Features
Medical Humanities:an interdisciplinary approach to holistic health
The Department of Medical Humanities at the University of Colombo’s Medical Faculty is another groundbreaking initiative by the institution as the pioneer of the discipline here at home and in South Asia. In an interview with the Sunday Island, Clinical Psychologist and Head of the Department of Medical Humanities, Dr. Santushi Amarasuriya elucidates on how this discipline, which is gaining momentum the world over, explores human experiences of health and illness drawing from a spectrum of other social and aesthetic branches.
Following are the excerpts:
BY RANDIMA ATTYGALLE
Q: Could you please share the ‘story’ behind the establishment of the Department of Medical Humanities at the Colombo Medical Faculty?
A:The Department of Medical Humanities was established in 2016 in response to global trends which recognize the role of medical humanities in medical education. It helps medical practitioners to reorient themselves into a holistic and person-centered approach to health care. There was also a general recognition of the impact of burnout and resultant empathy-deficits among medical practitioners, with medical humanities seen as a mechanism through which doctors can understand, reflect upon and deal with such issues. It is in recognition of all this that our Department was established.
Medical humanities lies at the intersection of medicine and humanities. It draws from various disciplines; from literature and philosophy to ethics and arts. The scope of medical humanities is very broad and therefore we find varying definitions of it. How we define it here at the Colombo Medical Faculty, is as ‘humanities in the pursuit of improving the well being and achieving goals in medical education.’ Our goal is to use medical humanities to foster compassionate care, professionalism and ethical practice among medical and other health care professionals, whilst also being sensitive to the socio-cultural context in Sri Lanka.
If we look at the specific history of how the department came into being, one of the highlights was when a brand-new stream called the Behavioural Sciences Stream, first conceptualized by Prof. Nalaka Mendis, was established within the curriculum of our Faculty in 1995. This was a pioneering effort that recognized the transition of the medical model of illness, which focused primarily on biological factors, into what is known as the bio-psychosocial model of health and illness in the late 70s. This latter model takes a more holistic approach and recognizes that there are psychological and social elements that also determine the outcomes of an illness.
Then, during a revision of the Behavioural Sciences Stream curriculum in 2013, Prof. Panduka Karunanayake proposed the establishment of a Medical Humanities Unit. The ensuing discussions led to Prof. Godwin Constantine proposing the establishment of a department. Subsequently, Prof. Saroj Jayasinghe, who was the Chairperson of the Behavioural Sciences Stream at the time became the driving force in establishing the Department in 2016, becoming its founder Head.
I was the first permanent academic staff member to have been recruited to the Behavioural Sciences Stream in 2006 and after the establishment of the Department of Medical Humanities in 2016, I came on board as its first Senior Lecturer.
Q: Could you elaborate on the nature of the learning enabled for the medical student by the Department and how medical humanities help students to brave a demanding curriculum with empathy and kindness?
A: Our main teaching input is through the Humanities, Society and Professional Stream, previously known as the Behavioural Sciences Stream. We provide input into areas of personality development and psychology, communication skills, ethical practice, professionalism, and humaneness, utilizing different teaching methodologies.
If I were to address the topic of empathy that you highlighted, many of our activities try to cultivate this skill in students. However, I would say it is not easy to develop. Many studies have shown that when medical students reach the third year, which is when they start their clinical rotations and need empathy the most, there is actually a decline of it. This is referred to as the ‘devil in the third year’. Many reasons are attributed to this. For example, what was hypothetical is now actually real and students are suddenly overwhelmed with a higher level of responsibility because now they are taking care of real people. There is also a marked increase in workload and it could also be the lack of role models. All this might lead to a decline in empathy. But we must remember that empathy is a hard job, stepping into another person’s shoes and understanding their problems, such as what is making them distressed. To make it even more challenging, it would be multiple patients whose shoes they have to step into and that can be really exhausting.
As a human being, your natural defense mechanism would be to detach yourself and not be empathetic. Therefore, what we try to do is to recalibrate, talk about and reinforce the importance of it.
Q: Could you please explain how the wide range of disciplines coming under medical humanities is translated into actual practice by physicians?
A: One of the methodologies that we have adopted is to use narratives in medicine. Very early in the students’ career, we ask them to go and draw from patients their personal story, and NOT their clinical history. This helps to cultivate a holistic approach to medicine. As a clinician, when you take a clinical history, you are very cognizant that there is a lot more going on for the patient than merely their disease.
A simple exercise that some international institutions utilize is to take students on a gallery visit where they are asked to study portraits to sharpen their finer observational skills; they start learning to notice certain physical signs or certain subtle cues that may have escaped attention. Therefore, at the point of their interaction with patients, they become more attuned to reading many nonverbal cues. For example, take a well-known painting like the Mona Lisa. Closer observation reveals her pale complexion, swollen hands and puffiness around her eyes, which can be used to hypothesize possible ailments she may have suffered from.
