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Importance of ethics in the medical profession

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Patients await their turn at a government hospital

The full speech of Emeritus Prof. Janaka De Silva, former director of the Postgraduate Institute of Medicine (PGIM) as chief guest at the inauguration of the Annual Academic Sessions (AAS) of the Sri Lanka College of Oncologists (SLCO) on October 13 in Colombo.

Prof. De Silva was speaking on ‘Postgraduate training and the professional practice of medicine’: As I am not qualified to talk to you about oncology, I thought I will speak briefly from my experience of working at the PGIM and the Sri Lanka Medical Council (SLMC) on a few issues that concern our postgraduate training, the professionalism that society expects from specialists and the challenges we face in fulfilling them.

Our postgraduate training system is one of the finest in the region and our post-MD trainees also have the privilege of being trained overseas. Several of our qualifications are recognized overseas, and some, like the MD Surgery have been granted equivalence by Colleges in the United Kingdom. There can little doubt that those who undergo this type of training have the necessary knowledge and skills to practice as specialists.

But, in addition to being knowledgeable and skilled, fitness to practise is also determined by professional conduct – maintaining a high standard of professional and moral ethics and being aware of and respecting the rights of patients. And although genuine efforts are being made in our training programmes, it is here that I feel there is room for improvement.

Doctors are expected to make the care of their patients their first concern. They should be competent in all aspects of their patient care related responsibilities and keep their professional knowledge and skills up-to-date. They should recognize and work within the limits of their competence and refer where it is considered necessary, prescribe drugs or treatments based on the best available evidence, be satisfied that consent is obtained before carrying out any examination, investigation, or treatment, and communicate effectively with patients and those who take care of them.

Doctors should not express personal beliefs (including religious beliefs) to patients in ways that exploit their vulnerability or cause them distress, and should maintain patient confidentiality at all times, especially when communicating publicly, be open and honest with patients if and when mistakes occur, and be honest about their experience and qualifications.

They should also be honest and trustworthy when completing or signing documents, when giving evidence to courts and in financial and commercial dealings. Doctors should also be fully aware of the rights of the patients they treat. Patients’ rights include the right to informed consent which refers to their agreeing to undergo treatments or procedures only after receiving accurate information wherever possible. This should include the names of healthcare providers and their qualifications and the estimated costs of investigations, procedures and treatments.

I am sorry if that felt like I was lecturing you, because what I have said is hardly new and should be common practice. But we all know that this is not the case. We have only to listen to the news, read the newspapers or log onto social media to hear ever increasing incidents of patients subjected to unnecessary investigations and procedures, given irrational prescriptions, issued false medical certificates and being charged unconscionable fees.

As our country becomes more developed, admittedly rather slowly, the medical profession has a duty to ensure that the health benefits of this gradual affluence reaches all communities in all parts of Sri Lanka. There can be little argument about that. But for this to happen, we need more specialist doctors, so that specialist medical services can be expanded to cover the more remote areas of our country. And, as we progress, we must also strive to improve, not only the coverage, but also the quality of care given to our patients. At present we are struggling with both, mainly because of the current brain drain and, paradoxically, protectionism within the profession.

Almost all of us specialists here have had the benefit of free education at some time or another – at school, at university or when we went overseas for our postgraduate training. It was certainly the case for me. It is something extraordinary for a lower middle income country to provide. So, we owe Sri Lanka and her people a debt of gratitude. Giving something back to the system that nurtured us are duties that are noble and proper.

I therefore, feel sad when I read the news of some specialist doctors cold-heartedly and without notice abandoning their posts and patients, and leaving the country, and worse, doing so secretively to avoid paying their service bonds and other dues. This is disgraceful and brings our whole profession into disrepute. The shame, however, is not only theirs, but should be shared equally by the affluent countries that poach them from this not-too-well-off country.

But, our system is also at fault. While our regulator, the SLMC is currently well into the process of drafting a new Medical Act to address some of the issues I mentioned earlier, our system also needs to fulfil a social obligation – that is to provide career opportunities for the nearly 2,000-odd doctors graduating from local and foreign medical schools joining our workforce each year – may I remind you at this point that we now have 12 state medical schools. If we fail, the lack of opportunities will continue to result in our brightest young doctors leaving the country.

