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Illness and Consciousness – A personal experience

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In the absence of such studies, the result is a heavy reliance on signs (lab reports, ECG, cardiogram, scanning, X-rays, etc.,) while downplaying symptoms. The doctors spend more time studying the reports rather than talking to the patient. The net result is that the hospitals are treating illnesses rather than patients. This also makes a good business opportunity for private hospitals in testing and treatment.

By Dr. Gamini Kulatunga

I had a slight fall at home with no injuries. But momentarily I lost my memory and I could not recollect how I fell. This condition is called ‘transient global amnesia’ caused by a sudden disruption of blood flow to the brain. While recovering from this ‘transient ischemic attack’ (TIA), I have been pondering over the experience I had, as a patient, with medicine and treatment, from an engineering perspective.

The diagnosis of a disease is based on objective and subjective aspects namely, signs and symptoms. The signs are quantitative and generally assigned values by the doctor whereas, the symptoms are mostly qualitative descriptions given by the patient. The weights given to signs and symptoms play a vital role in the diagnosis.

Most of the time, the patients do not distinguish the difference between cure and treatment as these terms are considered as synonyms by the non-medical personnel. A treatment is something that healthcare providers do for their patients to control a health problem, lessen the symptoms or clear it up. A cure is when treatment makes health problem go away and it’s not expected to come back. There are idiopathic diseases with unknown aetiology for which cures are replaced by treatment.

In my case, the troponin, an enzyme present in the blood, which indicates plaque formation in arteries and the ECGs showed signs of a mild heart attack. But, I have had a thickened heart muscle called Hypertrophic Cardiomyopathy (HCM) for a long time and I also take treatment for a mild kidney malfunction. These two factors, too, contribute to high troponin level in the blood. There were no other signs in the echo-cardiogram to justify further investigation.

I was to be sent to the ICU for monitoring but as I did not feel that ill, I asked the doctor to send me to a room with emergency facilities. The doctor asked me why I was reluctant to and I said the stress of spending a night in the ICU may trigger a heart attack. I was vindicated by the ECGs taken before and after admission to the hospital. The ECG on admission showed an abnormality which was not there before and after.

When I met the cardiologist, later, he said without an angiogram a definite opinion cannot be given but he asked me to see him in six months’ time. This I took as a green light and I ignored the reference to do an angiogram.

Back at home convalescing, I feel dizzy at times. My blood pressure was measured at home, while lying down and seated, which showed a drop in pressure when the position is changed. I was advised to change my postures very slowly to avoid dizziness and the symptom is called Benign Paroxysmal Positional Vertigo (BPPV).

I am taking things easy and resumed my gentle Tai Chi exercises that concentrate on relaxing muscles to allow body fascia to come into full operation. I feel a remarkable change of interconnectedness of the body and I keep wondering whether it is my experience or belief. David Chalmers in his book “The Character of Consciousness” explains this entanglement. I think it is a moot point to seek the difference as Harvard Medical School Guide to Tai Chi describes how effective motor-imagery is. Further, Bruce Lipton’s “Biology of Belief” describes how placebos and nocebos affect us.

As a mechanical engineer, I imagine the heart as a positive displacement diaphragm pump assisted by the calf muscles acting as a peristaltic pump (it is called the second-heart). The two pumps work as constant volume devices subject to compliance to accommodate slight changes.

The factors that influence blood flow are: volume, pressure, compliance, viscosity, blood vessel length and diameter.

The governing equation is: Volume per beat V = ΠΔPr4/8ƞλ

∆P – pressure difference, r – radius of blood vessel, ƞ – viscosity and λ – length of blood vessel

My speculation, not based on any medical literature, as a mechanical engineer is as follows.

In my old age of 78, the pumping system will be de-rated due to deterioration of the two pumps, the four heart valves, non-return valves in the veins and numerous blood vessels spread all over the body. The lymphatic system has no independent circulation system but makes use of the blood circulation system.