Similarly, certain films can be used to create a stimulating dialogue about patient-experiences. They are able to trigger strong emotional reactions and then also provide a safe space to discuss difficult topics which may be inaccessible if only relying on personal experiences. Another tool that I personally find fascinating, that is adopted by some of our colleagues in the region, is the use of the ‘spectator’ concept within forum theatre, where the spectators have the opportunity to intervene and become the actors to change the outcomes of stories depicting difficult situations.
This highlights and empowers the students in their future roles as reflective change agents. Medical students can also be helped to actually step into the patient’s shoes and share the experience of the patient. For example, what is it like to be wheelchair-bound or lack the use of a limb so that they could relate to a patient’s situation better. There is a wide array of methodologies, and this is important given the diversity of student preferences.
Q Is it justifiable to say that this interdisciplinary approach has gained momentum today as the innate ‘humane humaneness’ coupled with professionalism which was found in the good old doctor of yesteryear is largely eroding today, replaced by a stereotypical fact-finder?
A: The importance of humaneness in medical care is well recognized now. The concept of person-centred or patient-centered care is known to a medical student and medical curricula all over the world are adopting these concepts now. If you ask a medical student what empathy is, they will regurgitate the definition and they also know it is important. I would argue that maybe in the good old days these definitions might have been rather alien, but the values these definitions entail may have been innate in most physicians.
That is not to say that there aren’t many students with such skills today. But previously, medical professionals might have had time to actually cultivate these abilities and skills; they might have been able to immerse themselves in the arts. Whereas now, the landscape is very different due to the sheer volume of information to digest, too many competing demands and so forth. Therefore, it becomes a matter of prioritization and many are driven to only focus on the more tangible and measurable elements.
A second reason is the structure of our education. If you take the A-Levels, it’s a rat race to get into the medical faculty and how you get there is by knowing all the information to answer the questions. Along the way you may not have had time for extensive reflection or contemplation. The student who comes to us is trained in that way. So, when they take a clinical history, they may be more driven to simply gather data and make a diagnosis. They forget the holistic nature of the interaction along the way.
Q: Do you think the relevance of medical humanities is unprecedented today given the shift in socio-economic dynamics in society?
A: As a country we have faced several calamities and the most recent one is the economic crisis. Along with it there are several other problems that our people have to face: a significant number is impoverished and there has been a lack of medical supplies and an exodus in the medical profession itself. So, if you think about the professionals working today, they are overloaded with work, and this can lead to a sense of helplessness and frustration.
If you place it within Maslow’s hierarchy of needs, they may be struggling to meet basic needs. So higher-level needs like compassion and empathy start to look more like “nice-to-haves” than necessities, given that they are trying to deliver in a context that is resource-poor. It really is a balancing act. Therefore, it is often all too easy to satisfy ourselves with aggregate numbers. For instance, we say there are low rates of infant mortality and few maternal deaths. But what we might overlook in those aggregates is the experience that the patient has had in this whole process. What we do in our curriculum is re calibrate and remind them of what is finally needed.
Q: Today many patients lament that doctors are ‘poor communicators’, that their body language often doesn’t foster a sense of comfort and security in a patient. How does medical humanities envisage to address this so that doctors can be better communicators?
A: As a Faculty, we all endorse the importance of communication skills, and the input is given at different stages not only through our Humanities, Society and Professionalism Stream (HSPS) but through the other teaching arms as well. Interestingly, many students know the science behind communication practices, such as starting with an open-ended question, but they may not know HOW to do it. There’s a lot of art in asking a question. Although they may not have the innate gift of being effective communicators, with the right training, they can be developed into very successful ones.
In some of our activities we use different works of art, such as movies, paintings, poems, stories and so forth. In the recent past, we have used the painting titled ‘The Doctor’ by Luke Fildes. In the painting, a doctor is hovering over an ill child and we ask the students to interpret what’s going on. A lot is being communicated in this visual such as the stance of the doctor, the nonverbal behaviour, and in the background are the child’s parents who have entrusted the child to the doctor’s care. So just asking the students to analyze it and talk about it helps them to reflect. We use many other such methodologies to foster good communication in future doctors.
Another tool we often use is role-play. We recently launched a Communication Skills Master Class under the guidance of Prof. Dinithi Fernando, the current Chairperson of the HSPS, to give more muscle to the enhancement of communication skills.
Q: What are Sri Lanka’s strengths as a multi-cultural and a hospitable nation that medical humanities could draw from?
