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Lady Ridgeway Hospital: A haven for sick children in Sri Lanka

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125 YEAR BIRTH ANNIVERSARY:

By Dr. B. J. C. Perera

Specialist Consultant Paediatrician

I wrote an article in The Island newspaper, under the aforesaid title, 12 years ago, on Monday 09th June 2008. I have retained that title but content of this article is different. It’s worth looking at this hospital from a more current perspective particularly since the Lady Ridgeway Hospital for Children (LRH) is celebrating its 125-year jubilee in October 2020.

The LRH had very humble beginnings. At the outset, 125 years ago, it was constructed from public donations; rupees 46,000/- to be exact, as a small 50 bedded hospital. Lo and behold, today, this magnificent edifice, with over 1,000 beds, is the largest children’s hospital in the world, I repeat, in the whole world. It has stood the test of time as the final port of call and a veritable haven for sick children of our homeland. It is the National Referral Centre for this entire nation. The hospital functions sans any and every mundane consideration such as ethnicity, caste, creed and wealth of children who are brought there. This glorious medical facility is one that is solely devoted to sick children. If there is anything fanciful that is needed to be done in Sri Lanka for a sick child, it could be done in this hospital. It now caters to every type of malady that affects children. You name any specialty for the care of a sick child; it is available here. Everything is provided entirely free-of-charge and it is the crowning glory and the feather in the cap of the paediatric component of our Free National Health Service, the pride of Sri Lanka.

 

To date, I have been a doctor for exactly 50 years and a Specialist Consultant Paediatrician for 42 years. Out of that long period of half a century of service to the nation, I have spent 16 years in the hospitals of Kandy, Badulla, Ratnapura, Kurunegala and Kalubowila. Compared to that, and in contrast, I have worked in the Lady Ridgeway Hospital, in different capacities, for a total of 17 years. My service at LRH culminated with my retirement from the Ministry of Health in 2007. In lighter vein, I have been properly ‘themparadufied’ in our health sector, both public and private. I have most definitely, seen it all.

Those really were the days, around half a century ago, when during my medical student apprenticeship and internship, I saw how Mother Nature used to take the lives of our children with all kinds of infectious diseases. The wards at LRH were full with cases of meningitis, pneumonia, whooping cough, diphtheria, polio, diarrhoea, dysentery, cholera, measles, tetanus, tuberculosis, chicken pox, hepatitis, amoebiasis and even rabies. In fact, this is a list of just only a few of them. Add to it, the ravages of under-nutrition leading to marasmus and kwashiorkor, extensive vitamin and micronutrient deficiencies and major uncorrectible congenital heart abnormalities, and what did we have? A hospital bursting at its seams with sick children. It was practically a place that spelt out the real meaning of human susceptibility to disease and even mortality. During certain times it was indeed a bit of a hell on earth. The deaths were totalling up to some very significant numbers. By today’s standards, they had very few things they could do for intractable heart failure, liver failure and kidney failure. All types of paediatric malignancies and cancers were practically untreatable. The doctors and Specialist Consultants, as well as all other grades of staff of yore fought as hard as ever, tooth and nail, to save all those severely ill children who were brought to the LRH. However, most unfortunately and ever so very often, to no avail whatsoever. The dice was dreadfully loaded against those unfortunate children, as well as against the healthcare workers who had to look after them. In those halcyon days, each ward had a Consultant, a Senior House Officer and just two interns; a totally inadequate number of medical personnel to cater to the intense daily needs. Work was absolutely horrendous. It was not unusual to see many dead bodies of ill-fated children being wheeled out of the wards regularly, day in and day out. It was such a distressing and depressing landscape. There was hardly any light at the end of the tunnel. Yet for all that, the staff fought on bravely and relentlessly to save the precious lives of little children. To their eternal credit, they managed to save quite a few of the very seriously ill ones too.

