Ivermectin – A possible win-win situation
BY Dr. Sumedha S. Amarasekara
Ivermectin is a drug that has been increasingly occupying medical attention, following its possible role in the treatment and prevention of SARS-CoV-2 (Covid-19). A news item in the The Sunday Times of 05.09.2021 says, ‘Ivermectin divides doctors while NMRA gives waiver to import drug to stop black market sales’.
Ivermectin was discovered in 1975 and had come into medical use by 1981. It is an antiparasitic drug that has antiviral and anti-inflammatory properties. It is a well-known drug, approved as an antiparasitic agent by both the FDA (U.S. Food and Drug Administration) and the WHO (World Health Organization). It is on the list of the WHO’s Essential medicines. It is considered to be extremely safe in the recommended dose (0.2 to 0.4 mg/kg). Over the last 20 to 30 years the medical/scientific community has begun to investigate /appreciate its antiviral and anti-inflammatory properties (Kircik LH, Del Rosso JQ, Layton AM, Schauber J. Over 25 Years of Clinical Experience with Ivermectin: An Overview of Safety for an Increasing Number of Indications. J Drugs Dermatol. 2016 Mar;15(3):325-32. PMID: 26954318)
Ivermectin is also an extremely cheap drug. A 12mg tablet –the normal recommended dose for a 60 kg adult- is around US $ 0.03 -3 cents. The manufacturing cost is estimated at US $ 168 for 1 kilogram. Therefore, as one can work out, to manufacture 12 mg will cost: 168 divided by 1,000,000 and multiplied by 12 = US $ 0.002. Hence the bulk of the cost of the drug is in fact in converting the drug into tablets, packaging and distribution!
Evidence of the use of Ivermectin :
There is an increasing number of news items and journal publications showing the efficacy of Ivermectin’s role in reducing the mortality of Covid-19 and reducing the spread (prophylaxis) of Covid-19 among the population. A case-control study done at the All India Institute of Medical Sciences concluded that two-doses of Ivermectin prophylaxis at a dose of 300μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 (Covid-19) infection among health care workers for the following month (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886121/). A meta-analysis published in June this year shows a probable reduction of mortality (i.e. deaths) by 62%, when Ivermectin was used as a therapeutic agent and a possible reduction of spread by 86% when Ivermectin was used as a prophylactic agent(American Journal of Therapeutics 28, e434–e460 (2021).
In fact the control of Coivd-19 in the Northern states of India and across a number of other countries has been attributed to the use of Ivermectin. An increasing number of countries has stated that they are adding Ivermectin on to their arsenal in combating Covid-19 (https://www.youtube.com/c/WhiteboardDoctor/playlists- Ivermectin and Covid-19).
However, the NIH (National Institute of Health) maintains that there isn’t sufficient data to recommend Ivermectin for or against, in the treatment of Covid-19, which is the same stance that has been taken up by the National Medicines Regulatory Authority (NMRA) of this country as well. The WHO’s stand is still that, Ivermectin should not be used outside a clinical trial.
Conducting clinical trials:
To understand this apparent discrepancy between the results of the clinical trials and the stance of the NIH, WHO, etc., requires an insight into the interpretation of clinical trials. In today’s world conducting and interpreting clinical trials is almost a separate discipline on its own and is well beyond the scope of this article (and mine as well!).
However, an understanding of clinical trials and their interpretation is necessary to understand the clinical trials themselves and the decision-making process of these authorities. There is a variety of trials that could be done. The basis of all these trials is that one group of patients is given Ivermectin and the other group is not given Ivermectin. Following the trial, by comparing the mortality rates and spread of Covid-19 (the results) between the two groups, scientists would be able to say what effect Ivermectin has on the mortality and spread of Coivid-19. For the results to be valid, apart from the Ivermectin, everything else between these two groups needs to be the ‘same’, such as the male to female ratio of patients, other illnesses they have, other medication they take, smoking habits, alcohol consumption, etc. As one can see it is not easy to get two comparable groups. Thereafter, if one is treating for Covid -19, both groups need to have the same degree of sickness i.e. the average number of mild to moderate to severe cases should match up. If one is checking for prevention (prophylaxis) then their exposure to ‘known Covid-19 cases’ and ‘potential cases’ needs to match up as well. For example starting from, do they wear one or two masks, what type of masks, do they wear a face shield, do they maintain social distancing; all the time or some of the times, have they been exposed to any known Covid-19 patients, have they attended any weddings, funerals, parties, ‘get togethers’, do they live in apartments or individual houses, do they travel to work using public transport, do they shop on line or in person, etc… etc… As one can see this is even more complex than trying to match groups for treatment. This is what leads to the term Controlled. Thereafter, scientists need to make sure that every patient has an equal chance of either receiving the Ivermectin or not. In other words, there is no bias in who receives and who does not receive the drug. Because inadvertently one might be influenced by whom one gives the drug to i.e. the drug may be given to someone considered sick who needs the drug and not given to one with a milder disease. This process of randomly allocating the treatment leads to the term Randomised. From a patient’s point of view, they may feel psychologically let down by not having received the drug or psychologically boosted by receiving the drug. This can affect their response to the treatment. The doctors monitoring the patient can be influenced as well, if they know whether a patient is taking the drug or not. To eliminate this phenomenon everybody receives ‘the drug’- either the drug or the placebo –originating from the Latin phrase ‘I shall please’. Therefore only those who actually run the trial know, who gets what. So the person/s who gives the ‘drug’ and monitors the patients do not know what they are giving and neither do the patients know what they are receiving which is called a double blind. If all these elements are combined then we arrive at a randomised, double blind, controlled study which is considered as the golden standard.