A: We are a collective community and helping another human being in distress, is very much a part of our culture. It comes very naturally and that translates into the process of healing a patient in distress. Kindness and compassion are key messages that are collectively shared by all our religions practiced here at home. If you consider kindness, I think of it at two levels: people whose core is kind and those who superficially reflect kind behaviour such as talking in a nice way and similar social graces. But this second category may not be kind deep down. Now if you think about our cultural orientation, it is that first one which is emphasized- kindness at the core. What we are trying to harness is a natural or deeply culturally-endorsed tendency.
Another example is the cultural sensitivity that we may already possess. We have students coming from different contexts and different experiences. They already recognize the existence of ‘health pluralism’ and that the patient’s conceptualizations of illness and treatment encompass a wide range of practices and beliefs that are not directly relevant to western medical practice. Therefore, it is just a matter of reminding them of these to help them to be more empathetic about patient experiences.
Q: What are the collaborations the Department has forged with professionals outside the medical stream to cultivate a sense of appreciation in aesthetics in future doctors?
A: One good example is our Humanitas programme. This is the brainchild of Prof. Panduka Karunanayake. The Latin term humanitas translates into human nature, civilization and kindness and relates to what it is that makes us human. In this programme we address various human issues – be it a current crisis or a problem like a heart break.
Prof. Karunanayake’s objective in launching this programme was to trigger an emotional reaction and let the other cognitive processes occur on their own. The Humanitas programme is solely directed by Dr. Santhushya Fernando who is a Senior Lecturer in our Department, where she gets in different artists from musicians to poets to talk about such issues and reflect and share their vulnerabilities, giving flavour to the programme. The programme has received very good reviews and all credit for this must go to Dr. Fernando who has spearheaded this programme with passion and enthusiasm.
Similarly, we have been fortunate to receive generous support from the academics of the University of Visual and Performing Arts who have not only made wonderful contributions to the Humanitas programme but to many other activities of the Department.
Q: What inspiration does the Colombo Faculty offer other medical faculties in the country in terms of recognizing medical humanities and what are the future plans of your Department to give a further thrust to medical humanities?
A: Even in terms of the Behavioural Sciences Stream, we were pioneers and all other faculties have now adopted it under different names. It is heartening to note that many of the medical faculties here have taken a cue from our experience. Although they may not have a dedicated department to the discipline, many have incorporated these ideas into their curriculum.
In terms of expansion, we have many plans which are aligned with the goals of our Department such as using the humanities to facilitate health education and training, initiating research by drawing from best practices which could be replicated here at home and also to enrich our curriculum. We plan to explore on how to enable more patient-friendly environments so that our future doctors can actually translate the concepts espoused by the humanities, into actual practice and also explore the role of the discipline in developing therapies or interventions to promote health.
The department has now been allocated a larger space within the Faculty to grow and expand but lacks facilities to make it an occupiable space. We are seeking donations from philanthropists and wellwishers to make this project a reality.
Features
The NPP’s Constitutional Reforms: Purposes and Processes
Participating at the All Party Conference that then President Jayewardene convened in January 1984 in the aftermath of the watershed violence of 1983, Dr. Colvin R de Silva characteristically perorated that the structure of the Sri Lankan state is incongruent with the country’s sociopolitical reality. He said it more as Historian than as a Lawyer or the architect of the 1972 Constitution.
This gap between state structure and political reality was somewhat bridged by the 13th Amendment that came three years later, with all due credit to President Jayewardene no matter how begrudgingly he may have done it and even if it was under Indian duress as JRJ’s critics have been alleging ever since.
In this backdrop, it is fair to say that the NPP’s constitutional proposals, even if they may not have been drafted with this specific intent, could contribute to further bridging the structural-reality gap and potentially transform Sri Lanka into an ethno-equal state and an ethno-equal nation. The rub, however, is in the ability of the government, as well as its intention, to fulfill in practice what is otherwise a very laudable purpose. The experience so far with the Provincial Council elections and the absence of any manifest effort by the NPP government towards implementing any of its main constitutional proposals do not allow room for too much optimism.
As I cite below, the NPP’s Manifesto fulsomely promises to hold all provincial and local government elections within one year after coming into office. Now with all the ministerial and prime-ministerial explanations in parliament as to what and what pre-steps this overworked government is apparently constrained to take, the PC system would consider itself lucky if the next provincial elections end up being held at the same time as the next parliamentary elections. That is the reality. It could be much better and that too by a government that promised to be much better.
The NPP’s Constitutional Purpose
Section 4 of the NPP Manifesto, A Thriving Nation, A Beautiful Life, is entitled A Dignified Life – A Strong Country, and includes nine subsections, viz. 1) A new constitution – A united Sri Lankan nation; 2) An efficient public service – A skill based professionalism; 3) Rule of law – A judicial system with equal access; 4) Public security assuring – People friendly service; 5) A humanitarian prison – A lawful confinement; 6) A drug-free country – A healthier citizen life; 7) A dignified diplomacy – A sovereign state; 8) High level of national security – Secured state; and 9) A Sri Lankan Nation – The Universal Citizen. These subheadings and sections are indicative of the NPP’s vision for the Sri Lankan State, a Sri Lankan Nation, and the equality of all its citizens.