Then, over many a decade, especially over the last few of them, the tide gradually turned. Successful vaccination almost totally removed some of the deaths and disabilities caused by a plethora of nasty infections. Many medical advances provided ways and means of dealing with former killer diseases. Improvements in heart surgery made it possible to treat at least a majority of congenital heart defects. When I finally reached the out-and-out hub of Paediatrics, which LRH was, in 1995, as a Specialist Consultant in charge of a unit, just about 25 years after my own internship at LRH, the scenery and settings had changed so much and well beyond belief that it was almost unrecognisable. In my ward I even had the absolute luxury of the services of a Senior Registrar, one who just needed two further years of training abroad before becoming a Consultant, four Postgraduate Registrars waiting to sit for the Final MD in Paediatrics Examination and four intern house physicians. The academic level of all those individuals who cared for my patients was absolutely top-class. They were right up-to-date in the sphere of scholarly paediatrics. They were all very fine and dedicated young doctors who would never ever allow a child to die without a steadfast and committed fight.

The advances in surgery were almost unbelievable. To top it all, around the time that I finally reached LRH as a Specialist Consultant, we had the services of several very fine Paediatric Surgeons whose handiwork in the Operating Theatres were almost too good to be true. Some of the recoveries from incredible surgical tragedies were really like those from the pages of volume of fiction. They were the work of gifted artists who wielded the scalpel with telling effect. One little anecdote that comes to mind is the surgical prowess of one particular general surgeon in lung operations. He was, and still is, quite a maestro at it. In those days that I was in charge of a unit, because of my personal interest in childhood respiratory disorders, we used to get quite a number of children with major lung problems which sometimes needed expert surgery. The usual practice was to send them off to the Colombo General Hospital Thoracic Unit for surgery. Lung surgery in children is a very tricky business. Things could go wrong at the drop of a hat. I somehow got to know that this particular young surgeon at LRH was so very good at it and I used to plead with him to get the surgery done at LRH itself. I used to say “Aney, please, please, PLEASE.., do it for me as a personal favour”. The very fine man that he was, and still is for that matter, he never ever refused. He has surgically taken off lobes of lungs and even the whole lung sometimes of my ill patients. True to life, those children recovered without any problems in about a week to 10 days. We never had even a single death after extensive lung surgery. They went home to a normal fruitful life and an entirely normal life-span. Just for the record, one could remove a major portion of the two lungs and still be able to lead a normal life with even a well-functioning half a lung. When I used to thank the surgeon profusely for doing it for me, he used to just smile and even feel a bit embarrassed.

It was all in a day’s work for him but for us, it was an absolute life-saver for our patients. In fact, that surgeon is still in active service at LRH. That is the quality of the Paediatric Surgeons that we have even today, with no exceptions whatsoever. Their commitment is truly wonderful. They will not let an unfortunate child suffer unnecessarily. They will fight on with every available means, daytime as well as well into the middle of the night, to save the lives of children to whom they had practically committed their professional lives. I have seen with my own eyes, these surgical colleagues leaving their families and their own little children at home to come to LRH in the middle of the night to perform life-saving surgical operations on our little patients.

Now, fast forward to 2020!!!! After my retirement in 2007, I now work only in the Private Sector and there are several instances where I have had to send patients to LRH for further investigation and treatment. One particular little tale comes to mind rather forcefully. A frantic mother of one of my regular patients telephoned me around mid-day, just about a couple of weeks ago because her little pre-schooler had taken an overdose of some medicines. My immediate advice over the phone was “please do not take the child anywhere other than to LRH. Do not go to any other place but rush him to LRH. Do not even bring him to me. I am just asking you to take the child to the very best place in the whole island”. They rushed him there and the staff attended to him pronto. He had what we call a stomach-wash performed on him, then they instilled some activated charcoal into the stomach, did some baseline blood tests and kept him in the ward. He did not turn even a hair and recovered within a couple of days. Incidentally, I think the mother threw my name around a bit and when the Consultant of the ward got to know, he had said “I trained under Dr BJC and we have done exactly what he would have done in the circumstances”. He was one of my Postgraduate Registrars and it was extremely nice of him to say those things. Of course, the mother and the relatives of the child were ever so pleased.

There were many other patients whom I had sent to LRH over several years and I have always asked them how it was at LRH when they came to me again. Every single time the mothers have said “It was a bit inconvenient for us but the child got star-class treatment and that really is what matters” or something basically to that effect. It has always warmed the cockles of my heart to hear such complimentary statements. My heart and soul have always been with LRH and anything unsavoury and disparaging said about that hospital would really hurt me to the core. We did care so much for the little children admitted under us and it is so good to see that those who have come after us do care as much, and are dedicated to the cause of providing the very best possible care for the patients as well.