Interpretation of clinical trials:
So the trial is done and the results are out. Now a complex issue remains as to how certain the scientists are that these results are due to Ivermectin and not due to a natural variation of events. To illustrate this we can look at a hypothetical situation of 10,000 Covid -19 patients that have an overall mortality of 2% i.e. 200 deaths. If we were to divide these patients into lots of 1000, it is extremely unlikely that these deaths would be distributed equally for every lot of 1000 patients. Some lots would have had more deaths, other lots would have had less, averaging out at 20 per group of 1000 i.e. 2%. Now let us assume that the two groups of patients selected of a 1000 each for the study, were to have 10 deaths in one group and 30 deaths in the other –averaging out at 2%. The critical issue to grasp is that, which group is which is not known. Assume Ivermectin was given to the group that was to have 30 deaths and as a result of Ivermectin the death rate was halved and ended up being 15 –a 50% reduction- this is 50% (5) more than that of the control group, so it could be erroneously concluded that Ivermectin does not work, when it actually does work. On the other hand Ivermectin may not actually work, but in this instance it was given to the group that was to have 10 deaths, so erroneously the conclusion is that Ivermectin does work, when in fact it doesn’t. If things were not as complex as it were, it is worthwhile to remember that this natural variation exists for all of the characteristics mentioned above between the two groups as well. This needs to be taken in to account.
So when scientists interpret data, these variations are taken into consideration and there are three main aspects that they consider. The first is the power of the study. That basically means, are there sufficient numbers of patients in the study for the scientists to be able to pick up a true difference that goes beyond the natural variation. The hypothetical study shown above, has very little power; as one could see that the results could not be interpreted due to the natural variation. Next is significance. That is a measure of allowing for chance to be involved in the result. For most studies the significance level, known commonly as a P value is set below 0.05 (P< 0.05). In this context it would mean that, there is less than a 5% chance that the decrease in mortality is, not due to Ivermectin i.e. the chance of Ivermectin causing the decrease in mortality is more than 95%. Thirdly, there is the concept of ‘a confidence interval’. Broadly speaking the narrower the confidence interval the more valid the results are.
Clinical interpretation and Ivermectin:
It is a deficiency of some of the above factors in the clinical trials so far conducted and their subsequent interpretation that have resulted in this stance of the various authorities. Therefore the vital aspect to understand in going forward is that the issue is not primarily to do with the results from all these trials (and other evidence) that have been conducted across the world; that have shown that Ivermectin does work. But, it is to do with the validity of these results. Therefore the view put forward by those who are guarded in their recommendation in the use of Ivermectin, is that the validity (certainty) of these trials is not strong enough for the use of Ivermectin to be recommended. Which of course is not the same as saying that Ivermectin does not work.
This view needs to be counterbalanced by the following facts. Firstly, there have been no significant adverse effects reported in any of the trials conducted using Ivermectin. Secondly, there is only an extremely limited number of drugs that have been recommended in the treatment of Covid-19 and none of these is ‘curative’ in the strictest sense of the word. Thirdly, though vaccination makes a significant difference to the outcome if one were to get Covid-19, it has not been as successful in preventing its spread.
The WHO apart from the vaccines, has only recommended a few drugs to be used in the treatment of Covid-19. Remdesivir is one such drug. This is however, only to be used in the treatment of Covid-19 patients, essentially in a hospital environment. A vial of this drug costs over US $ 500. Not exactly a practical solution for us! Besides there are no clinical trials scheduled by the major pharmaceutical companies comparing Remdesivir (US $ 500) with Ivermectin (US $0.03) to be seen in the near horizon. Countries that have already used Ivermectin and are satisfied with its outcomes are not going to be conducting trials to assess a drug that they already find works.
One option is to evaluate all the existing evidence and start using Ivermectin. Prof. Saroj Jayasinghe (Faculty of Medicine, University of Colombo) a highly respected clinician has already written to the Ministry of Health recommending that Ivermectin should be used in the treatment of Covid-19.
However, to take a national stance on a drug not approved by the WHO could be considered ‘irresponsible’ and may jeopardise our future with regard to health and safety issues on an international forum.
Therefore, another option would be to follow the guidelines of the WHO and conduct a clinical trial. The issue that would now cross one’s mind is given in this discussion; conducting a trial that would give valid results would be an extremely complex and arduous undertaking. How does one organise these matching groups etc..?
An islandwide clinical trial with the use of Ivermectin.
With regard to an islandwide clinical trial, the numbers will be huge running into millions. This leads to an enormous power and thereby an incredible validity of the study. It also ironically means that the amount of extra data that one needs to record, to make sure that one has matching groups, etc., becomes minimal as well. As a point of illustration, if we were to have a randomised clinical trial–blind or not-across the 14,022 Grama Niladhari Wasams involving around 22 million adults and children, where half are given Ivermectin; the outcome would be dependent on the use of Ivermectin, as the chance of another confounding factor or natural variation affecting one group-of roughly 11 million- and not the other would be almost nonexistent!
Let us not forget that we are probably one of the few countries in the world where countrywide elections are held and the results are given within a day or so.
The WHO will/should give its blessing and if need be, provide help with the necessary expertise (and resources?) to conduct this trial.
This is essentially a win, win
and win situation
An acceptable clinical trial is required to provide the definitive answers-what the WHO, the NIH and our NMRA need. The medical sector would be happy to get the findings they require with a ‘controlled opening of the country’. The country needs to be opened in some manner to assess the prophylactic role of Ivermectin and the ‘government’ would find it feasible and more than willing to do so for economic reasons. The people would be happy to get ‘a drug that would/could work’ and more importantly an easily affordable one in their hour of need.