The Section specific to the constitution (Section 4.1) includes the NPP’s promise to usher in “a new constitution” for “a united Sri Lankan nation.” The process for introducing the new constitution is described thus: “A new constitution will be drafted and passed through a referendum with the necessary changes, if there any, after going through a public discourse.” In addition, Section 4.9 – A Sri Lankan Nation – The Universal Citizen, elaborates on the premise and the purpose of a new NPP Constitution which are outlined as follows:
“Introduce a new constitution that strengthens democracy and ensures equality of all citizens. This initiative will build on the constitutional reform process started in 2015 which remains incomplete. The proposed constitutional reforms will guarantee equality and democracy and the devolution of political and administrative power to every local government, district and province so that all people can be involved in governance within one country. Provincial councils and local government elections, which are currently postponed indefinitely, will be held within a year to provide an opportunity for the people to join the governance.”
Fifteen “activities” are included as making up the constitution making process: 1) Recognizing and enacting the rights mentioned in the International Covenant on Civil and Political Rights as basic rights; 2) Broadening the constitutional law about the rights of children, women, and people with disabilities according to international conventions; 3) Safeguarding the voting rights of immigrants within and outside of the country; 4) Abolishing the executive presidency and appointing a president, without executive powers, by the parliament; 5) Introducing a new parliamentary electoral system; 6) Limiting official presidential residences to one; 7) Abolishing the pensions and special privileges given to retired presidents and their families; 8) Appointing 25 ministers and corresponding deputy ministers to 25 logically determined ministries and abolishing State Ministerial posts; 9) An advisory council consisting of specialists on the subject will be appointed to each ministry; 10) Introducing a code of ethics, including not allowing members of parliament (MPs) and ministers to appoint their immediate family members to their personal staff; 11) Abolishing allowances made to MPs for participating in parliamentary sessions; 12) Abolishing the pension offered to MPs after 05 years; 13) Preventing MPs or their close family members from directly or indirectly engaging in businesses or contracts with the government; 14) Removing the tax-free vehicle permits for MPs; and 15) Giving only one vehicle for Ministers /Deputy Ministers to be used during their period of office.
Interestingly, while the aborted 2015 constitutional reform process that the NPP was a part of is acknowledged, there are no references in the proposals – to the 1972 Constitution or the 1978 Constitution, and missing in the proposals are some of the signature terms that were/are both the badges and burdens of the two constitutions viz., the republic; unitary state; socialist (1972) and democratic socialist (1978); and special status for Buddhism. On the other hand, the proposals (Activity #1 & #2) include the commitment to enshrine and enforce rights and freedoms of Sri Lankans in accordance with international covenants and conventions. This inclusion is refreshingly open in contrast to the 1972 and 1978 constitutions which were rather averse to embracing anything ‘foreign’ due to the misplaced fear of diluting the island’s sovereignty, which is more theoretical than concrete.
Sovereignty and territorial integrity are duly emphasized in Section 4.7 of the proposals: A Dignified Diplomacy – A sovereign State, and in Subsection 4.8: Sovereignty and Territorial Integrity. Section 4.9: A Sri Lankan Nation – The Universal Citizen, underscores national reconciliation, equality of citizens in religion and language, and the vigorous operationalization of the Provincial Council system even though the 13th Amendment is not mentioned in the proposals. There is, however, specific reference to the 16th Amendment and the promise to implement the National Language Policy that is enshrined in 16A. Sri Lanka’s ethnic diversity is acknowledged and various measures are identified for achieving national reconciliation and a free and equal society.
Among these measures are: establishing an Inter-Religious Council consisting of all religious leaders and religious scholars to resolve inter-religious issues; releasing all political prisoners and ensuring their free socialization; abolition of all oppressive acts including the Prevention of Terrorism Act (PTA); regularization of civil administration in a way that the civil rights of the people in all parts of the country including the North and East are guaranteed; providing educational and employment opportunities to all ethnicities based on merit without political influence; providing relief to war widows, internally displaced persons, people with disabilities and people with trauma in need of relief and shelter; settlement of existing land related issues by a National Commission on Lands and Settlements; and ending resettlement programmes that operate with the aim of changing population composition; and addressing the wages, land, housing, education, and health issues of the Malaiayaka Tamils based on the NPP’s Hatton Declaration of 2023.
This is an impressive list by any comparison and it will be all the more impressive if the NPP government were to seriously and capably set about achieving most or all of them.