There are several ways that we may be able to deal with this issue: one is to develop more specialties, once adequate numbers of generalists have been trained. Another is to increase the number of mid-level qualifications like Postgraduate Diplomas and Masters Degrees; doctors with middle-level qualifications can play a very important role in our health service, provided their services are utilized optimally.

To achieve these, the medical profession needs to overcome its protectionist ideology that sadly pervades even our professional colleges. In fact, when I was Director of the PGIM, I found that some colleges were actually the biggest obstacle to developing sub-specialties and awarding mid-level qualifications and the reasons given by them were not even remotely academic. It is in matters such as this that the support of professional bodies is needed. I thought I will speak freely about these inconvenient and uncomfortable truths, firstly, because I have been waiting a very long time to do it, and secondly, because I do so at the induction of a man, who is an oncologist of the highest integrity, who, as a professional, is a role model. I am proud to have made a small and very early contribution to his professional career.



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Norochocholai coal-fired power complex seen as facing staggering financial losses

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While the Parliamentary debates were purely focused on missing the calorific value benchmark, the excessive Ash content (21% in the samples tested) is also a reason to reject the shipment, as maximum allowed ash percentage in the tender is 16%. This means even if the tests clear the coal on calorific values, the shipments still must be rejected based on ash content as per tender terms. This fly ash and low moisture will create a massive ecological disaster to the communities in Norachcholai - Withanage

Sri Lanka’s first and largest coal-fired power complex at Norochcholai is staring at mounting financial losses running into millions of rupees as low-quality coal imports, rejected shipments and unusable stockpiles disrupt operations and expose deep flaws in coal procurement, power sector and environmental experts warned yesterday.

Energy sector sources told The Island Financial Review the economic damage has already begun, with rejected coal stocks, delayed payments and declining plant efficiency forcing the system to absorb losses from under-performance, additional handling costs and the risk of turning to more expensive backup generation.

Insiders estimate that continued reliance on sub-standard coal could result in tens of millions of rupees in losses per day, once reduced output, higher fuel burn and maintenance costs are factored in.

At the centre of the controversy is a recent coal shipment procured by the Lanka Coal Company (LCC), which has come under intense scrutiny after laboratory tests reportedly showed ash content of around 21%, far exceeding the 16% maximum allowed under tender conditions.

While parliamentary debate has focused narrowly on whether the coal meets the required calorific value, experts stress that excessive ash alone is sufficient grounds for outright rejection, regardless of calorific performance.

The situation worsened after coal stocks at the Norochcholai Coal-Fired Power Complex were recently rejected, leaving shipments in limbo and payments withheld. Power sector officials say this has resulted in logistical losses, demurrage risks and operational uncertainty, while existing low-quality coal stockpiles continue to deteriorate in storage.

“Coal that does not meet specifications is not just unusable — it becomes a financial liability, a senior electrical engineer said.

High-ash coal reduces boiler efficiency, increases fly ash generation and accelerates wear on ash handling systems, electrostatic precipitators and boilers — translating into higher maintenance costs and forced outages. Industry analysts warn that these hidden costs ultimately find their way into CEB losses or consumer tariffs.

Environmental Scientist Hemantha Withanage warned that accepting or burning such coal would push Norochcholai into a new environmental crisis, with serious consequences for communities in Norochcholai, Puttalam and surrounding areas.

“This is not just about calorific value. High ash coal means significantly more fly ash, Withanage told The Island Financial Review. “With low moisture and excessive ash, particulate matter spreads easily, contaminating air, soil and water. This is a massive ecological threat that will directly affect public health.”

He stressed that fly ash contains toxic heavy metals and fine particulates linked to respiratory illness and long-term environmental degradation. “If tender conditions are ignored, the cost will be paid by communities, not the suppliers, Withanage said.

Critics say the crisis exposes serious weaknesses in coal procurement oversight, with questions now being raised about supplier selection, quality verification and accountability. They argue that repeatedly importing low-quality coal — only to reject it or burn it at reduced efficiency — amounts to systemic mismanagement of public funds.

By Ifham Nizam

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IRCSL launches ambitious mission to transform Sri Lanka’s insurance sector

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Dr. Ajith Raveendra De Mel

In a groundbreaking initiative, Insurance Regulatory Commission of Sri Lanka (IRCSL), announced an ambitious mission aimed at transforming the insurance industry into a cornerstone of national economic resilience and social stability.