The advantage of an island wide clinical trial:
There are a number of important points that are extremely favourable in terms of conducting an islandwide clinical trial with Ivermectin.
1. Ivermectin is an extremely safe drug at the prescribed doses. It can be given to children as well, leading to a comprehensive island\wide clinical trial. This is particularly important as we still do not have a proper handle on vaccination when it comes to children.
Given that Ivermectin is already used as an antiparasitic agent and given to children, it can be used separately in an islandwide clinical trial to re-open the schools.
2. Ivermectin is an extremely cheap drug. This is most relevant to us in our current economic predicament. The cost of treating an adult with Covid-19 and /or using Ivermectin as a prophylactic drug (the loading dose and the required tablets for three months) on average will be less than Rs. 500 per person. As the dose is based on body weight, the cost will be less for children.
3. When used as a prophylactic drug, it has an extremely simple dosing schedule – a loading dose administered a couple of days apart then a maintenance dose once a week or at a prescribed interval.
4. The existing trials show a considerable impact from this drug. Based on the existing trials, if Ivermectin were to work, we should be expecting at least a 50% reduction of mortality and at least the same reduction in the spread of the disease, or there about. Therefore the effects of using this drug would be extremely easy to monitor.
5. A very important point, the prevention (i.e. prophylactic) aspect of Ivermectin, starts once the drug has got absorbed into the system – pretty much immediately. When one considers the vaccine, the first dose needs to be given, then a period of at least four weeks has to pass for the body to generate a sufficient immune response for the second dose to be given. Thereafter, a further two to three weeks need to elapse before one is considered to be immune i. e. close upon almost two months. With Ivermectin, if one takes the tablet at night, by morning one is ‘good to go’.
6. Finally, another significant and interesting aspect is that we would be able to evaluate the relative efficacy and interactions between Ivermectin and our vaccines. How does Ivermectin impact on those who have completed both vaccine doses or only had one or have not been vaccinated at all? Looking to the future, how does Ivermectin-given that it has therapeutic as well as prophylactic properties- compare with Vaccination?
The country still faces a dilemma of opening the country vs having an uncontrolled spread of Covid-19. The reality is that we will need to ‘reopen the country’. This is the best time while the country is in a lock down to organise an islandwide clinical trial. Plan what type of trial/trials we want to execute, formulate the primary and secondary questions that need to be answered, identify the significant sub groups, determine what monitoring processes are required, etc. Make necessary plans to reopen the country systematically with an islandwide clinical trial in place.
Hopefully, we shall see the light at the end of the tunnel.
The Box of Delights – II
Seeing through testing times and future
Text of the keynote address by Prof Rajiva Wijesinha
at the 8th International Research Conference on Humanities and Social Sciences,
University of Sri Jayewardenepura on 16 March, 2023.
Sadly, too, the GELT materials we produced are now forgotten, though in the end they were taken up by Cambridge University Press in India and prescribed too at some Indian universities. But in this country producing materials is a way of making money and so, though three years ago the UGC asked about using our materials again, they were prevented from making use of these, and individual universities demanded autonomy and nothing went forward as swiftly as our poor youngsters needed.
Delay also affected the curriculum reform I initiated when I chaired the NIE AAB [Academic Affairs Board]. I had told the then Education Secretary Tara de Mel that we should move immediately, but for once that normally efficient lady was diffident, and said we should wait. Six months later she told me to go ahead, and we did, swiftly, but then Chandrika Kumaratunga lost a year of her Presidency through carelessness and the new President and his Minister simply did not understand the need for continuity, and the vital changes we had embarked on were forgotten.
But Mahinda Rajapaksa and Susil Premjayanth did continue with perhaps the most important initiative begun under Tara—the English medium in secondary schools in the government system. That had begun in 2001, but was sabotaged by Ranil Wickremesinghe, who became Prime Minister at the end of that year. But his Minister of Education, Karunasena Kodituwakku, a former Vice-Chancellor of this University, was more enlightened, and ignored Ranil’s instructions that he halt the programme, and it continued. He was lucky not to be tear-gassed, but, in those days, there were some restraints on unbridled authority with the forces then more supportive of alternatives.
But the teacher training programme I had started with support from Paru and Oranee, had to stop. The NIE then took that over and completely destroyed the learner friendly approach we had initiated, with its hierarchy promoting formulas, such as three Ts and then five Es and seven Ks, gloriously asserted in lengthy sentences such as ‘Also the teacher should closely observe the children learning, identifying students’ activities, disabilities, providing feedback, developing the learning capacities of the students and making implements to extend the learning and teaching outside the classroom are some other tasks expected from the teacher.’
As I commented on this in English and Education: In Search of Equity and Excellence?, ‘It might seem churlish to cavil about the two main verbs in this sentence, were this not an instructional guide to English teachers, with three language editors who have doubtless been well paid for their pains, or the lack of them.’
Training then was in the hands of the NIE, and the programme began to flounder. But, fortunately, the contract to produce books had been for two years, and Nirmali continued in charge of this, so at least a good foundation was laid, though after that the Ministry and the NIE took over and the usual tedious stuff was reintroduced. Our efforts to introduce wider knowledge, and creative thinking, were abandoned totally, unsurprising given the ignorance I had found in those entrusted with producing textbooks at the NIE (which managed once to produce a history syllabus which left out the French and the Industrial Revolutions in the whole secondary school curriculum). Let me, to prove my point, give you an extract from what the NIE managed to produce
‘Red the story …
Hello! We are going to the zoo. “Do you like to join us” asked Sylvia. “Sorry, I can’t I’m going to the library now. Anyway have a nice time” bye.
