MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), 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.
On the 20th of August 2021, The Island most kindly published an article of mine, where I stated that the Doc Call 247 initiative of the Sri Lanka Medical Association (SLMA) and SLT Mobitel, joined later by Dialog, Hutch and Airtel mobile communication providers, is a veritable labour of love. It was initiated as a hotline answered by Western qualified allopathic doctors to provide state-of-the-art information and advice on COVID-19, in all three languages, to the needy, in trying to fill a telling vacuum where the general public needed empathy, information and advice. The SLMA was ever so quick to recognise this dire need and act promptly in a gesture of goodwill to society in general.
In a landmark effort hitherto unseen, coordinated by Mobitel, the other three mobile communication providers selflessly put their collective shoulder to the wheel. Generally speaking, the mobile providers are continuously competing and vying with each other to get the greatest number of subscribers into each network. Here they sunk all their differences, perhaps for the very first time in this little island nation, and produced a magnificently coordinated venture of collaboration, completely free-of-charge to the entire country. It was a dazzling example of their commitment to Corporate Social Responsibility. All the callers needed to do was to dial 247 from any mobile service provider connection or dial 1247 from a Sri Lanka Telecom Land Line, all completely toll-free, to be connected to a qualified doctor for a maximum call duration of ten minutes. In an automated system that can process around 100 calls at any given time, the maximum waiting time or ‘lag time’ has been around 90 to 100 seconds. There were hardly any instances of the system being ‘engaged’ and uncontactable at any given time. The final common pathway was a dedicated network of Mobitel.
The people who answered the calls were all Registered Doctors practising Western Medicine, who selflessly gave of their time and effort, in a purely voluntary and sparkling gesture of commitment. It was without any remuneration whatsoever; just a gesture of compassion to help the people of our land. There were Specialist Consultants, experienced Grade Medical Officers and even most recently qualified men and women of medicine awaiting their internship; the young and the old and anyone who could spare even just a little time from their precious lives to help in this endeavour. The gesture of love has indeed borne fruit now and is just the personification of the immortal words of the poetry of volume II of John Bunyan, “You have not lived today, until you have done something for someone, who can never repay you”.
Up to the time of writing of this piece on 14th September 2021, just about 30 days after the entire venture started, the network has handled around 44,000 telephone calls. At present, there are about 150 Consultants, around 500 Grade Medical Officers and around 100 Pre-Interns who have joined as volunteers into the system. In addition around 80 Sri Lankan doctors resident abroad too joined in. The expatriate doctors resident abroad have taken turns on a roster to cover the Sri Lankan nights due to the time differences in other parts of the world where they are residents. All these doctors of all types listed above have responded to emergencies, provided well-thought-out advice and even gone to the extent of discussing the problems with the seniors and the health authorities, and got back to the callers. Through the entire network, which is now linked to the Ministry of Health COVID-19 Resource Centre and the Suwaseriya Ambulance Service, they have responded magnificently to this hour of need of the men, women and children of our country. The numbers given above are just the number of calls. In most instances, entire families with several COVID-19 positive people had been the recipients of the services provided by the system. The doctors for their part, have taken great pleasure in giving back something to the people of this country who have funded and sponsored their professional advancement in healthcare. Some of these medical women and men have handled thousands of calls while others have responded to just hundreds of them. However, big or small, their contributions have made the entire venture a very successful one.
Answering around 44,000 calls from needy patients is a Herculean task. That is a kind of a superhuman response with a waiting time or lag time of under 2 minutes. What do all these numbers tell us? They very clearly show us that there is a crying need among patients and families afflicted and affected by COVID-19 for accurate information. It also portrays the anxiety and concerns amongst these people of our land. Each call represents a household where there may be many who are infected, but not tested often and not even represented in national data. It has been assessed that the average number of likely patients per call is around 4. In such a context, the system has tried to help around 150,000 men women and children of our country in just about 30 days. Our experience suggests that the vast majority of patients can be successfully managed at home, with a few simple instructions and guidance. However, to save lives, it is of paramount importance to detect the small number of people who need immediate care and refer them to hospitals for as early management as humanly possible. The system and the operators have striven so hard to do just that.