Well, the Lady Ridgeway Hospital for Children, the mother of all hospitals in our resplendent isle, is 125 years old. If walls could talk, the walls of LRH would have all kinds of stories to tell. She would say how she had seen the worst of many diseases that affected children and also how things have changed over a century and a quarter of her existence. She would have a perpetual smile on her face in view of the progress achieved in caring for sick children, especially over the last few decades.

The lady needs to be feted and acclaimed on her 125th Birth Anniversary. The administrative staff, the doctors and all other grades of workers of LRH have planned a fitting celebration for her on the 01st of October 2020. In a glittering ceremony due to be graced by Prime Minister Mahinda Rajapaksa and Minister of Health of Sri Lanka Pavithra Wanniarachchi MP; they will acknowledge the priceless role played by LRH towards the healthcare of Sri Lankan Children. The ceremony will include the laying of the foundation stone for a new nine-storey building, opening of the new bone marrow transplant unit, opening of the new Operation Theatre Complex, official issuing of the hospital logo, formal release of the hospital song written by Dr. Rathnasri Wijesinghe with music compiled by Dr. Rohana Weerasinghe, and the commissioning of the new website for the hospital. These latest developments would help to make an excellent place for sick children, even a little bit of a better place for them.

All these would be a fitting and splendid accolade to an illustrious medical facility that is absolutely like no other. May she go from strength to strength and continue to be a dazzling beacon of excellence in healthcare for our children in this Pearl of the Indian Ocean.

Viva Lady Ridgeway Hospital, please do take a bow on your 125-year Birth Anniversary. It is the very least you so richly deserve, for the commitment that you have shown for the sick children of our beautiful Motherland. You are indeed a majestic haven of excellence for them.

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Teaching for job market and ‘liberating the whole person’ during Covid-19 pandemic

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by Liyanage Amarakeerthi

 

(This is based on a short presentation made at a promotion interview at the University of Peradeniya on November 19th, 2020. Author thanks Professors KNO Dharmadasa, Wimal Wijayarathne and OG Dayarathna Banda, Dean/Arts who encouraged him to publish this speech.)

At universities, we are busy teaching online. It is heartbreaking to find many students lack required facilities. Teaching on Zoom, for example, takes smart phones and personal computers for granted. We have to assume that Internet access is as ubiquitous as air, but reality is otherwise. Attendance at live Zoom classes can be as low as 40 percent in the Faculty of Arts, where students from underprivileged backgrounds account for the majority. Therefore, we need to record our lectures and make them available through other means. I myself have WhatsApp groups for all my classes to transmit important course content with a minimal cost. The university and the faculty take admirable care with extremely limited resources to make sure that no student is left behind. But the situation is far from satisfactory.

In addition to Corona, our political authorities routinely tell us that what we teach at the faculties of arts has become irrelevant and obsolete. They regularly ask us to produce employable graduates. Recently, President Gotabaya Rajapaksa was seen in a video clip telling a graduate that she should have studied ‘something technical.’ While it is wrong to produce an endless number of external graduates merely with degree certificates to wave at media cameras at the Lipton Circus, learning something ‘technical’ signifies a poor understanding of university education.

I want to reflect on the true meaning of education at the faculties of Arts. At our faculties we teach courses in the humanities and the social sciences. As a scholar in literature and language, I am at the most pressured end of the spectrum: Learning literature is the most removed from ‘something technical.’ Therefore, we, the humanities scholars at universities, routinely have to justify what we are doing in teaching and research. There reflections are made in that context.

 

Vision of the founding fathers

The founding fathers of the University of Ceylon, never imagined that future scholars in the Humanities would have to face the particular challenge mentioned above. In the inaugural address of the Ceylon University movement Ponnambalam Arunachalam, the President of the movement, had elaborate plans for a university of our own. Out of 13 professorships they had imagined to create in the University of Ceylon, eight were for the humanities. They wanted professorships for vernacular languages such as Sinhala and Tamil, and when the university was established, in 1942, the curriculum had considerable focus on local language and traditions. Indeed, there were professorships for natural sciences, and many science-based subjects were to enter within the first decade of the university.

In addition, those founding fathers had much larger and grander ideals for education; here are the words of Arunachalam:

“University will be a powerful instrument for forming character, for giving us men and women armed with reason and self-control, braced by knowledge, clothed with steadfastness and courage and inspired by public spirit and public virtue.” “A Plea for a Ceylon University” (A. T. Alwis. Peradeniya: The Founding of a University).

