being reported on, at least, five days, last week. This being the predicament of a vaccine-producing nation, with a reasonably efficient vaccination rollout, the vulnerability of other countries is not difficult to guess. Similar unfortunate situations have been reported from other parts of the world as well. The US, which is among the nations with impressively high COVID-19 vaccination rates, is also troubled by a sudden increase in the number of pandemic-related deaths.
If the vaccine rollouts fail to reach a successful conclusion the world over fast, it may not be possible to achieve global herd immunity through vaccination, and the chances of beating the virus may be slim due to its mutations, experts warn. COVAX is scheduled to supply as many as two billion doses of vaccines to 190 countries within one year with 92 poorer nations gaining access to vaccines at the same time as their wealthier counterparts. This is a highly ambitious target, which, however, must be achieved if the world is to get on top of the pandemic. But help from the rich nations is not forthcoming, and it is only natural that the WHO is disappointed.
The WHO is hopeful that it may be possible to change the composition of the existing vaccines to deal with the mutations of the virus, but it is still trying to figure out what kind of impact new variants may have on the effectiveness of vaccines. Reuters reported yesterday that a new coronavirus variant discovered in South Africa had been found to be able to break through Pfizer/BitoNtech’s vaccine to a considerable extent. Some Indian epidemiologists interviewed by BBC yesterday said they feared that the emerging variants might even be able to escape the human immune system!
The need for all nations, which are currently at cross purposes as regards the global battle against the virus, to support and be guided by COVAX, which alone can make them work in unison to beat the virus, cannot be overemphasised.
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