As a result, if less blood flow takes place, the pressure will drop or the viscosity will increase. Generally, then a blood thinning drugs is administered. To accommodate less flow, the blood vessels could reduce their diameter by building up plaque which consists of fat, cholesterol (a substance needed by the body to build healthy cells), cellular waste products, calcium and fibrin. To clear the pathways normally, cholesterol reducing drugs are administered or in the extreme cases, stents are inserted. By-pass surgery is also common in the case of a blockage in the heart. But food control, exercise and relaxation would reduce the inflammation of the inner artery walls.

The body’s homeostasis properties may reduce blood vessels’ diameter, by depositing plaque, if compliance cannot cope with it. The heart may also have redundancy built-in to find alternative pathways in case of a restriction.

More importance must be given to seeking the connection between consciousnesses and functioning of the body’s organs. Psychoneuroimmunology is one such attempt but by and large, placebo and nocebo effects are considered epiphenomena that hinders drug testing. This is the result of heavy dualism still pervading science, despite quantum behaviour. At present, consciousness is treated as a mere epiphenomenon of the brain belonging to pseudoscience. The micro-physical laws need to be expanded to cover psychophysical laws.

In the absence of such studies, the result is a heavy reliance on signs (lab reports, ECG, cardiogram, scanning, X-rays, etc.,) while downplaying symptoms. The doctors spend more time studying the reports rather than talking to the patient. The net result is that the hospitals are treating illnesses rather than patients. This also makes a good business opportunity for private hospitals in testing and treatment.

This is not a critique of the medical care I received, at a private hospital, which was very good. It is more or less my views on what has to be done to improve patient care.

Notes:

Systolic blood pressure is defined as the pressure exerted on the artery walls by the heart. But the measurement is taken when flow stops. This is the maximum pressure that the heart can produce and not the system’s pressure.

The systolic pressure varies with age. At 40 years the average pressure for men is around 110/68 mm Hg and it goes up to 133/69 at around 60 years. These figures are based on statistical studies and individuals could be at the ends of the bell-curve.

The pulse rate in adults remains in the range of 60 to100 beats per minute without much variation with age. However, it varies with bodily changes. If the pulse rate remains constant it is an indication that the heart is not responding to signals from the body, which is not a good sign.

The blood vessels and the diaphragm are pliable and could accommodate slight variation in capacity. The system acts as a surge chamber to even out the pressure waves.

Homeostasis of the body would keep the volume flow the same by accommodating high pressure by restricting the flow through plaque formation on the inner walls of the blood vessels. Unnecessary intervention, through drugs and surgery, may tip the balance with unwanted complications.



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Opinion

The Indian Ocean as a zone of peace

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Late Prime Minister Sirimavo Bandaranaike

Recently, we all held our breath when a conflict began to develop very close to Sri Lanka. The sinking of the Iranian frigate IRIS Dena in the Indian Ocean took place in international waters about 30 miles from Sri Lanka’s southern coast. As the whole world watched, the President and the Government of Sri Lanka were faced with a humanitarian crisis. A second Iranian ship was also in distress and needed assistance. Although Sri Lanka’s maritime history dates back to 5th

Century BCE, this type of geopolitical crisis has been very rare.

Sri Lanka considered it the moral responsibility of the country to help out those affected during this geopolitical crisis. It chose to activate its role as a custodian of the Indian Ocean. Perhaps, not many individuals are aware of Sri Lanka’s historical role in calling on the United Nations to declare the Indian Ocean a Zone of Peace. In 1971, under the leadership of the first woman prime minister of the world, Sirimavo Bandaranaike, Sri Lanka, together with Tanzania brought forth a resolution to the 26th Session of the General Assembly of the United Nations to declare the Indian Ocean a “Zone of Peace.” This was done to avoid it being used by superpower rivalries to gain military control of the region. Sri Lanka’s Ambassador Shirley Amarasinghe, the President of the 31st general Assembly of the UN was responsible for working on this resolution as with others dealing with the “Law of the Sea”.