Those beautifully profound words demonstrate that Arunachalam’s vision for education was much more than teaching ‘something technical.’

 

Liberal Arts

In order to rediscover the true meaning of the Humanities education, one may look into what is meant by the liberal arts in contemporary international universities. ‘Liberal arts’ is a bit more inclusive than what we call ‘arts subjects’ since they include natural sciences, basic mathematics and the like. A rich liberal arts degree programme exposes students to a wide range of subjects––languages, literature, philosophy, religion, natural sciences, mathematics, Fine Arts, citizenship education, social sciences (at least key concepts of them) and so on. Since there is nothing strictly prohibited from the domain of liberal arts, one could add numerous other things to the curriculum.

The word ‘liberal’ in liberal arts a loaded one. It includes knowledge required to liberate human beings from socio-cultural bonds they are trapped in producing hierarchy, inequality and injustice. Rousseau famously claimed that chains binding human beings were human-made’ and the hammers to break them were also made in earth not in heaven. A high quality education in liberal arts should help us see those chains and to forge the hammers that can break them. In other words, liberal arts teach us the significance of working towards a just society. For that goal, there are many sources of wisdom. Unlike political parties and rigid ideologues, universities believe that there are multiple ways to reach that goal. That goal may be always at the horizon resisting our reaching it. Still, a society that has given up on that goal is perhaps so much poor even with endless affluence. Teaching liberal arts at universities is one important way societies hold on to a richer dream even in the midst of relative economic hardships. A country can be poor but yet not philistine.

‘Liberation’ in liberal arts includes internal liberation as well, and it could include several modes of refining oneself within. When modernity was an unquestioned project, liberation from the Nature was one goal of humanity. But now we know better. While we have to keep Nature at bay, we also have to realise that we are also part of it. The time of coronavius is opportune to reflect on this. Moreover, our nature itself is something that needs refinement and taming while it is very much a part of big Nature. So, in recent times a diverse set of course related to environmentalism has made its way into our liberal arts curriculum. As Professor Spencer McWilliams has aptly put, “a liberal arts education can help us develop a more comprehensive understanding of the universe and ourselves”. (Liberal Arts Education: What does it mean? What is it worth?)

Our political authorities may ask for graduates with a certain set of limited technical skills to be productive in the narrow roles assigned to them in contemporary economy. For us in universities, a human being is not just a worker. His or her life in the world of work is only one small segment of his or her life. For us as in the Humanities, questions such as what human beings do, what they reflect on, what and how they enjoy during their non-working hours matters as much as the ‘job skills’ they are supposed to hone. To make matters even more complicated, the liberal arts is interested even in the dreams that occur to human beings during their sleeping hours. To put it simply, for liberal arts human self is much more than a human worker.

A holistic development of the ‘whole person’ is the goal of liberal arts. It includes eight interrelated aspects: intellectual, emotional, physical, spiritual, vocational, ethical, personal, and social. Intellectual development requires acquiring broad-based knowledge, learning how to learn, and learning how to think critically. Emotional development includes understanding, managing and expressing emotions. Developing high quality relationships with other people is the basis of social development while ethical development aims at providing students with a clear value system that enables them to make sound decisions. Physical development concerns the understanding of one’s own body and taking care of it. Spiritual development may be the most culture-sensitive as each culture may have its own take on what is ‘spiritual. ‘Vocational’ is indeed a form of development that must be a part of contemporary education. But is only one among eight. It includes exploring career possibilities and developing skills required for a career. As university teachers we do want our graduates to find jobs and achieve some sort of financial independence to pursue other goals of life articulated here. Personal development, the last of the eight, stays the last because it is the bottom line, so to speak. For personal development one needs to cultivate a strong sense of self-identity and agility to step out of that identity in being considerate towards others.