The Constitutional Process
While the Manifesto indicates that “a new constitution will be drafted and passed through a referendum with the necessary changes, if there are any, after going through a public discourse,” it is not clear if the NPP intends to comprehensively amend the current (1978) constitution, or repeal and replace it based on a referendum. Similar to its 1972 predecessor, the 1978 Constitution provides for repealing and replacing itself but requires the people’s endorsement in a referendum. Although the referendum requirement is limited to specific provisions of the constitution, an interpretive judicial culture has since evolved widening the referendum net to capture other provisions that are not stipulated in Article 83 of the constitution.
Opposing and, in my view, more persuasive voices have been heard from experts like Dr. Nihal Jayawickrema, and long before that from Dr. Colvin R.de Silva during the controversy over 13A referendum requirements, that a referendum requirement should be limited to changing only the provisions that are specifically to the provisions mentioned in Article 83. By this interpretation, a referendum is required to extend the term of a president or of parliament, but not for abolishing the system of elected executive presidency itself.
At the same time, a synthesizing view has also evolved that if the constitution were to be changed in a substantial manner, let alone repeal and replace it even without changing any of the Article 83 provisions, it would be prudent to have a referendum and be done with it. The latter is also the NPP’s position but seemingly taken from a more positive and democratic standpoint than a narrow interpretive standpoint. But there are questions as to how and when the NPP government will have a constitution package ready and when will it likely call for a referendum. It is not necessary to detail the amending processes in an election manifesto, but with nearly two years in office it is time for the government to indicate what is going to be its new constitution and how is it going to be achieved.
Another technicality is that when it drafted the manifesto promising constitutional changes subject to a referendum, the NPP may not have been expecting a two-thirds majority in parliament. So, what was its thinking about meeting the initial amendment requirement of a two-thirds majority in parliament without having sufficient numbers in the government. It would have had to find common ground with opposition parties in parliament. That is the very purpose of the two-thirds majority in parliament – to achieve interparty consensus as opposed to using a steamroller single-party majority.
The question to the government is why is it not being consultative with at least some, if not all, of the parties in opposition. As well, inasmuch as the Manifesto refers to a continuation of the 2015 constitutional reform process, why is the government not consulting with those individuals and organizations who were significantly involved in that earlier process. Some of them were directly associated with the NPP. But none of them is in the scene now, while the current Minister of Justice was politically unheard and unseen at that time.
The double burden of Justice and Constitutional Affairs is too much for even the most experienced and equipped political leader. It is too much to saddle a first time MP and Minister with such heavy responsibilities. As well, there is much talk about the government inviting non-NPP experts to play lead roles in institutions and agencies involved in running the economy. Why not extend this approach to implementing the NPP’s constitutional reform process?
To hark back briefly to the making of the 1972 Constitution, neither Colvin R de Silva nor the United Front were banking on winning a two-thirds majority in the 1970 elections. Instead, they were relying on Colvin’s legal theory that the new constitution will be a total rupture from the Soulbury Constitution and that its making will follow its own path based on an electoral mandate from the people.
“Not merely despite the Queen, but in defiance of the Queen and her Crown,” was Dr. Colvin’s platform pitch. The two-thirds majority that the United Front turned out to be a curse in disguise. While the NPP is now saddled with a two-thirds majority it doesn’t have Colvin’s legal theory to ignore the amending procedures of the 1978 Constitution. JR Jayewardene faithfully followed the amending procedure of the 1972 Constitution, but created a more rigid constitution than its far more flexible predecessor.
Ushering new constitutions are easily done on the morrow of independence or a revolution. Midlife constitutional changes are extremely difficult in any country and there are only a handful of countries that have successfully achieved this feat. The successful making of the 1972 and 1977 constitutions in Sri Lanka were almost entirely due to the power and competence of their two architects, Colvin R de Silva whose power was entirely intellectual and professional, and JR Jayewardene who in addition had absolute political power after the UNP’s landslide victory in 1977.
Sri Lankan politics has not been able to replicate their circumstances ever since, and the circumstances of the NPP are no different, its two-thirds majority notwithstanding. If the government is serious about drafting a new constitution, conducting public consultation, and holding a referendum, it should have started the process the day after it was sworn into office. It could start the process right away even now. The task deserves a separate ministry and supporting expertise. It cannot be the part time job of a first time Minister of Justice.
All that said, many of the NPP’s reform proposals can be implemented without introducing a new constitution. Few have already been introduced and many more can be introduced by simple legislation or through amendments without a referendum. For the super majority the government has in parliament, its legislative record has not been sufficiently impressive. The government has given priority to implementing proposals that it considers to be more resonant with the voters at large.