So Syliva went to the zoo with her parents. At the entrance her father bought tickets. First, they went to see the monkeys
She looked at a monkey. It made a funny face and started swinging Sylvia shouted.
“He is swinging look now it is hanging from its tail it’s marvellous”
“Monkey usually do that’
And, so it seems does the NIE, was my comment. Unfortunately, I cannot in a speech make clear the carelessness with regard to punctuation and spelling, but a printed version will show just how appalling the NIE usage of English is and the callousness of inflicting half-baked stuff on our children.
Despite all this English medium has survived, but that it could have done so much better is obvious from the continuing proliferation of private English medium schools. Interestingly, the former Permanent Secretary to the Ministry of Education, Dharmasiri Peiris, whom I met after many years, reminded me that in the early nineties he had wanted me to work at the Ministry to remedy the situation, but he had abandoned the effort when officials at the Ministry opposed this, understandably so given that I do not tolerate nonsense. And though Tara was made of sterner stuff, and did make use of my services, two changes of regime before things could be consolidated meant that our children still get short shrift as far as English Language Learning is concerned.
I have spoken thus far of English at university level and in schools. I have also worked on English for vocational training, first thirty years ago when the World University Service of Canada commissioned a basic textbook for those starting on vocational training, then more comprehensively when I chaired the Tertiary and Vocational Education Commission.
Having discovered that what were termed NVQ Levels 1 and 2, supposed to prepare youngsters for vocational training, hardly existed, I started Career Skills courses at those levels, to develop other soft skills and in particular English capacity, and these rapidly became the most popular courses in the system. After all, I had done a trawl and found that parents wanted something for their children to do in the fallow period after the Ordinary Level examination. Uniquely, Sri Lanka wastes the time of its youngsters by delaying the resumption of school, a boon to the tuition industry which embarks on recruitment and hooks youngsters for the next few years.
Needless to say, when I was sacked, the English courses were abolished, and successive Ministers of Education, who now have charge also of vocational education, bleat about the need for more English but do nothing to promote this. Least of all do they think of learning from the past, and far from reinventing the wheel, they simply talk about movement while allowing all means of transport to be dismantled, with parents and children who have been left in the lurch turning if they can to private education, tuition in particular.
As your former Vice-Chancellor perceptively put it, when I was last here, the education system is abandoned by those who have the means to pursue alternatives, and it is only the most deprived who cling to it. And whereas any country with a conscience would do its best by the deprived, decision makers in Sri Lanka do not care about them – like the Mr Lokubandara, who ranted against English in the state system and sent his son to an international school, and then when I reprimanded him told me sanctimoniously that it was his wife who had insisted on that.
Is there then no hope? I fear not, and now I can understand the despair of Mabel Layton in Paul Scott’s brilliant analysis of the failure of the British in imperialism, and her lament that “I thought there might be some changes, but there aren’t. It’s all exactly as it was when I first saw it more than forty years ago. I can’t even be angry. But someone ought to be.”’ I rather fear then that your Vice-Chancellor’s observation will prove even more apposite in the years to come. There was a brief moment three years ago, when covid first hit us, when I thought the system would bestir itself to provide alternatives, but I fear nothing of the sort happened.
But let me end now with what should have happened. Given that the onset of covid saw closure of schools and institutions, there should have been efforts to develop curricula appropriate for a time when face to face contact would not be easy. And this required, as I started by saying, thinking as learners do, and tailoring the content of curricula, as well as systems to convey it, to the abilities of learners, not teachers.
This was particularly important in the context of 2020 in which learners had limited access to teachers. But our decision makers could not think on these lines, nor understand that the key to this was simple materials, that are not just user friendly but that will allow learners to gain not only knowledge but also relevant thinking skills on their own. Provision could and should have been made for guidance, but this had to be minimal, and also provided through small group clusters, where students could learn from each other, in addition to getting guidance at a higher level as available. I recall vividly the brilliant initiative of Oranee Jansz, in insisting that all GELT students not only did a project, but that they dramatized this. This proved a wonderful motivating factor, and students in the remotest of areas worked hard together, and the synergy they developed, to use one of Oranee’s favourite words, led to rapid learning by even those who had been initially very weak.
Such a system was especially important for youngsters in rural communities, and could have been activated in 2020, at a time when communication was difficult, and where the panacea authorities developed, of online contact, was not easy, and in many instances not even possible. But as I have noted, those rural communities are of no concern to our decision makers, whose main motivation is to have their children advance through educational systems different from those the majority of our children have to undergo. They are not at all like Oranee, or one of the academics I remember most fondly from my time at this university, Prof Wickremaarachchi, who started an accountancy course in English medium only, and noted that one had failed as a teacher if one’s students did not end up better than oneself.
To continue, in the midst of a country in a desperate plight, with the positives this university could develop, I will revert to the last time I was here, in December, and highlight again the initiative I mentioned when I began, to work through the national library system to promote English through entertainment for early learners. The project which has been developed suggests at last, after two decades, an effective approach to extending opportunities and means of learning.
This can easily be taken further, at all levels – and work on this has begun – to fill gaps that the state has sedulously ignored for several decades. Costs would be minimal, if only innovators such as the personnel here responsible for the initiative were given a free hand. I can only hope that, with the support of the hierarchy here, and the other players who have combined to take this forward, from the Governor of the Northern Province to the Chairman of the National Library Services Board, that this initiative will lead to the proliferation of user friendly materials and personnel able to use them productively.