The Role of Peradeniya:

Whole Person, Whole Campus

A fully developed university must have all the facilities needed to address at least those eight areas. Holistic education believes that curriculum and co-curriculum must make use of whole campus for that purpose. Founding fathers of University of Peradeniya seem to have endowed with a concept of holistic education in the early twentieth century. Just to give only a few examples, for those who argue for making use of the whole campus for holistic education claims that for one’s intellectual development, a university has to utilise learning centers, library, academic advising services, tutoring services, information technology centers, invited talks on various topics, workshops, theatre halls, art shows and so on. This list, though not comprehensive, demonstrates that the intellectual development of a graduate is much more than following time tables and attending formal lectures. At Peradeniya, we may not have all these facilities, but when the university was founded a considerable attention was paid to these aspects. Taking a long walk through the beautiful University Park can be education in itself if one is rightly attuned to the lessons of natural beauty. I have learned those lessons at stunning campus parks at Wisconsin and Cornell.

Now, let me touch on ‘spiritual development.’ In addition to formal instructions on subjects such a philosophy and arts that concern one’s spiritual life, there should be co-curricular involvements with campus religious communities. Programmes such as inter-religious dialogue could be part of these activities. Perhaps, it was for such holistic education that places for all religions have been established within the University of Peradeniya.

Instead of cutting down funding on ‘liberal arts’ education, the government must invest more in the kind of education explained above. Even without enough financial resources some of us have been working hard to promote such a holistic education. Yes, just some of us. There are people who have no idea as to what they should be doing at universities. Among them, there are academics who believe that training students to site exams that lead to a certificate is university education. Yes, that is education often found at private tuition classes. But there is much more to university education. If our holistic education is only partially done, it is natural that authorities ask out graduates to learn ‘something technical.’

The prevailing pandemic has crippled nearly all co-curricular activities at campus. An education that does not include library, playground, gymnasium, the Sarachchandra Open Air theater, the E.O.E. Perera theatre, heated discussions with guest speakers, and, even some trips to the lovers’ lane or other ‘lanes’ cannot help achieve eight developmental goals of holistic education. COVID-19 has corroded that education. But holistic education is faced with a bigger threat. It is the demand that education be geared for the job market. True academics must do everything possible to prevent that philistine virus making inroads into our higher education institutions. Only those who are capable of realising the true meaning of holistic education envisioned in the Humanities and liberal arts can stand up to such philistine invasions. Those are the ones who really deserve to be hired and promoted.

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Chinese Development Experience:

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Why Have Sri Lankans Failed So Far

by Luxman Siriwardena

 

During the past decades, several East Asian Economies have experienced consistent high rates of economic growth while achieving unprecedented improvements in the standard of living of their citizenry, an achievement that has been described in the famous World Bank study as ‘Asian Miracle’.  Hong Kong, Taiwan, Singapore and the Republic of Korea (ROK) were the partners of this achievement. One analyst explained this miracle as developments that have ‘telescoped into a single generation, a process of socioeconomic development that took the advanced economies of Western Europe centuries to achieve’. This group have now been dramatically overtaken by Communist China which has also eliminated poverty, probably excluding a few clusters in remote parts of rural China. 

Unfortunately, however, all South Asian countries, including India, Pakistan, Bangladesh and Sri Lanka still remain far behind China as developing economies. It has been estimated that a high percentage of the population of many of these countries are living in abject poverty and deprivation. 

China’s economic development as now well demonstrated, has been associated with technological advancement surpassing many of the advanced market economies. It is only a matter of time before China   becomes the largest economy in the world. Even in the current COVID-19 pandemic situation it has emerged as the only country to record a positive growth rate in 2020, according to multilateral lending agencies.

In this context it is of significance to understand how President Xi Jinping has articulated the Chinese development within the framework of Marxist Political Economy. In this regard, a speech delivered by Jinping, in the mid-August needs to be closely studied by the academics and policy makers in developing countries like Sri Lanka. President Jinping proposes in the speech that the Marxist political economy must be studied and developed as a higher stage of theoretical and practical advancement of Political Economy. Most relevant to the current development discourse is his combining of Marxist political economic principles with new practices of reform and opening up of the Chinese economy. 

President Jinping has also categorically mentioned that the belief of some people that Marxist political economy and the analysis in Das Capital is outdated or outmoded is arbitrary and inaccurate. Jinping states that nowadays there are various kinds of economic theories but the foundation of Chinese development cannot be explained by any theory other than the Marxist theory of political economy. 

With reference to the development of theory and practice in China, Jinping upholds the contribution by successive Chinese leaders. Going through his argument it is clear that President Jinping is contributing to the new stage of development in Marxism termed as Socialism with Chinese Characteristics. 