They include, the taking away the manifestly undue perks and privileges of former presidents, and the proposals to end the more offensive perks and privileges of parliamentarians. The reform of parliament itself is to be achieved by implementing a new electoral system; by limiting cabinet size to 25 and appointing an advisory council for each ministry; and introducing a code of ethics for MPs. These measures will also go down well with the public, but they can all be implemented through simple legislation without having to change the constitution through a referendum.
The most glaring omission is the continuing foot dragging over the repeal of the Prevention of Terrorism Act (PTA). There are already new victims of this continuation. What is the point in indefinitely detaining people like Retired Major Gen. Suresh Sallay under the PTA? It only vitiates however plausible a case the government might have against Gen. Sallay. More importantly, it flies in the face of the NPP’s promise to abolish the PTA, and its promise of custodial and prison reforms under Section 4.5 of the Manifesto: A humanitarian prison – A lawful confinement. The PTA only keeps the door open for police abuse and overreach.
The most recognizable and much talked about proposal is for “Abolishing the executive presidency and appointing a president, without executive powers, by the parliament.” If only the NPP government can deliver on this promise during its current first term, it can justifiably claim to have fulfilled its constitutional promise almost in entirety. No one will likely ask for anything more from the NPP, constitutionally speaking. But that seems unlikely to happen and this gets clearer as each day goes by. The talk inside the NPP and outside would seem to suggest that President Dissanayake will seek a second term as an elected Executive President and renege on what was made out to be a historic promise. It will become another daydream, so to speak.
by Rajan Philips
Features
Inside Xi’s Pyongyang Doctrine
Soon after Pyongyang unveiled a new facility to produce nuclear bomb fuel, with Kim Jong Un reaffirming plans to expand the country’s nuclear forces “at an exponential rate”, President Xi Jinping crossed the border after seven years to visit his neighbouring state. Before his arrival, Xi published a carefully crafted message, couched in the deeply rooted lexicon of diplomacy and carrying layered meanings for a North Korean audience, in which he argued against hegemonic politics and the erosion of international rules. It was not merely a gesture of goodwill but a calculated act of strategic signaling, written in the language of stability while echoing the rhetoric of geopolitical rivalry that increasingly shapes the international order.
The visit itself, staged with extraordinary ceremony across Pyongyang’s grand civic spaces, was presented as an affirmation of friendship between socialist neighbours. Yet beneath the choreographed spectacle lies a more complicated reality. China is no longer speaking to North Korea as a problem to be solved, but as a condition to be managed within a fragmented international system. Xi’s carefully chosen phrases — “shared destiny”, “mutual assistance” and “unbreakable friendship” — were not decorative flourishes. They were assertions of permanence in a relationship that has survived war, sanctions and decades of strategic ambiguity.
At Kim Il Sung Square, where formations of soldiers, students and citizens performed beneath fluttering flags, the language of unity concealed an underlying imbalance. China’s diplomatic doctrine, repeatedly articulated in Xi’s writings, presents both states as “fellow travellers on the socialist road”; yet the material reality is more hierarchical. Beijing is not merely a partner to Pyongyang. It is the centre of gravity around which much of the North Korean system revolves economically, diplomatically and, increasingly, strategically. This is not openly acknowledged, but it is reflected in trade patterns, energy dependence and the tightly managed permeability of the border regions.
Xi’s article, published ahead of the visit and carried by North Korean and Chinese state media alike, reveals the intellectual framework behind this engagement. It speaks of “top-level strategic guidance”, a phrase that in Chinese political language denotes the primacy of leader-to-leader diplomacy over institutional negotiation. It also reiterates opposition to “hegemonism and power politics”, a formulation that simultaneously criticizes Western strategic dominance while offering ideological reassurance to Pyongyang. The brilliance of the wording lies in its dual purpose. It reassures North Korea while signaling to the United States without ever mentioning it directly.
Less visible, but widely recognized among regional specialists, is the dense network of economic activity that sustains the frontier between China and North Korea. Officially, trade remains constrained by sanctions and regulatory controls. Unofficially, the border operates through a mixture of state-approved commerce, local barter arrangements and carefully managed informal exchanges. Chinese provinces adjoining the frontier depend on this controlled permeability, particularly in sectors such as food supplies, textiles and consumer goods. In return, North Korea provides labour, access concessions and selected resource exports. This is not a “shadow economy” but a tolerated grey area maintained by both governments because it preserves stability without allowing the relationship to descend into crisis.
It is within this grey area that stories of “secret networks” frequently emerge. Yet the reality is often more bureaucratic than clandestine. Trade is driven less by rogue actors than by overlapping permissions, discretionary enforcement and shifting instructions from the centre. The notion of a handful of powerful profiteers orchestrating cross-border commerce oversimplifies a system in which benefits are dispersed through layers of administrative authority, provincial intermediaries and sanctioned enterprises. The defining feature is not secrecy but carefully managed ambiguity.
