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Giving ‘wrong’ medical advice?

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by Dr Upul Wijayawardhana

“Have I given wrong medical advice?” From the time I read the interesting and heart-rending account ‘My 18 week ordeal of double trouble’ by my friend Dr Lakshman Abeyagunawardene (Sunday Island, 25 October) I have been pondering over this question. Poor Lucky has had a double whammy, on top of the lockdown, due to Shingles on his face (Herpes zoster) followed by heart block necessitating a pacemaker implantation. He suffered first due to severe neuralgic pain following Shingles, which is well-known to be one of the most severe and intractable pains, and due to the limitations imposed following the pacemaker implantation. My thoughts were provoked by the following comments:

“I had to go through the procedure of pacemaker implantation while the pain in my right eye persisted. It was after my fainting episode and pacemaker implantation was recommended that I was debarred from climbing stairs. I was confined to the guest room and this is where my agony really started. My wife did not allow me to even go to the living room which was just three steps below. Towards the latter stages, I watched news on the small TV in the kitchen. I had to be satisfied with the laptop computer that my son brought. But it was a far cry from the desktop I was used to. I missed my weekly shot of an alcoholic drink! I had not taken even a beer since the beginning of June.

I think I had a turnaround in my fortunes after the doctor did the Programming on September 27. It was this doctor’s advice that I strictly followed (more so my wife and son) because there was nothing more the Neurologist who was treating my neuralgic pain could do.”

What perplexed me was the advice given not to climb stairs which made my friend’s life miserable. I had never given this advice though I implanted many permanent pacemakers in Sri Lanka as well as in UK. In fact, I can claim credit for starting the permanent pacing programme in Sri Lanka, way back in late seventies, when pacing was in infancy. In spite of the very ‘primitive’ devices I used at the beginning, I did not impose this restriction.

A permanent pacemaker is needed when there is a failure in the electrical conduction system built in the heart to ensure an appropriate heart rate response to bodily needs as well as to coordinate contractions of the four chambers of the heart. The permanent pacing system has two major components. First, there is a ‘box’ with the electronics and a battery. Due to the huge advances in electronics ‘the brain’ of the pacemaker is tiny, the size of the pacemaker depending on the size of the battery. The second component, the leads (electrodes) deliver a tiny current generated in the ‘box’ to the right side of the heart after sensing whether the heart’s own electrical system is functioning properly or not. Invariably, two leads are used, one to the small ‘collecting’ chamber; the atrium and the second to the large muscular chamber; the ventricle. The procedure of implantation is done under strict aseptic conditions. First, the vein underneath one of the collarbones is punctured and the lead is advanced to the heart under x-ray guidance. Once a satisfactory position is found the lead is fixed and connected to the box, which is then implanted in a pocket under the skin.

When I started implantations, batteries lasted only two to five years but today most pacemakers have much smaller batteries lasting more than 10 years, due to improved battery technology. The electronics in the box then was very simple, just discharging a current when it did not sense innate activity but the electronics today is so sophisticated that the pacemaker is able to record and store heart beats continuously. Stored data can be retrieved by interrogating the pacemaker using an externally held device which is also used to programme, to tailor the pacemaker for the needs of each person. Not only the electronic circuitry and batteries but also leads have improved very significantly, becoming slimmer and having fixation devices at the end to make sure the lead tip does not displace. My nightmare, at the beginning, was lead displacement, as there were no fixation devices. This resulted in not infrequent reopening and adjustment, a tedious process.

In spite of refinements lead displacement still occurs, though very rarely, and it is to reduce this that some limitations are imposed. However, I could not find advising against going upstairs in guidelines issued by any renowned Cardiology institution. Patients are advised not to lift the arm of the implant side above shoulder level for four to six weeks. It may well be this recommendation that had been misinterpreted or miscommunicated.

Notwithstanding allegations of overdoing procedures for gain in the private sector, some of which are true unfortunately, I am well aware that the standards of practice of cardiology are very high in Sri Lanka. As a ‘veteran’ who contributed to the establishment of the speciality of cardiology on a firm foundation I can look back with a sense of satisfaction. Therefore, these comments are not meant, in any way, to be critical of the Electro-Physiologist who implanted the pacemaker but to highlight the importance of communication in medicine; an art we had to master on our own. I do not know whether things have changed since and Medical Schools are teaching how to communicate.

Am I guilty of having given wrong advice to patients? Yes, but in my defence, it was mostly ‘authenticated’ wrong advice. What do I mean by that? We give medical advice on the basis of existing medical knowledge which on hindsight may prove wrong. Concepts change with advancing knowledge; accordingly, we change management as well as advice. When I was a young doctor, we advised patients with heart attacks to have strict bed rest for six weeks. It transpired later that it did more harm than good. With new evidence we changed and treatment revolutionised. Now, a patient with a heart attack has an angiogram straight away and the ‘culprit’ vessel is dilated with a stent. Patient is out of bed the next day! I can go on giving many examples. Medicine keeps changing, like any other science. That is the difference from religion where belief is the foundation, not exploration and experiment.