In his analysis President  Jinping refers to almost all challenges the modern-day advanced market economies are confronting and strongly advocates study of them in the context of Marxist political economy which include  theories of developing a socialist market economy, enabling  market to play a decisive role in allocation of resources while providing for a prominent role for the government and state-owned enterprises in promoting, facilitating and coordinating  new industrialization, agricultural modernization and other  essential players of growth and development. It is also interesting to learn the way China addresses the property ownership/rights and right of the farmers to contract out lands. 

What President Jinping has emphasized with regard to the study of political economy has a direct relevance to Sri Lankan academics and policy makers irrespective of what they have learned in universities of the West or from multilateral or other agencies. In his presentation President Jinping has emphasized the importance of six key principles in economic development in China. 

i. Adherence to people-centric development thinking 

ii. Focusing on new development concepts with a futuristic view 

iii. Upholding basic economic systems preserving Chinese Socialists Characteristics 

iv. Improvement of basic distribution systems 

v. Focusing on the direction of socialist market economy 

vi. Adherence to the basic national policy of opening up when effecting    necessary reforms. 

His concluding remarks would be an eye-opener to Sri Lankan and other developing country policy makers, particularly economists. 

Their commitment to upholding the basic principles and methodology of Marxist political economy does not imply rejection of the rational components of other economic theories. Western economic knowledge on areas such as finance, prices, currency, markets, competition, trade, exchange rates, enterprises, growth, and management do reflect one side of the general laws underpinning socialized production and market economics, and should therefore be used as reference. At the same time, however, Jinping suggests that it is necessary to keep a discerning eye on the economic theories of other countries, particularly those of the West, making sure that the wheat is being separated from the chaff. It should be ensured however, that these theories reflecting the nature and values of the capitalist system or are colored by Western ideology are not blindly adopted. Although the discipline of economics is devoted to the study of economic issues, it does not exist in a vacuum, and therefore cannot be separated from larger social and political issues.  

Why have our economists, both in academia and in policy making positions, not understood this simple truth?  Why have they failed to develop theories and explanations that address local needs like their counterparts in the region? For example, India, Pakistan or even Bangladesh have world class economists who have come up with homegrown theories and homegrown solutions to local problems. Could it be that our economists, unlike their regional counterparts who have succeeded, have not been able to free themselves from the clutches of the west intellectually and ideologically? How much their education in the west, reinforced through regular training given by West-dominated multilateral agencies and also frequent exposure to thinking of the West in their work, is responsible for this unfortunate situation? Whatever the reasons are, instead of thinking independently on their own they parrot their mentors in the West for short-term gains like easy recognition and self-fulfillment continuing the vicious circle and perpetuating the misery of their people. Irony is that when a solution is needed the only thing our experts are capable of doing is seeking refuge in programmes of multilateral development agencies reminding us the famous saying attributed to Einstein that “insanity is doing the same thing over and over again and expecting different results”

Sri Lankan policy analysts, this applies to academics and researchers too, must desist from advocating indiscriminate reliance on foreign concepts. Their analyses should be based on objective conditions that exist in Sri Lanka and associated socio-political environments namely, political economy. thoroughly and at length to prevent them being marginalized in the emerging discourse.

It is time for our academics and policy makers to change the path on which they have been travelling, the path not only built by the West but also the road rules for the travellers have been written by them.  What our academics and policy makers, especially, economists, have been hitherto repeatedly preaching and implementing are literally  carbon copies of classical, neoclassical or Keynesian theories they have learnt without adaptation to meet Sri Lanka’s development needs.

It is stated by the historians that Lenin further developed Marxism where it was further fashioned by Stalin and Trotsky. In the modern era remarkable adaptations to it were brought in by Chairman Mao. Since then there have been many Chinese leaders who have made various pragmatic contributions for the Chinese economy. President Jinping has presently brought Chinese economy to a new stage of development through more pragmatic and innovative ways without deviating from fundamental Chinese characteristics.

In view of the above it can be concluded that there are many lessons that developing countries like Sri Lanka can learn from the Chinese development experience. If our academics and policy makers can come out of the ivory tower of conventional framework and improve on theories and models that they have learned in the past by adapting them where necessary to local conditions that may go a long way in help promoting effective policy for sustainable growth and development. Until and unless that happens our attempts to achieve sustainable economic growth and development in the country will remain only a pipe dream, which it is today. 