Chandra Fernando, Educational Consultant, USA)

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The shadow of a Truman moment in the Iran war

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Wars often produce moments when leaders feel compelled to seek a decisive stroke that will end the conflict once and for all. History shows that such moments can generate choices that would have seemed unthinkable only months earlier. When Harry S. Truman authorised the atomic bombings of Hiroshima and Nagasaki in 1945, the decision emerged from precisely such wartime pressures. As the conflict involving the United States, Israel and Iran intensifies today, the world must ensure that a similar moment of desperate calculation does not arise again.

The lesson of that moment in history is not that such weapons can end wars, but that once the logic of escalation begins to dominate wartime decision-making, even the most unthinkable options can enter the realm of strategic calculation. The mere possibility that such debates could arise is reason enough for policymakers everywhere to approach the present conflict with extreme caution.

As the war drags on, both Donald Trump and Benjamin Netanyahu will face mounting pressure to produce decisive results. Wars rarely remain confined to their original scope once expectations of rapid victory begin to fade. Political leaders must demonstrate progress, military planners search for breakthroughs, and public narratives increasingly revolve around the need for a conclusive outcome. In this environment, media speculation about “exit strategies” or “off-ramps” for Washington can unintentionally increase pressure on decision-makers. Even well-intentioned commentary can shape the climate in which leaders make decisions, potentially nudging them toward harder, more dramatic actions.

Neither the United States nor Israel lacks the technological capability associated with advanced nuclear arsenals. The nuclear arsenals of advanced powers today are far more sophisticated than the devices used in 1945. While their existence is intended primarily as deterrence, prolonged wars have historically forced strategic communities to examine every available option. Even the discussion of such possibilities is deeply unsettling, yet ignoring the pressures that produce such debates can be dangerous.

For that reason, policymakers and societies on all sides must recognise the full range of choices that prolonged wars can place before leaders. For Iran’s leadership and its wider strategic community, absorbing this reality may be essential if catastrophic escalation is to be avoided. From Tehran’s perspective, the conflict may well be seen as existential. Yet history also shows that wars framed as existential struggles can generate the most dangerous strategic decisions.

The intellectual climate in Washington has also evolved. A number of influential voices in Washington now argue that the United States has become excessively risk-averse and that restoring global credibility requires a more assertive posture. Such arguments reflect a broader shift toward the language of renewed deterrence and strategic competition. Yet this very logic can make it politically harder for leaders to conclude conflicts without visible demonstrations of strength.

The outcome of this conflict will also be watched closely by other major powers. In 1945, the atomic decision was shaped not only by the desire to end a brutal war but also by the strategic message it sent to rival states observing the emergence of a new geopolitical era. Today, other significant powers will similarly draw lessons from how the United States manages both the conduct and the conclusion of this conflict.

This is why cool judgment is essential at this stage of the war. Whether the original decision to go to war was wise or ill-advised is now largely beside the point. Once a conflict has begun, the overriding priority must be to prevent escalation into something far more dangerous.

In such moments, the international system can benefit from the quiet diplomacy of actors that retain a degree of strategic autonomy. Among emerging nations, India stands out as a major emerging power in this regard. Despite its energy dependence on the Gulf and deep economic engagement with the United States, India has consistently demonstrated a capacity to maintain independent channels of communication across geopolitical divides.

This unique positioning may allow New Delhi to explore, discreetly and without public fanfare, avenues for de-escalation with Washington, Tel Aviv and Tehran alike. At moments of heightened tension in international politics, the world sometimes requires what might be called an “adult in the room”: a state capable of engaging all sides while remaining aligned exclusively with none.

If the present conflict continues to intensify, the value of such diplomacy may soon become evident. The most important lesson from 1945 is not only the destructive power of nuclear weapons but the pressures that can drive leaders toward choices that later generations struggle to comprehend. History shows that when wars reach their most desperate phases, restraint remains the only safeguard against catastrophe.