When I was in active practice, I found it difficult to keep pace with advances in my speciality till the world wide web came into being. Since then updating knowledge has become so easy. Before that, I may have given wrong advice without realising that knowledge has passed me by. At least, we know our limitations but wonder whether those who practice static systems of medicine protected for political and historical reasons realise that they are giving outdated advice. We need to be in touch with new developments and revise our advice accordingly. Admittedly, it is no easy task but one that should be done, as misguided advice can make life intolerable for patients, as Lucky’s story clearly illustrates.



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‘There are no private universities in Sri Lanka’ – some considerations for higher education reform

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Academics involved in education policy like to say that there is no such thing as a private university in Sri Lanka. The only ‘universities’ in the country are state universities; anything else offering degrees is a private higher education institution (HEI). This position is technically accurate. Yet, in the discourse and imagination of the public, private universities are very real – people teach in them, students register in them, families pay fees, and such degree holders enter job markets in Sri Lanka and outside.

For decades, activists concerned for public higher education have ignored or resisted looking at private HEIs, as if such scrutiny would taint them. Others have worked in both types of institutions, carrying practices from each to the other. The apex body governing state universities, the UGC, has, meanwhile, ignored the concept of conflict of interest and appointed individuals in private higher education in committees and leadership positions. It is unsurprising then that some of the ideologies informing private higher education appear in reform agendas in the state sector.

This is a good time then to consider the varying types of private HEIs around us, and to take a look at some of the issues within them in the hope that higher education reform agendas will include private, as well as state higher education.

What is a ‘private university’?

First, some clarifications. In the public imaginary, a ‘private university’ is typically an institution that provides a foreign or local degree for which the student makes a payment. But this broad classification encompasses a host of diverse institutions and types of degrees which I detail below.

The Non-State Higher Education Division (NSHE) of the Ministry of Education has recognised 295 degrees by 32 institutions. Most of these are private companies and include a handful of established, well-known private HEIs that are ‘university like’. The degrees are local degrees conferred by the institutions accredited by the NSHE Division. While private HEIs conferring local degrees must be accredited by the NSHE Division, there appears to be no legal consequence for not doing so. In addition, there are several permutations of the private degree that miss the net of this Division and the Standing Committee on Accreditation and Quality Assurance (SCAQA) that assists this Division.

For one, degrees conferred by foreign universities offered, via these same private HEIs, are not vetted by the NSHE Division. Secondly, there is a growing plethora of private HEIs which have either no physical presence locally or only a dubious presence. The University Grants Commission has notified the public, through their website, that foreign universities listed in the Commonwealth Universities Yearbook and the World Higher Education Database are recognised, but refrained from giving any other details – which degrees? Offered by what modes? These details are not known. Some of the foreign universities in the lists may be legitimate entities in their own land but the degrees conferred locally, in their name, may not adhere to curriculum or teaching specifications of the NSHE Division or the UGC.

Another troubling phenomenon is the ‘top up degree’, which appears to work on the same principle as that of a pre-paid mobile connection: if I have a Diploma or an HND of a sort, I am eligible to complete a course of study which provides me with a degree, usually from a foreign university. The idea that someone who does not initially qualify for a degree programme should be able to work their way towards one is a progressive notion. This is the concept that open and distance learning (ODL) was based on initially, but which is now sadly exploited. ODL models are expected to provide opportunity for learning for those who may be excluded from traditional learning institutions. In Sri Lanka, however, we have seen ODL become a marketplace offering easy to obtain, for-fee qualifications by institutions with little commitment to superior teaching and learning.

Finally, a perusal of the many types of private HEIs and their varied degrees bring to mind another question – how should the private degrees, provided by state institutions (that are not educational institutions), be regulated? Who should do so?

All of these create a host of problems for the public – for hopeful students and parents and trusting employers. For the higher education sector, recruitment of academic staff, too, has become difficult due to this plethora of ambiguous higher education qualifications, as I discussed in a previous Kuppi article (‘Recruiting academics to state universities’).

Some issues in private HEIs – a bellwether for change in state universities

In this second part of this article, I will discuss some aspects of work in private HEIs – albeit the more established institutions – given that such issues may appear in reform agendas in future.

Across state universities, all permanent staff of a specific category are paid according to the same criteria. The picture is not so clear when it comes to private HEIs since they are different entities legally, typically companies. Private HEIs have salary scales and financial incentives that are different to each other. The more established private HEIs reportedly have attractive renumeration packages, possibly a reason for academics of state universities migrating eagerly to such institutions during sabbatical years and on retirement. This may not of course be the case with other less established, or improperly registered HEIs of which we know little. Academic staff of these more accepted private HEIs seem to value the high financial remuneration they receive (in comparison to state universities) as something that makes their work rewarding.