In this ground-breaking and history-making venture, without any exceptions worthy of note, the callers have been extremely grateful to the doctors who have always remained anonymous through the facilities built into the system. At the end of the conversations, many callers have deemed it fit to shower unrestricted praise on the responding doctors, the SLMA and the mobile service providers. They have invoked the blessings of the Triple Gem, Lord Buddha, Jesus Christ, Allah, Lord Shiva and many other deities on the doctor who responded to their call for help. Such gestures of gratitude have left some of the doctors visibly moved, even speechless and given them the kind of personal satisfaction that, in their own words, was just priceless. Indeed, many of them have had misty eyes due to the obvious appreciation expressed so frequently by the callers. As for me, from a personal perspective, it has been such a humbling and gratifying experience in my entire professional life to have done even a little towards the welfare of our Sri Lankan people.
Yet for all that, we cannot say that we have sufficient numbers of volunteer doctors to cater to the tremendous demand. We do appreciate the fact that doctors are very busy people with the current pandemic, trying hard to get on with their own lives while having to balance many things in their homes as well. It is to their eternal credit that with all their commitments, they are able to give even an hour or two a day to this endeavour. There are no fixed duty hours or rotas for the doctors. They can ‘opt in’ and ‘opt out’ of the system at the press of a couple of buttons on their mobile telephones. If you do not wish to be disturbed at night and ‘opt out’, the system will not bother you. The entire endeavour has been designed to be ever so flexible simply because of these considerations. There are close to 25,000 registered doctors who practise Western medicine in Sri Lanka. If just one-fifth of them, just 4000 to 5000 or so, agree to give an hour of their precious time every day, or even every other day, we will be able to run the system that has the potential to handle around 100 calls at any given time; ever so efficiently, and smoothly, to the very benefit of our people.
SO…, THIS IS A FERVENT CLARION CALL AND A VERY SINCERE APPEAL TO ALL DOCTORS IN SRI LANKA, TO LEND A HAND TO THIS HUMANITARIAN INITIATIVE. All they need is a Mobitel connection and if they do not have one already, Mobitel will provide them one with a SIM Card, free of charge. A Mobitel connection is needed to get into the system as the final common pathway is through a Mobitel network.
Finally…, take a bow…, Mobitel, Dialog, Hutch and Airtel, the system operators and the Special Working Group of the SLMA, the President, Secretary and the Council of the SLMA, and all the volunteer doctors who are the backbone of this initiative, for a splendid job so very well done. I am quite sure that if that legend of yore, Muhammad Ali, the champion heavyweight boxer who immortalised his own words, “I am the greatest” was alive today, he would be quite happy to unhesitatingly paraphrase his words to say “YOU ARE THE GREATEST”.
Cosmic Egg, Jealousy and Rhetoric
Remarks I made (The Island, 12 Oct) on Upul Wijayawardhana’s article on Astronomy, Astrology, Cosmology, etc., in The Island of 07 October, weren’t at all meant to be ‘snide’ or derogatory as he wrongly alleges in his 15 October The Island article! I just would have liked him to delve somewhat deeper into the subjects he referred to in his article’s title, without fanning out tongue-in-cheek (his phrase) in various directions anecdotally. He listed scientists doing excellent work both at home and abroad, throwing in vignettes too from their lives. This is inspiring, of course, and cause for much pride; but it would have been more useful if he had included, even briefly, some specific findings from their work that had a bearing on his article’s title.
I am sorry I did not ‘expand’ more on the ‘cosmic-egg’ as, he says, he had wished. Far finer heads are grappling with it with little or no success; its understanding could well be even outside the confines of science as we know it. My purpose was to point out that the Big-Bang couldn’t have been the start of it all, as casually accepted by some. Let’s be happy anyway that the ‘cosmic-egg’ did ‘expand’ by itself to make the Universe – even without my help!