(Milinda Moragoda is a former Cabinet Minister and diplomat from Sri Lanka and founder of the Pathfinder Foundation, a strategic affairs think tank, can be contacted via email@milinda. This was published ndtv.com on 2026.03.1

by Milinda Moragoda

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Opinion

Practicality of a trilingual reality in Sri Lanka

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Dr. B.J.C. Perera (Dr. BJCP) in his article ‘Language: The symbolic expression of thought’ (The island 10.03.2026) delves deeper into an area that he has been exploring recently – childhood learning. In this article he writes of ‘a trilingual Sri Lanka’, reminding me of an incident I witnessed some years ago.

Two teenagers, in their mid to late teens, of Muslim ethnicity were admitted to the hospital late at night, following a road traffic accident. They had sustained multiple injuries, a few needing surgical intervention. One boy had sustained an injury (among others) that needed relatively urgent attention, but in itself was not too serious. The other had also sustained a few injuries among which one particular injury was serious and needed sorting out, but not urgently.

After the preliminary stabilisation of their injuries, I had a detailed discussion with them as to what needed to be done. Neither of them spoke Sinhala to any extent, but their English was excellent. They were attending a well-known international school in Colombo since early childhood and had no difficulty in understanding my explanation – in English. The boys were living in Colombo, while their father would travel regularly to the East (of Sri Lanka) on business. The following morning, I met the father to explain the prevailing situation; what needs to be done, urgency vs. importance, a timeline, prioritisation of treatment, possible costs, etc.

Doctor’s dilemma

The father did not speak any English and in conversation informed me that he had put both his boys into an International School (from kindergarten onwards) in order to give them an English education. The issue was that the father’s grasp of Sinhala was somewhat rudimentary and therefore I found that I could not explain the differences in seriousness vs, urgency and prioritisation issues adequately within the possible budget restrictions. This being the case and as the children understood exactly what was needed, I then asked the sons to ‘educate’ the father on the issues that were at hand. The boys spoke to their father and it was then that I realised that their grasp of Tamil was the same as their father’s grasp of Sinhala!

In the end I had to get down a translator, which in this case was a junior doctor who spoke Tamil fluently; explained to him what was needed a few times as he was not that fluent in English, certainly less than the boys, and then getting him to explain the situation to the father.

What was disturbing was having related this episode at the time to be informed that this was not in fact not an isolated occurrence. That there is a growing number of children that converse well in English, but are not so fluent in their mother tongue. Is English ‘the mother tongue’ of this ‘new generation’ of children? The sad truth is no and tragically this generation is getting deprived of ‘learning’ in its most fundamental form. For unfortunately, correct grammar and syntax accompanied with fluency do not equal to learning (through a language). It is the natural process of learning two/three languages (0 to 5 years) that Dr. BJCP refers to as being bilingual/trilingual and is the underlying concept, which is the title of Dr. BJCP’s article ‘Language: The symbolic expression of thought’.

“Introduction into society”

It is critical to understand at a very deep level the extent and process of what learning in a mother tongue entails. The mother’s voice is arguably the first voice that a newborn hears. Generally speaking, from that point onwards till the child is ‘introduced into society’ that is the voice he /she hears most. In our culture this is the Dhorata wedime mangalyaya. Till then the infant gets exposed to only the voices of the immediate /close family.

Once the infant gets exposed to ‘society’ he /she is metaphorically swimming in an ocean of language. Take for example a market. Vendors selling their wares, shouting, customers bargaining, selecting goods, asking about the quality, freshness, other families talking among themselves etc. The infant is literally learning/conceptualizing something new all the time. This learning process happens continuously starting from home, at friends/relatives’ houses, get-to-gathers, festivals, temples etc. This societal exposure plays a dominant role as the child/infant gets older. Their language skills and vocabulary increase in leaps and bounds and by around three years of age they have reached the so-called ‘language explosion’ stage. This entire process of learning that the child undergoes, happens ‘naturally and effortlessly’. This degree of exposure/ learning can only happen in Sinhala or Tamil in this country.