‘A Jaffna-man, an eminent surgeon with an European reputation’
180th Birth Anniversary of Hon. Dr. W. G. Rockwood
March 13, 2023 marks the 180th Birth Anniversary of the late Hon. Dr. William Gabriel Rockwood, MLC, MD, MRCP, MRCS. Born on March 13, 1843 in Alaveddy, a small agricultural town in Jaffna; was the second of four children born to Elisha and Ms. Jane Backup, based on Alaveddy Church Records in the custody of Rt. Rev. Dr. Velupillai Pathmathayalan, Bishop of the Jaffna Diocese of the Church of South India (JDCSI), formerly the American Ceylon Mission. Hon. Dr. W. G. Rockwood died on March 27, 1909 at the ‘Emms’, Horton Place, Colombo 7.
His father, Elisha born Sinnatambi on April 06, 1820, was one of six children born to a Saivite Hindu, Perumalpillai who migrated from Karaikal, South India to Sri Lanka and married a land-owner’s daughter Ms. Vairavi of Alaveddy. He was baptised ‘Elisha Rockwood’ in 1831 in Tellipallai and was given US $ 200 to complete his education at the Batticotta Seminary, known today as the Jaffna College, Vaddukoddai, by the American Congregational Movement, which later became known as the American Ceylon Mission. Elisha completed his education and taught mathematics at the same school. He later joined the Customs Department as a Sub-Collector.
Dr. W. G. Rockwood married Ms. Salome Muthamma Muttucumaru, daughter of Mr. Adam Cathiravel Muttucumaru on November 1, 1871. Mrs. W. G. Rockwood was born in Kalpitiya in the Puttalam District on March 15, 1857 and died at “Pembroke,” Horton Place, Colombo 7 on Saturday, August 29, 1925.
Thus born to humble beginnings, ‘Dr. W. G. Rockwood was a most skilful and distinguished physician and had by rare ability proved himself ‘the greatest surgeon in the East. His reputation was not confined to Ceylon (Sri Lanka) or the adjacent continent, but had extended far beyond the seas to Great Britain, where he won the esteem of such eminent members of the medical profession as Dr. Marcus Beck, Dr. Charles Stoiiham, Dr. J. Bland Sutton. Sir Thomas Barlow, Lord Lister, and Sir Frederick Treves’. Dr. Rockwood was also president of the Ceylon Branch of the British Medical Association (BMA).
Dr. W. G. Rockwood, in 1851 aged 08 years, had his early education at the Vembadi Boys’ School and later at Central College, Jaffna, which was founded by the Methodist Missionaries. In 1855, aged 12 years, he went with his father to Batticaloa and joined Central College, Batticaloa which was also run by the Wesleyan Mission.
Dr. W. G. Rockwood in 1862 was in the last year of his teens, when a maternal uncle, Mr. E. R. Chelliah Pillai told him to come to Madras University for a “good education.” Mr. E. R. Chelliah Pillai died on March 19, 1900 at the “Emm’s,” Regent Street, Colombo 7.
In January 1866, aged 23 years, Dr. W. G. Rockwood passed the Calcutta University Matriculation Examination in Madras and applied for the arts course. His father prevailed on young Rockwood to follow medicine which he did with many misgiving and much reluctance. His disinclination soon disappeared for Rockwood took to anatomy with such interest. In July 1866, he joined the Madras Medical College and received the scholarship of Rs.20 allowed for those who pass the London matriculation Examination.
‘On his obtaining the degree of Doctor of Medicine from the University of Madras, a member of the Board of examiners paid him the following rare compliment, “I have lately had, on behalf of the Madras University to examine a man of the name of Rockwood from Ceylon, for the Degree of Doctor of Medicine, and certainly was quite unprepared to meet a candidate for medical honours of this country so remarkably proficient. I fully believe that in any English or Scotch University he would have carried the highest honours” ’. (Source: Jaffna Catholic Guardian April 03, 1909).
Dr. W. G. Rockwood while he was serving in Puttalam skilfully handled an outbreak of cholera and because of his experience in handling it, he was sent to Jaffna in1868 to control the outbreak of cholera. He returned to Puttalam and then was transferred to Hambantota (June 1875) and later to Gampola (1878). It was while he was in Gampola that the vacancy for the post of Surgeon in the Medical Department of the General Hospital in Colombo arose.
Dr. W. G. Rockwood in 1878 aged 35 years held the post of Principal Surgeon at the General Hospital Colombo now known as the National Hospital, Colombo for a period of 20 years. He was the sole surgeon of the hospital and at the same time he was Lecturer in Clinical Systematic and Operative Surgery in the Ceylon Medical College. Besides this what leisure he could snatch from his official duties was given up to the demands of a large and growing practice.
He travelled to London in 1884 when he was admitted as a Member of the Royal College of Surgeons (MRCS) and Member of the Royal College of Physicians (MRCP).
Dr. W. G. Rockwood retired from active service from the Medical Department after 31 years on March 13, 1898 at the age of 55 years. Upon his retirement and in recognition of his long-standing service he was immediately appointed Consultant Surgeon to the General Hospital in Colombo.
It is said of his authority on handling tropical diseases that there was an instance when a colour conscious Englishman who had an ailment was asked to consult Hon. Dr. W. G. Rockwood of Ceylon while on his way to Australia from England. The Englishman thinking from the name – Rockwood – was an Englishman made an appointment to see him at the Galle Face Hotel, Colombo when the ship docked at the Colombo harbour.
On that day Dr. Rockwood was at the Galle Face Hotel, Colombo waiting to see his patient. The patient was informed that Dr. Rockwood had arrived, came to the lobby and was pacing up and down the lobby impatiently when the management of the Hotel who were well acquainted with Dr. Rockwood had to draw his attention to the coloured man in the room. Seeing that Dr. Rockwood was coloured he had returned to his room. A year later the patient was back with his pride in his pocket to consult Dr. Rockwood.