In his 15 October article again in a familiar vein, he asks in his title, ‘Jealousy: is it in our genes?’ As before, he then wavers away to give detailed accounts of some scientists doing excellent work abroad, and of Yohani, the successful young singer, and exhorts us, I assume, not to be jealous of them. Message taken; thanks!
To return to his rhetorical title, if jealousy is indeed in our genes no DNA sequence has been found for it as yet, but fingers are always crossed!
Let’s not scoff at it overmuch either; jealousy’s quite human; and harmless too – but only if indulged in extremely lightly and in passing; it could even prompt initiative and creativity!
President must match his words with deeds
We were pleased to read the recent speech delivered at the 72nd anniversary of the Gajaba Regiment by President Gotabaya Rajapaksa, in which he admitted about the voter disillusionment in his government. We are aware that the government had to contend with unprecedented issues on account of the Covid epidemic, and had to give priority in seeking solutions to the challenges by imposing restrictions to the economic and social activities; while channelling limited resources to medical supplies and social service facilities.
If the President is prepared to review and turn a new page for the improvement of the country, one should expect the President to rehash the decision-making procedure of the Government. The voters are of the view that some of the crucial steps adopted, were either introduced or implemented in some instances, without recognising the impact on the country’s sovereignty and security.
As an initial step, the President should consider appointing a National Planning Committee with nationalist-minded experts, to work on a programme to tackle key economic issues and management of nationally important strategic centres for the next four years. Without proceeding ahead haphazardly and creating crisis situations, once such decisions are adopted, if the government can adhere to a plan with a nationalist vision, it will be acceptable to the voters who elected the President. Such a plan should also investigate the country’s priorities, future stability, resources, and national security. The implementation should be transparent and accountable.
Let us examine some of the issues which were tackled without a proper plan, which resulted in causing frustration and disappointment among the voters and the public. The method of overseeing the pricing and supply of commodities, such as sugar, rice, garlic, gas cylinders, etc was atrocious, which brought untold hardships to the consumer and to the producers. The complete mismanagement must be admitted by the government, and a more rational formula will have to be adopted, if the plan is to take the country systematically forward. It is necessary to exercise detailed examination of the supply chain, the storage facilities, and the Government outlets, to get rid of the unconscionable profiteers awaiting to fleece the consumers and marginalise the public organisations, which are established to protect the consumers. Once a rational decision is taken, the government should pursue the implementation with determination; rather than surrender to the dictates of the unscrupulous middlemen who hold onto the stocks, causing loss of confidence of the public.
A crucial area which needs urgent review is how to regulate luxury and semi-luxury imports, which consumes a considerable amount of foreign exchange earned by export of goods and services, including the foreign remittances of Sri Lankan workers. At least as a short term measure, the free trade introduced by JRJ about 40 years ago, should be re-examined and suitable qualitative controls should be introduced, to curb the outflow of foreign exchange for non-essential goods.
The President’s holistic decision on the banning of chemical fertiliser is, indeed, a step in the right direction, which will bring expected results in the improvement in soil and water quality and the general health of the masses. However, such a crucial decision was not followed professionally to ascertain the availability of other nutrients, and enough supply of compost fertiliser to apply in the following growing season. The unscientific method of managing the subject gave opportunities to many to engage in public agitation against this holistic decision.
It was, indeed, ironic to hear the slogans mouthed by ‘farmers’ of 2021 demanding chemical fertiliser, whereas their fathers were demonstrating in 1970s decrying the government’s and the officials’ dictates to replace bio-fertilizers with chemical fertiliser to ‘usher in thegreen revolution ‘. It is the wish of the majority of the population to get rid of the vicious cycle of poisoning, resulting from the use of chemical fertiliser, and we would request the government to take the required steps in the right direction to implement the laudable decision effectively and efficiently.
We need a clear and dedicated policy in relation to our international relations. We must always be nonaligned in our dealings with the big powers who are engaged in a global power game.