Second language in chilhood

Learning a second language in childhood as pointed out by Dr BJCP is a cognitive gift. In fact, what it actually does is, deepens the understanding of the first language. So, this-learning of a second language- is in no way to be discouraged. However, it is critical to be cognisant of the fact that this learning of the second language also takes place within a natural environment. In other words, the child is picking up the language on his own. As readily illustrated in Dr. BJCP’s article, the home environment where the parents and grandparents speak different languages. He or she is not being ‘forcefully taught’ a language that has no relevance outside the ‘environment in which the second language is taught’. The time period we (myself and Dr. BJCP) are discussing is the 0 to 5-year-old.

It does not matter whether it is two or three languages during this period; provided that it happens naturally. For as Dr. BJCP states in his article ‘By age five, they typically catch up in all languages…’ To express this in a different way, if the child is naturally exposed to a second /third language during this 0 to 5-year-old period, he /she will naturally pick it up. It is unavoidable. He /she will not need any help in order for this to happen. Once the child starts attending school at the age of 5 or later, then being taught a second language formally is a very different concept to what happens before the age of 5.

The tragedy is parents, not understanding this undisputed significance of ‘learning in/a mother tongue’, during the critical years of childhood-0 to 5; with all good and noble intentions forcefully introduce their child to a foreign tongue (English) that is not spoken universally (around them) i. e., It is only spoken in the kindergarten; not at home and certainly nowhere, where the parents take their children.

Attending school

Once the child starts attending school in the English medium, there is no further (or minimal) exposure to his /her mother tongue -be it Sinhala or Tamil. This results in the child losing the ability to converse in his/her original mother tongue, as was seen earlier on. In the above incident that I described at the start of this article, when I finally asked the father did he comprehend what was happening; his eyes filled with tears and I did wonder was this because of his sons’ injuries or was it because his decisions had culminated in a father and a son/s who could no longer communicate with each other in a meaningful way.

Dr BJCP goes on to state that in his opinion ‘a trilingual Sri Lanka will go a long way towards the goals and display of racial harmony, respect for different ethnic groups…’ and ‘Then it would become a utopian heaven, where all people, as just Sri Lankans can live in admirable concordant synchrony, rather than as a splintered clusters divided by ethnicity, language and culture’. Firstly, it must be admitted from the aspect of the child’s learning perspective (0 to 5 years); an environment where all three languages are spoken freely and the child will naturally pick up all three languages (a trilingual reality) does not actually exist in Sri Lanka.

However, the pleasant practical reality is that, there is absolutely no need for a trilingual Sri Lanka for this utopian heaven to be achieved. What is needed is in fact not even a bilingual Sri Lanka, but a Sri Lanka, where all the Sinhalese are taught Tamil and vice versa. Simply stated it is complete lunacy– that two ethnic communities that speak their own language, need to learn another language that is not the mother tongue of either community in order to understand one another! It is the fact that having been ruled by the British for over a hundred years, English has been so close to us, that we are unable to see this for what it is. Imagine a country like Canada that has areas where French is spoken; what happens in order to foster better harmony between the English and French speaking communities? The ‘English’, learn to speak French and the ‘French’ learn to speak English. According to the ‘bridging language theory of Sri Lanka’, this will not work and what needs to happen is both communities need to learn a third language, for example German, in order to communicate with one another!

Learning best done in mother tongue

eiterating what I said in my previous article – ‘Educational reforms: A Perspective (The Island 27.02.2026) Learning is best done in one’s mother tongue. This is a fact, not an opinion. The critical thing parents should understand and appreciate is that the best thing they can do for their child is to allow/encourage learning in his/her mother tongue.

This period from 0 to 5 years is critically important. If your child is exposed naturally to another language during this period, he /she will automatically pick it up. There is no need to ‘forcefully teach’ him /her. Orchestrating your child to learn another language, -English in this instance- between the ages of 0 to 5 at the expense of learning in his /her mother tongue is a disservice to that child.

by Dr. Sumedha S. Amarasekara

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