Xi’s emphasis on “jointly upholding the international system with the United Nations at its core” becomes particularly revealing when viewed alongside these frontier realities. On the surface, it is a reaffirmation of multilateral order. In practice, it reflects China’s preference for a world in which legitimacy flows through established institutions, even while bilateral relationships such as that with North Korea operate according to a different set of political calculations. This dual-track approach enables Beijing to retain strategic flexibility without formally dismantling the international framework from which it continues to benefit.
The visit also took place against a wider shift in global diplomacy. The Financial Times has noted the growing number of world leaders traveling to Beijing rather than Xi traveling abroad. Some interpret this as evidence of a China-centred diplomatic sphere. Whether viewed as modern statecraft or, more controversially, as a distant echo of tributary-era symbolism, one fact remains evident. Xi Jinping has built a diplomatic model in which China is less a participant in international gatherings and more a focal point through which bilateral relationships are channeled.
Within this arrangement, North Korea occupies a uniquely delicate position. It is at once a liability, a buffer and a strategic asset. Its nuclear programme complicates China’s relations with much of the international community, yet its existence also serves as a geopolitical barrier on the Korean peninsula. Xi’s language avoids direct reference to nuclear weapons, concentrating instead on “regional stability” and a “peaceful environment”. That omission is deliberate. Silence, in this context, is not avoidance but the management of contradiction.
One of the most closely watched questions following Xi’s visit is whether North Korea’s rapid nuclear expansion will become less visible, or simply retreat further from public view. Xi later stated that he and Kim had reached an “important consensus” and agreed to safeguard regional and global peace, a formulation that may signal a preference for restraint in presentation rather than any fundamental change in Pyongyang’s strategic ambitions.
Under Xi, Chinese foreign policy has increasingly prioritized stability over transformation and management over resolution. Nowhere is this more evident than on the Korean peninsula, where the objective is not denuclearization through coercion but the containment of escalation within predictable limits. In this sense, North Korea is not being pushed towards change.
Rather, it is being held within a carefully maintained balance that serves broader regional interests.
The wider geopolitical setting, including Russia’s deepening alignment with Pyongyang and the fluctuating approach of the United States towards Asia, further complicates this balance. Xi’s diplomatic language — with its emphasis on multi-polarity, opposition to “power politics” and the creation of a “community with a shared future for mankind” — is intended to place China at the centre of an alternative vision of international affairs. Yet that vision is not merely ideological. It is expressed through trade agreements, infrastructure investment and selective political partnerships.
What emerges from the Pyongyang visit is not a straightforward story of alliance, but one of carefully calibrated interdependence. North Korea retains leverage through its strategic unpredictability, while China retains influence through economic indispensability. The border between them is not merely geographical. It is a political and economic mechanism composed of regulated flows of goods, labour and messaging. It is this managed interdependence that allows both governments to preserve autonomy while avoiding collapse or confrontation.
Xi Jinping’s rise in global politics, therefore, cannot be understood solely through military strength or economic weight. It rests upon the construction of a diplomatic order in which China functions simultaneously as host, mediator and stabilising force. Foreign leaders travel to Beijing not as supplicants, but as negotiators entering a system where outcomes are increasingly shaped through bilateral and asymmetrical relationships. Within that framework, North Korea remains both an exception and a participant, its nuclear status complicating but not excluding its place within China’s strategic sphere.
Xi’s visit to Pyongyang reflects a world in transition, where the old certainties of alignment and isolation no longer fully apply. In their place is emerging a more complicated pattern of selective cooperation, managed tensions and carefully cultivated historical memory. Xi’s diplomacy does not resolve contradictions. It arranges them. And within that ability to arrange competing interests lies much of his contemporary influence. Whether that model ultimately proves durable or fragile remains one of the defining geopolitical questions of our age.
by Nilantha Ilangamuwa
Features
The Examiner at lunch: Nihal Jayawickrama, architect of justice
Justice Ministry secretary and attorney-general at 33, Nihal Jayawickrama was the architect of the justice system’s most radical overhaul. Over a leisurely lunch at Tintagel we talk about the speed of justice, an independent public prosecutor, and the 1972 constitution.
“Tintagel” was Nihal Jayawickrama’s reply when I asked him where we should lunch. I smiled. The former secretary to the Justice Ministry, appointed at the tender age of 33, and now 88, hasn’t lost his mojo.
No restaurant — even Bawa’s studio, now become the Gallery Café — can claim anywhere near Tintagel’s pedigree. It was the home of the three Bandaranaike prime ministers. If the waiters’ intelligence is on point, it will be home to one of them again soon. Yes, Tintagel’s lease is up. Lunch while you can.