We should know the friendly nations who stood by Sri Lanka when it waged war with Tamil Tiger terrorists and subsequently at UNHCR, and about the other countries which attempted to crucify Sri Lanka for defeating the world’s most brutal terrorist organisation. Their attempts to continue persecuting Sri Lanka will naturally weaken the Sri Lankan state, and at all times Sri Lanka should express her rejection of such vicious attempts, and should bring these facts at bi-lateral discussions and multilateral conferences.
India, our neighbour, is leaving no stone unturned until we have PCs and with all powers. Most of the Sri Lankans do not want PCs, an additional tier of administration at a cost of colossal expenditure and with practically no benefits. At a time when Sri Lankans are required to tighten their belts and manage expenditure, the Government must convey to India that all issues can be managed under the present unitary system of Government. Sri Lanka should be noticeably clear on this issue to enable Sri Lanka-India international relationship to prosper. Sri Lanka should also continue bi-lateral discussions with India regarding oil tanks in Trinco, as to how these can be used for the economic development of the country, assuring that Sri Lanka will not allow any other country to have any control over the strategically important Trincomalee harbour. Recently an Indian writer has stated that India does not bother to understand her neighbouring countries, and decides on inter-state policies without considering the expectations of her neighbours. Imposing PCs on Sri Lanka and insistence on the implementation of the failed proposal emanated from the Indian centralised foreign policy machinery, which in this instance primarily addressed the aspirations of the Tamil Nadu agitators, who were expressing their support for the separatists in Sri Lanka. India’s strategy was to kill two birds with one stone, and executed its policy of proposing PCs to weaken the central government of Sri Lanka, while appeasing the extremists in Tamil Nadu to divert their attention from their own struggle for a separatist racist state in India. Sri Lanka should be firm in rejecting the Indian formula to destabilize the country, and continue to address the common issues faced by ordinary people in Sri Lanka, including the minorities living in the periphery.
The mandate given by the public clearly stated that the proportional representation system should be changed, and all future elections should be held according to the number of electorates, and members should represent the electorates based on the percentage of votes gained by the candidates. All who investigated into the system introduced by JRJ were of the view that the system breeds corruption and bribery, while precluding the visible representation of an electorate.
The President recently invited the expatriate Tamil groups, presumably as an effort to improve reconciliation of Sinhala and Tamil views and expectations. Such discussions should be based on specific conditions that the participants do not support separatism in Sri Lanka, and they accept a unitary Sri Lanka. Otherwise, such discussions will only provide opportunities to reopen the subject of traditional homelands, pushing the country back to the unenviable 1990s.
Gamble of Provincial Council elections at this time
By Jehan Perera
There are indications that the government is planning to conduct Provincial Council elections in the early part of next year. It is reported that the cash-strapped government will be providing parliamentarians, who are in charge of district development, with Rs 100 million each to engage in development activities in their electorates. In addition, former members of Provincial Councils, and local government authority members will also be entitled to substantial monetary resources to do likewise. If these large sums of money are made available to politicians to spend prior to the election, they could contribute to the thinking that the government is investing in development for better times, ahead despite the hardships of the present. But the cost of this gamble which will include printing money could be high, so there must be other motivations.
The present situation on the ground is hardly propitious to the conduct of elections. The economy is in deep trouble with foreign exchange reserves threatening to be negative if scheduled foreign loans are repaid on time unless there is a fresh infusion of foreign loans. Among the several reasons why foreign exchange is scarce is that the government is keeping the foreign exchange rate artificially low instead of letting market forces determine the price. This is no different from the price controls that the government attempted to place on rice which led to hoarding and artificial scarcities notwithstanding the declaration of a state of emergency to deal with the hoarders. If the government relaxes the exchange rate it is likely that the foreign exchange rate, will soar and prices of imports will soar likewise, adding to the inflation in the country.
Some of the present day economic problems are beyond the control of the government to resolve. These would include the loss of economic production due to the months of lockdown that followed the rise in Covid spread. The contribution of the tourism industry to the economy has been much diminished due to the closure of the country’s airports to prevent infection spread from abroad. However, some of the economic setbacks have been self-inflicted. The biggest one is the implementation of the chemical-free agriculture policy on a scale that has no precedent in any other country in the world. Even the most economically advanced countries, such as Germany, where there is a high demand for organic food, has only devoted around 10 percent of its agricultural land to chemical-free agriculture. And Switzerland, known as one of the cleanest countries in the world, recently rejected the banning of pesticides at a referendum as voters felt it was impractical.