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Covid-19 prevention:

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Revamp CMC’s crippled Public Health Services

By Dr. Pradeep Kariyawsam
Former Chief Medical Officer of Health / CMC

When the second wave of the Covid-19 epidemic started, it was inevitable that the wave would reach Colombo, as many other epidemics such as dengue fever, chikungunya, cholera, influenza started in Colombo and then spread to other areas. Here of course those who travelled from abroad obviously brought the disease to the country, and then it spread towards the city in no time. There are many who travel from Gampaha District to Colombo city area and they were the potential carriers of the virus.

Prevention activities should have been started from all fronts, especially in Colombo North and Central areas, as soon as we heard about the Minuwangoda outbreak; and without hesitating when it reached Peliyagoda which lies in the northern bank of Kelani river. Colombo North lies just a few hundred feet away in the Southern bank. True the CMC started carrying out PCR tests, but most of them were off target as hardly a patient was found initially. There is no point in crying over spilt milk now. The importance of Public Health Services should be recognized at least now, and that a proper service could save the city and country from economic collapse and social unrest. The latter mostly instigated by politicians. The deaths at home is a sign that all is not well with the prevention services. Unfortunately, some politicians and government servants do not understand this reality.

Around 40 years ago, the Minister of Local Government realized the importance and the necessity to organize the people in these areas, who actually lived in slums and shanties and the need to prevent communicable diseases and provided them with basic amenities. Hence under his direction the CMC went on to carry out surveys of the needs of the people through new recruits called Health Wardens. The Health Wardens formed Community Development Councils after having elections in the so-called Gardens (Wattas) where the people in them chose their leaders as the office-bearers to run the Councils. Women’s and children’s groups were also formed by the Health Wardens, and these GCE (AL) qualified youth were the acceptable officials to give instructions on any matter on health and welfare. I can remember they even arranged marriage registrations.

They teamed up with the Public Health Inspectors, Nurses, Midwives and Medical Laboratory Technologists (MLT), Health Education Officers, and formed a network that supported the preventive services to the hilt. In short, we were proud of our work and it was appreciated by UNICEF, WHO, UNCHS, etc. For example, when we had to get Colombo as polio free, all of them teamed up and with the help of Rotarians gave vaccines to all children under five years of age in the city in one day! In order to provide a proper service, the city needs at least 65 Public Health Inspectors, 35 Nurses, 175 Midwives, 35 MLTs and over 200 Health Wardens or Health Instructors as they are called now. (The Salaries and Cadres Commission please note!) These services are in a sorry state of affairs now, as the number of officers in service have dwindled so much that we no longer have a single maternity home that is operating at night, as only nine nurses are available, the PHIs have neglected food hygiene work, and Midwives are over stretched so much they are running a crippled service, the laboratories lack material and the poor people have to go to the private sector to get expensive tests done, when they could have got them done free at the CMC labs. But the most important aspects of all this, which are organizing the communities, health education, creation of awareness about communicable diseases, communicating with all and being the link between the people and the health units that were handled by the Health Instructors do not exist anymore.

There aren’t even Health Education Officers anymore, who used to supervise them. The information thus collected then can be analysed by the Epidemiologist to understand the vulnerable areas and direct prevention activities. Unfortunately, there is no Epidemiologist as the post of Deputy Chief Medical Officer (Epidemiology) is not filled during the last three years. That is what is lacking mainly in CMC’s Covid-19 prevention programmes today. It is not the ambulances that the people need as CMC already has two ambulance services; The ambulances run by the MCH Division and the 110-service are run by well-trained fire-fighters. The people need someone to be with them in their hour of need as it happened years ago, looking after their health and welfare needs, as Health Instructors were allocated to areas in which they were responsible for the people in slums, shanties and apartments.

Therefore, it is my humble appeal that the CMC, the Western Provincial Council, and the Ministry of Health get together and fill these posts, create higher cadres for these posts and appoint suitable persons immediately. We have to allocate vulnerable areas to these officers and get them to go to the people, organize them, look after their health and welfare needs and prevent a disaster happening as there will be more Covid-19 waves and new epidemics in the near future. This will definitely reduce deaths at homes. A stable Colombo, health-wise, will make the country stable in the same way. With all my experience I know that this is the only way to prevent this kind of disaster happening again, and this will be a feasible way of managing this crisis for the government to prevent and control this disease.

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