Another story is related where a passenger ship had docked in the Port of Colombo and an SOS was sent out for a surgeon to attend to a German National. It turned out that the German National was the German Consul Freudenberg who was treated and cured of his ailment and later became a very close friend of the family. Dr. Rockwood was also physician to the Governor of Ceylon Sir West Ridgeway.
A combination of medicine and politics
The Governor of Ceylon Sir West Ridgeway appointed Hon. Dr. W. G. Rockwood to the Legislative Council representing the Tamil community for a period of five years from March 14, 1898 to March 12, 1903. Dr. Rockwood succeeded Mudaliyar Ponnambalam Coomaraswamy who was the eldest brother of Sir Ponnambalam Ramanathan who served as the first Tamil representative in the Legislative Council for a single term. Governor Sir West Ridgeway in a private letter to Dr. Rockwood inviting him to join the Legislative Council as the Tamil representative said: ‘The Tamil community could think of no one who has earned the esteem and the admiration not of one community or of two, but of every community, of all men, of all races, as Dr. Rockwood’.
Hon. Dr. W. G. Rockwood was presented to His Majesty the King of England, Edward VII at St. James’ Palace on June 01, 1902 while he was serving as a Member of the Legislative Council. He was appointed to the Legislative Council for a second term on July 09, 1903. Due to continuing failing health, Hon. Dr. W. G. Rockwood in1906 laid off from all public activity.
The Legislative Council was the first Assembly set up under the Colebrook Reforms with 15 members in 1833 by the British under Governor Sir Fredrick North. There were two categories of members. Officials numbered nine and unofficial members numbered six. The official members were appointed directly by the Governor and their communities nominated the unofficial members. The six unofficial members comprised one each Sinhala, Tamil and Burgher and three Europeans.
The Legislative Council was altered in 1931 under the Donoughmore Commission and lasted until 1947. Ceylon gained Independence from the British on February 04, 1948. Ceylon changed her name to Sri Lanka on May 22, 1972 when she became a Republic. The second Constitution was enacted in 1972 when Hon. Sirimavo Bandaranaike was the Prime Minister. Today we have the third Constitution enacted in 1978 when Hon. Junius Richard Jayewardene became the first Executive President under that Constitution.
‘Dr. Daniel Anthonisz, of Galle had demonstrated the advantage of breaking the monopoly of the legal profession over the unofficial seats in the Legislative Council. Dr. Rockwood’s tenure of the seat emphasised that advantage. Dr. Rockwood illustrated his preferences for his principles at the sacrifice of popularity when he proposed a motion in the Legislative Council on October 18, 1899, asking the salary of the judges of the Supreme Court to be raised high enough to make it possible to secure English barristers for the bench’.
On that occasion Dr. Rockwood said: ‘To have the certainty of even-handed justice is the greatest blessing a community can enjoy and the purity of that administration must be above suspicion. In a small place like Ceylon, where every man is known to every other man, it is necessary in the interests of the public that the Supreme Court Judges, who administer justice between man and man, must be men who have no local or permanent interests or connections. By, these remarks I do not mean to shut out local talent. Those who have established a reputation for efficiency and who have claims for meritorious service are possibly eligible for a higher post and these may be sent to other parts of the Empire where they have no personal interests to serve and no connections’. (Source: The Ceylon Morning Leader: Sunday, March 28, 1909).
Dr. W. G. Rockwood is described as one of Asia’s greatest surgeons who could operate with the use of both his hands (ambidextrous). He also promoted the choice of opium in the treatment of certain ailments. He was a member of the commission appointed by the then Governor of Ceylon to oversee the planning and construction of the Colombo-Chilaw railway line from Negombo. It was later extended to Puttalam. While serving on the commission he also suggested the construction of a railway line to Jaffna.
Six years after his death in 1915, Mrs. W. G. Rockwood donated Rs.20,000 to be utilised towards the construction of a 38 X 26 feet ‘Waiting Hall’ called ‘Rockwood Memorial Hall’ for patients who come to the General Hospital, Colombo now known as the National Hospital, Colombo for treatment. The foundation stone was laid in 1909 and the construction began in the same year. On April 16, 1912, ‘The Rockwood Hall’ was opened by His Excellency the Governor Sir Henry Edward McCallum (1907-1913). The plaque was unveiled in three languages – Sinhalese, Tamil and English to mark the donation: ‘The Rockwood Memorial Hall erected to the memory of Dr. William Gabriel Rockwood MD, MRCS, MRCP, Chief Surgeon of this hospital 1878 to 1898, Consulting Surgeon from 1898 until his death. Tamil Representative to Legislative Council from 1898 – 1905’. It is unfortunate that during the structural alterations made to the original building the three plaques and his photograph have been lost.
His character can be judged by his teaching. Once it is said that he rebuked a somewhat light-minded student and the latter, now an elderly man himself occupying a responsible position, remembers the rebuke. ‘Never make differences in your patients’, said Dr. Rockwood. ‘Every time a surgeon has a life depending upon his knife, it takes a fortnight off his own life, and the sense of responsibility is perhaps the greater when the man is a pauper than when he is a great and wealthy patient. The surgeon dare not take risks with the great man, for the world is watching him; but he fears still more to do so with the pauper, for then it is God who watches’.
He emphasised to his students that the surgeon must regard his treatise on anatomy as second only to the Bible. The words are characteristic of the man whose religion was always a predominant factor in his every thought and deed.