Attractive remuneration is important to sustain the good life and is at times seen as the institution’s way of encouraging good work. Yet, this has implications for the future of the institution: to continue to deliver on promised financial packages, institutions must continue to have large profit margins. One strategy has been to enroll multiple cohorts of students per year, even up to three or four intakes per year. This can result in exploitative work conditions, since staff must cater to all these cohorts in that same year. If there is inadequate staff, employees are further burdened. On the other hand, if there is a sudden drop in enrolments (degrees can go out of fashion) unexpected layoffs occur. Similar to other sectors that employ short-term contract staff – including state universities – in private HEIs, too, individual teachers, who are on short term contracts that need regular renewal, can feel pressured to work under difficult or exploitative conditions.

At the same time, even in the more established private HEIs, work norms differ from those of state universities in that they include promotional work that keeps the institution’s name in the eye of the public. The Marketing (or similarly named) unit comes up in conversations as one of the most important departments. It appears to weigh in on decision-making related to the number of staff, the amount of re-sits per exams, and other pedagogically important matters. This is a worrying example of how financial rationales interfere with pedagogically or academically sound processes, resulting in problematic results in the classroom. On the plus side, junior colleagues, who had experience in both state and private HEIs, also felt that they faced less harassment in private HEIs – primarily due to the private HEIs ability to take swift action in reported cases of harassment. This is a real indictment on state institutions and their reluctance to address chronic issues of harassment in our universities.

Yet, while we hear much about problems in state universities, we hardly hear of problems that staff in private HEIs face. One rationale for a lack of public expressions by staff is that expressions of discontent might lead to trouble given the importance of reputation for private HEIs. The worry about reputational damage is a growing concern in state universities, too, as evidenced by social media policies and internal conversations on reputational damage, consequent to negative publicity. Institutional worries of reputational damage are harmful in the long run since these impact not only freedom of expression by student and staff, but also research that is possible in and about the education sector.

Some thoughts at the end…


A close look at the private higher education sector is important given its strong presence in the country. Impending reform needs to regulate this diverse array of higher education offerings in the private sector, as well as the state institutions that offer privately-funded options of higher education (a topic for a separate Kuppi on its own). It is time we carefully considered how to build a whole system of higher education out of this broken mess.

Kaushalya Perera is a senior lecturer at the University of Colombo.

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.

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Ready for solo spotlight

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Nish Peiris: Excited about future plans

Singer Nish Peiris is set to take the next big step in her music journey.

The talented vocalist, who has been seen and heard in the scene here for a short while, and was also featured with the now-defunct band, Inner Vision, has announced that she will be fully committing to her solo career, after completing her degree this year.

“I’m finishing my degree this year, and after that I’ll be fully committing to my solo music career,” Nish told The Island.

“I’ve already got a few tours lined up for next year, so I’m really excited for what’s ahead.”

Fans, no doubt, will remember Nish for her smooth voice and stage presence, and the good news is that she is now ready to chart her own path and bring new music to audiences at home and abroad.

With tours already planned for 2027, the year 2026 promises to be an exciting year for the young artiste as she steps into the spotlight on her own.

We wish Nish every success in this new chapter!

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Exclusive musical evening for Sri Lankans in Toronto

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Toronto Ceymphony Live Band, with Sri Lankans doing the needful

While Sri Lankan music lovers, in Dubai, are eagerly looking forward to being a part of the action on Saturday, 25th July, with Rajiv Sebastian in the limelight, Sri Lankans, in Toronto, Canada, are equally excited and are anxiously awaiting the arrival of Sri Lanka’s famous singer/entertainer Sohan Weerasinghe.

Having done the needful with The X-Periments, the legendary performer has now embarked on an exciting new chapter – a solo career – and Toronto, Canada, will see him do the needful, on Friday, 31st July, 2026, from 8.00 pm to 12.00 am, at the Angus Glen Golf Club.

Sohan Weerasinghe: In Canada, and ready to do the needful on 31st July

Reports indicate that it’s a ‘sold out’ event – naturally with Sohan in the spotlight.

Gamini Hemalal: Creating all the excitement for Sri Lankans in Toronto

Having built his reputation through years of unforgettable performances, and hits that became part of our musical fabric, Sohan is ready to bring his own vision, sound, and stories directly to the audience, in Toronto, Canada, backed by the phenomenal Toronto Ceymphony Live Band.

Says Gamini Hemalal, who has been instrumental in reviving the Sri Lankan entertainment scene, in that part of the world:

“The countdown begins for the most exclusive musical event of the summer! Join us for a premium night of incredible music, elite hospitality, and a lavish buffet as the legendary Sohan Weerasinghe takes the stage live in Toronto!

“This is a high-end event, designed for those who appreciate exceptional entertainment and great food.”

Gamini, who is also a member of the Toronto Ceymphony Live Band, mentioned that it’s going to be an intimate musical evening with the celebrated Sohan Weerasinghe.

From packed auditoriums to intimate shows, Sohan continues to prove why he remains one of Sri Lanka’s most beloved entertainers.

For decades, Sohan Weerasinghe has been a household name in Sri Lankan entertainment.

Known for his captivating smooth voice and charismatic stage presence, Canada will experience it all on Friday, 31st July.

Next on the list of events, Gamini Hemal is working on, is Halloween night and he says “what we plan to do will be very interesting and unique … with a surprise guest star, as well!”

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