To address this, the IRCSL will launch a nationwide education campaign titled “Insurance for All: For a Secure Future,” focusing on enhancing financial literacy across the country said Dr. Ajith Raveendra De Mel, the newly appointed Chairman IRCSL. Few sample events have already commenced last year in Matara, Jaffna and Kilinochchi that have set a strong precedent for future initiatives. “The positive response from participants highlighted the strong need for direct engagement and community-level awareness,” he said.

The IRCSL has also partnered with the Ministry of Education to integrate insurance literacy into the national curriculum, starting as early as Grade 5. This initiative aims to embed core concepts of risk management and financial protection, preparing students for future roles in the insurance industry. Complementing educational efforts, the IRCSL is also hosting an Inter-University Quiz Competition focused on insurance and financial literacy, aiming to engage university students and cultivate future thought leaders in the sector. Additionally, an e-Newsletter will keep stakeholders informed about industry updates and regulatory developments.

Dr. De Mel emphasized that this transformation it is not just about increasing insurance penetration, currently at a mere 1.1%, but about fostering a financially literate society where every citizen, family, and business is shielded from unforeseen risks. He said “Our mission is to cultivate a fully insured, financially literate, and future-ready society. The journey ahead involves profound regulatory, technological, and educational reform to create a modern, transparent, and robust regulatory environment that earns public trust while promoting innovation and sustainable growth in the industry.”

He pointed out the critical need for awareness, noting that many Sri Lankans perceive insurance as complex or exclusive to the wealthy. “We need to change how people think about insurance. Our goal is to make it simple, relatable, and accessible to everyone, particularly in rural and underserved communities,” he explained. The IRCSL will collaborate closely with the Insurance Association of Sri Lanka (IASL), the Sri Lanka Insurance Brokers Association (SLIBA), and the Sri Lanka Insurance Institute (SLII) to ensure that the message of financial preparedness reaches all corners of the nation. As Sri Lanka stands on the brink of an insurance transformation, Dr. De Mel’s vision promises a secure future driven by informed financial decisions and enhanced protection against life’s uncertainties.

The IRCSL is also focusing on digital transformation, enhancing operational excellence within the insurance sector. Key initiatives include establishing a Centralized Motor Insurance Database to improve transparency and efficiency in motor insurance, and advancing health insurance through digital integration, including standardized disease coding and electronic health records.

To ensure global competitiveness, the IRCSL is benchmarking against international best practices. A recent study tour to India has provided valuable insights into implementing risk-based supervision and capital frameworks, as well as developing accessible insurance products for underserved communities.

As the IRCSL approaches its 25th anniversary, it emphasizes the importance of staff development and alignment with other financial regulatory bodies to maintain high professional standards. The upcoming OECD/ADBI Roundtable on Insurance and Retirement Savings in Asia will further position Sri Lanka as a leader in insurance discussions, fostering regional collaboration and innovation.

by Claude Gunasekera

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Sri Lanka’s first public allergy awareness wristbands

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LAUGFS Life Sciences, in collaboration with the Medical Research Institute (MRI), Colombo, has launched Sri Lanka’s first-ever publicly driven allergy awareness wristbands, a groundbreaking initiative aimed at improving patient safety and preparedness in medical emergencies. The wristbands provide essential information about drug sensitivities, allowing healthcare professionals to respond quickly and effectively when time is critical.

The official handover ceremony featured distinguished medical experts, including Dr. Dhanushka Dassanayake, Consultant Immunologist and Head of the Department of Immunology – MRI, Dr. Rajiva De Silva, Senior Consultant Immunologist – MRI and Dr. Prabath Amerasinghe, Deputy Director – MRI, marking a historic milestone in patient care in the country.

Commenting on the initiative, Dr. Rajiv Perera, CEO of LAUGFS Life Sciences, said, we are proud to partner with the Medical Research Institute to launch Sri Lanka’s first-ever publicly driven allergy awareness wristbands. This initiative underscores our commitment to patient-centric healthcare by providing critical information that can save lives during emergencies. We believe that thoughtful collaborations like this can have a meaningful impact on patient safety, and we look forward to expanding the program to cover additional drugs and allergens, further advancing healthcare standards across the country.

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