The ‘Rockwood Surgery Medal is awarded to the student who shows the greatest aptitude for surgery by the Medical Faculty of the University of Colombo, Peradeniya and Jaffna in memory of Hon. Dr. W. G. Rockwood.
‘A dutiful son, a faithful husband, an affectionate father, a loyal friend, a skilful surgeon, a good man, not slothful in business, fervent in spirit; serving the Lord; rejoicing in hope; patient in tribulation; continuing instant in prayer; distributing to the necessity of saints; given to hospitality.’ – Romans Ch 12; Vs 11-13
(Source: The Ceylon Morning Leader – Extraordinary Edition of Sunday, March 28, 1909).
(Excerpts from the book ‘From Williamstown to Vaddukoddai: The history of the Rockwood family’, published by the author William Sukumar Rockwood, MCPS, PgD. IHL, BA, JP, great grandson on August 21, 2011) -/end – 2280 words
LTTE writ on coral exploitation more effective than govt. orders
Tragedy and drama in the dry zone jungle
Excerpted from the authorized biography of Thilo Hoffmann by Douglas B. Ranasinghe
(Continued from last week)
North of Thenaddi Bay and a little inland is the village of Kathiraveli. In 1975 Thilo discovered there a folk art not found elsewhere. He described this in an article published in the Journal of the Royal Asiatic Society of Lanka. For many years he was a Committee Member of that body. As recently as 2004 he wrote a sequel, which was not accepted for publication. Parts of it are reproduced here:
“In 1980 I contributed an illustrated article to the JRAS (New Series, Vol.XXV: 91) in which I described certain remarkable decorations in Kathiraveli, Eastern Province, on the outer walls of thatched mud-and-wattle houses, painted by women on the occasion of the Tamil New Year. The pigments used are lime and natural clays of different colours found in the village environment. The painting lasts about a year and is renewed before the next New Year.
“During the following decade I visited the village once or twice a year. Calamity soon befell the remote area in the form of the ethnic conflict. The village was occupied first by the army, the IPKF and finally the Tigers under whose control it still is. (at the time this note was written) It was, much of the time, in a war zone. My last visit had been in January 1992. By then the spirit of the villagers had been broken by untold tragedy.
“Only one house had still some basic decoration. Compounds were neglected and houses dilapidated, the people apathetic and subdued. Farming had become impossible. An aged couple whose neat and tidy homestead was a model for my paper had lost their only son who was taken to the army camp and never returned. Sadness and grief prevailed.
“In April 2003 I was able to pay a visit to Kathiraveli, although it is in an ‘uncleared’ area. After answering a few suspicious questions and establishing my bona fides, I was allowed to pass the LTTE checkpoint situated a little north of Mankerni. Up to that point the landscape had been devastated by the extensive and far-reaching destruction of all vegetation for security reasons.
“Thereafter I was passing through the familiar countryside which had hardly changed during so many decades, even centuries, in parts. The majestic trees are still standing along the road and on the coast. There are forests and a serene tranquility and seemingly timeless peace. Only here and there a jarring note: the memorial to fallen Tiger heroes, a large ‘military’ cemetery. new LTTE offices and installations with loafing youngsters around them. With considerable curiosity and apprehension I approached Kathiraveli.
“Nothing seemed changed. Soon we spotted the first painted house, rather simple but unmistakably in the traditional style. In all we found about a dozen such houses, each freshly painted, along the main roads, though generally there are fewer inhabited homesteads.
“Unfortunately ‘progress’ has reached Kathiraveli in the form of corrugated metal roofing sheets; two of the painted houses were covered with this material giving them a totally different and far less pleasing appearance than those with the cool and pleasant cadjan thatch.
“But the younger women had remembered the New Year tradition and had revived it in its pure, simple and natural form, some rather tentatively as if still trying to recall the old designs and motifs. The colours and basic patterns give these dwellings a clean, even festive and happy appearance.
“In December 2003 I was again in Kathiraveli, when I distributed nearly 100 colour photographs of decorated houses I had taken in 1977 and 78. They were intended to help strengthen the old tradition.
Otherwise the visit was a disappointment because in the short interval of eight months ‘development’ appears to have overtaken the village. There are glistening roofing sheets on old houses many of which have been replaced by stereotyped cement block constructions.
“For living comfort in this environment nothing can beat a well-constructed and maintained mud-and-wattle house generously covered with a thick and overhanging thatch of cadjan: cool during the hot season, dry and warm and cosy when the north-east monsoon is on.
“In this connection I might be permitted to touch upon another facet of personal contemporary history in this area. Not far away at Kayankerni on the coast I had for 30 years, a house, now a sad ruin. It was wrecked and the material looted in 1992. Even the well rings were dug up and carted away. For decades I had been fighting a mostly losing battle against the mudalalis who openly flouted the laws of the country by breaking and burning corals for lime. As a result erosion set in, the coast was altered and the protective reefs were destroyed, together with the trees and forests which provided the firewood.
“The process was aided and abetted by a lethargic and dishonest bureaucracy and a corrupt police force. Only once for a short few years was my campaign crowned with success when an energetic and honest GA at Batticaloa stopped the rapacious exploitation by ordering the police to destroy all the kilns in Passikudah, Kayankerni, Panichchankerni, and elsewhere in the district.
“When in 1990 the Tigers took over the area after the IPKF, they prohibited all coral breaking. The order was instantly obeyed by all, as non-compliance would have resulted in most dire consequences. Only ‘war widows’ were allowed to collect coral debris washed up on the shore and turn them into `sippi’, a traditional and acceptable ‘soft’ use of the resource.