The government has so far shown a singular commitment to going ahead with the decision to have chemical-free agriculture. There has been some concession to big business interests such as in the case of the tea industry. Some of the necessary chemical inputs for fertiliser are being permitted. However, this is an exception and the general rule that agriculture should take place without chemical inputs continues to prevail. So far there has not been flexibility shown with the farming community who are coming out publicly in protest as they are seeing their harvests being reduced. These protests are taking place in all parts of the country and in some areas the small farmers have not been planting crops fearing that the yield will be too small. The government has offered compensation but, given the financial crisis it is in, this is unlikely to materialise in the short term.
The government’s present policy on organic agriculture appears to be following a military logic that sees the objective clearly and goes for it at all costs. One of the key features of democratic governance is that consultations take place with those whose interests are bound up with issues prior to the implementation of change. These consultations need to take place at multiple levels over a period of time if the decision being made is likely to have major consequences. Further it is not sufficient to practice tokenism in consultations. Often consultations take place but the views generated are not heeded. Those who consult sometimes appear to be listening but do not really listen nor are they willing to change their preconceived attitudes and plans. The essence of democratic government is to be responsive to public opinion, and to educate public opinion on new measures that need to be taken in the larger interests of society.
On the positive side, and to the credit of the government, it is providing space for public protests against its policies. Speaking in New York at the UN General Assembly, President Gotabaya Rajapaksa said he had instructed the police not to use batons and violence to break up peaceful protests. Restraint has been shown in the case of the three-month long strike by government school teachers who continue to be paid their salaries while doing no work. There were initial signs of harsh restraint when Covid control laws were used to detain some of the teachers who were leading the protests. At this time these strong arm methods of control have stopped. Unfortunately, however, the problems that the organic farming problems and teachers’ strike pose show no signs of being resolved through compromise.
There may be multiple motivations in holding Provincial Council elections at the present time. These elections are already three years overdue. The previous government failed to conduct the elections fearing that a bad performance would send a negative message to people who were already moving away from it. They changed the election law to make it more difficult to hold elections again. However, unlike the previous government, the present government leadership is made of sterner stuff when it comes to holding elections and winning them. It appears to be planning new strategies to regain the upper hand. The 2022 budget which is to be presented to Parliament later this month will offer the government an opportunity to address the immediate concerns of voters at least in the short term. They may also see elections at this juncture as being helpful to ensure political authority and benefits for its second tier of leaders who will be satisfied with them at the moment.
There is also speculation that the government’s sudden decision to conduct Provincial Council elections is the result of pressure from the Indian government. It is notable that the government’s announcement was made shortly after the visit to Sri Lanka of India’s Foreign Secretary, Harsh Vardhan Shringla. At his meeting with President Gotabaya Rajapaksa he had reiterated India’s position regarding the need to fully implement the 13th Amendment and to hold the Provincial Council elections at the earliest. During his visit the Indian Foreign Secretary had also urged the Tamil political parties not to look to India for a solution to their problems but to discuss the issues that trouble them and resolve them in dialogue with the Sri Lankan government.
In this context, the decision of the government to go ahead with Provincial Councial elections is the silver lining to the grey clouds that overhang the country. It is an indication that President Gotabaya Rajapaksa is being consistent with the pledges he made in New York at the UN General Assembly. The holding of Provincial Council elections, even in the present disadvantageous political situation that the government is in gives a positive message that the President is not neglecting his promises to the international community with regard to the reconciliation process. Addressing the root causes of the war and bringing reconciliation between the communities needs to be the number one priority of any government. The provincial council system as presently constituted is in need of improvement, both in terms of the distribution of powers and resources, but it is the way forward if the ethnic and religious minorities are to feel they are a part of governance structures of the country, and hence co-architects of a shared future in which there is national reconciliation.
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