“When the government regained the area the old abuse was resumed and as late as April 2003 did I note with dismay that more lime kilns than ever were in operation at Kayankerni, under the very noses of the security forces. (Note: The burnt lime is transported mainly to upcountry vegetable growing areas where it is used as a soil conditioner. Other uses are in mortar for construction and for whitewashing. Alternate sources of raw material are Miocene limestone and dolomite). All the more was I surprised when in December of the same year all the kilns had once again disappeared, again on the orders of the Tigers.
“Thus we have the absurd situation that in an area controlled by the Government an order from the LTTE is instantly and scrupulously obeyed, and the ordinary laws are brazenly flouted. Weak and disinterested authorities at all levels have long lost the will to enforce good laws, especially in the field of conservation. `Non- enforcement’ has been elevated to a fine art and policy under the influence of foreign gurus; doing nothing is so much easier than doing the right thing.”
The Vakarai area including Kathiraveli was retaken by government forces in early 2007.
Facets of the jungle
In the wilderness, too, there were aspects other than nature which engaged Thilo’s attention.Among the many parts of the dry zone he visited Wilpattu was a favourite. Several sections in this book describe his involvement with the area.
He explored extensively on foot the former Wilpattu West Sanctuary – now part of the National Park –especially the northern half of its 30 mile (50 km) coastline, between Kollankanatta and Kudremalai Point.
Much of this coast towards the north is formed by a cliff which is being eroded by the sea. To the north of Kollankanatta towards Pallugaturai this erosion exposes and destroys layers of the remnants of an ancient settlement. Thousands of clay and porcelain and worked seashell fragments litter the shore. There was even a clay-ring well. Thilo informed the Department of Archaeology, which then undertook a sample dig, but no further action.
It would have been a trading harbour during the Anuradhapura era, because in the vicinity on the track to Sinna Uppu Villu, not far away, he had discovered several baobab trees, as in Mannar, introduced from Africa. There must also have been, he thinks, a factory to make conch-shell bangles.
On the highest point, 225 feet above sea level, of the coastal ridge stands a chimney-like tower about 50 feet high. This and similar towers near Mullikulam and south of Arippu would have served as beacons during the time of the pearl fisheries.
In Kudremalai, at 123 feet, on the very edge of the cliff is the ruin of an ancient Hindu temple which, too, is fast disappearing with the erosion. Here is found the deep red soil, nearly purple or almost violet, to which is linked the ancient name ‘Tambapanni’ for Sri Lanka. It is said that Vijaya, the founder of the Sinhala race, landed here. A motorable track provided by the Park authorities now leads to this point.
The beacon at Arippu is near the massive brick ruin of the `Doric’, built by Frederick North, the first British Governor of Ceylon from 1798 to 1805, for use as a residence when visiting the pearl fisheries. Again due to the erosion the ruins are now rapidly being lost. In the book The Dutch Forts of Sri Lanka, 2004 update, these are wrongly identified and depicted as being of the small Arippu Fort, the ruins of which are aboutfour km further north in the village.
Thilo also explored the North-eastern sector of Wilpattu which lies between the old Arippu road (now long abandoned) and Tantirimale. The ruins at this site, on the extensive rock outcrop (highest point 298 feet), were originally inside the National Park, the boundary of which in that sector was the Malwatu Oya. The place was entirely engulfed by the dense jungle. He first visited it on Vesak Day of 1966. Later the Park boundary was adjusted, the forest was cleared and people began to settle there.
To enable his explorations, from time to time he exercised walking through thick track and featureless monsoon forest with the help of a compass. The danger of missing the target several miles away was great because of the very restricted visibility, especially, where the nillu (Strobilanthes sp.) had grown high. Nevertheless, he always reached the goal with reasonable accuracy.
Observations at historical sites across the country were recorded in his notebooks, described later.Thilo also took an interest in the villagers who live in or by the jungle. Amidst his memories are tragedy and drama:
In a village called Manawa, some distance from Anuradhapura, Tikiri Bandara and 15-year-old Bandara Menike had fallen in love. Her family opposed the marriage. In desperation he shot to death three members of her clan. Then he took her by the hand and disappeared with her into the jungle, as witnessed by some women bathing in the village tank. He carried only his gun.
Tikiri Bandara was charged with three murders before the Anuradhapura Magistrate, in November 1957. The police mounted a search with dogs but failed to find the couple. Some months after this a poacher waiting for game in the fork of a tree at an abandoned tank observed a young man and woman coming out of the jungle in tattered clothes, she highly pregnant. They had a bath and vanished into the forest. Four years later, two skulls, some bones, two ear-studs and plastic bangles, a knife and the rusted barrel of a gun were found by hunters and produced before the magistrate.
Outgoing BASL chief asks lawyers to continue struggle to safeguard rule of law, democracy, judicial independence
SC summons IGP for disregarding court order
Opposition slams govt. for move to undermine judiciary
‘Dates have the highest sugar content to fight Coronavirus’
Sunday Island 27 December – Headlines
U.S. Congress to probe assets fleecing by US citizens of Sri Lankan origin
Features3 days ago
Happy Birthday dearest Mrs. Peries !
News2 days ago
Mano says LG and PC elections equally important
News4 days ago
Decorated gunship pilot blacklisted for appearing on political stage
Breaking News6 days ago
SRI LANKA RECEIVES IMF EXECUTIVE BOARD APPROVAL FOR THE EXTENDED FUND FACILITY (EFF) ARRANGEMENT
Midweek Review5 days ago
Growing foreign dependency and India’s USD 4 bn lifeline
News4 days ago
No more selling of Hajj visas, assures Minister
Breaking News5 days ago
Property tax to be replaced with Wealth Tax, Gift Tax and Estate Tax – President
Editorial5 days ago
Celebration of debt