I’ve reserved one of two verandah tables, a few meters away from where S.W.R.D. Bandaranaike, the former prime minister, was assassinated by Talduwe Somarama, “a foolish man in robes”. Thinking Jayawickrama is a few minutes late, I wander to the sitting room. But he is waiting for me. I’m surprised that, at 88, he has come alone.
We make our way to the verandah and sit down. I break the ice, asking Jayawickrama when he first came to Tintagel.
Jayawickrama pauses to think, then with twinkling, mischievous eyes, says it was 70 years ago, in 1956. He had come to Tintagel to invite Bandaranaike to speak to the Royal College literary association. Jayawickrama said there was no security, save for maybe a sole policeman at the gate. He had walked to the verandah, and sat on one of the many chairs where the public would sit in the mornings, waiting for the prime minister to talk to them.
Bandaranaike’s response to the invitation had been clever rather than candid. He said it would be a great honour to address the Royal College literary association, and that he would be so happy to drop by. But the prime minister had only one problem: he’d have to go to the one at his own school, S. Thomas’, first. But they hadn’t invited him. Thus nothing ever came of the invitation.
We move on to more important business, lunch. Jayawickrama eschews the wine, we settle on thambili, almost always the best value drink on a Colombo resto menu. A veggie, he orders his usual, the parmesan gnocchi. I’d have ordered the pumpkin gnocchi, for many years my Paradise Road staple, but sadly they dropped it years ago. Good. For having taken up the pen, the purse won’t permit me anyway. Really wishing for Caribbean ox tail, I reluctantly settle for the osso bucco.
I’m too impatient for subtlety, so launch right into one of my burning questions: how did Jayawickrama become both secretary to the Ministry of Justice and attorney-general at such a young age. The answer is found in Balangoda, where Sirima Bandaranaike’s brother contested the 1965 election. He faced a few court cases, but the SLFP was strapped for cash. So, the party asked Jayawickrama to represent him. Jayawickrama went on to represent other members of the Ratwatte family, and then eventually, Mrs. Bandaranaike started consulting him too. He also served as her election agent and ended up drafting her prime ministerial acceptance speech in 1960.
A few days after her victory, Mrs. B called him and asked if he could be the permanent secretary to the justice ministry. Jayawickama said he was a lawyer, not a public servant. She responded:
“No no no no, you had been complaining for a long time that absolutely nothing had been done about law reform. I am telling you now come and do whatever you want to do — all the reforms you have been talking about. You have a free hand; we have got a two-third majority so the legislation can be passed. So come and do that.”
The Justice Ministry secretary’s monthly take-home at the time was around 1,800 rupees, which more than covered the 500-rupee rent onof his Park Road flat. Today, the secretary’s entire salary wouldn’t even pay for half the rent of such a flat.
Jayawickrama’s work was cut-out for him. The tale sounds familiar. The civil procedure and criminal procedure codes — the backbone of court work — were from 1880. Two distinguished commissions, chaired by Justices Noel Gratian and C. Nagalingam respectively, had already figured out what needed to be done. They produced “excellent reports” but “no government had done it”, Jayawickrama said rather ruefully.
When the attorney-general died, an acting attorney-general was identified. But he had to finish some cases he was presiding over. As the country needed to have an attorney-general, Bandaranaike appointed Jayawickrama to the office on his 33rd birthday. His contemporaries were the most junior state counsel. It was not a friendly atmosphere. Luckily for him, he had friends who warned him of the files which contained traps and snares.
He set up a research division in the Justice Ministry for law reform, consisting of five or six bright young things. The division included Dhara Wijetilleke, who became the planning ministry secretary, Suri Ratnapala, who became a distinguished constitutional law professor, and Priyani Wijesekara who became the Parliament’s secretary-general.
Unclogging justice
This team was the moving force behind the Administration of Justice Law of 1973, which overhauled the justice and courts system.
Among the many changes brought by the act was a recommendation from the Gratiaen Commission of 1952. The attorney-general’s role was almost bifurcated by creating the office for a director of public prosecutions.
The key reason Jayawickrama pushed this initiative through was to de-clog and speed-up the justice system by eliminating “non-summary proceedings”, where the police would present evidence to a magistrate to decide which court would hear a case. The public prosecutions director would instead direct the police’s inquiry and decide whether to file a case in the magistrate’s court, or at a higher court.
The team also introduced pre-trial conferences for non-criminal cases and mandated day-to-day hearings for trials, with postponement only granted in the event of family bereavement.
These initiatives faced massive protest from the Bar, as they “would change their lifestyles” and affect them financially. Not all his reforms succeeded. When he tried to regulate lawyers’ fees, the cabinet paper leaked and a lawyer representing the prime minister barged into Temple Trees, left his briefs on the breakfast table, said “you appear for yourself”, and went off. Mrs. Bandaranaike told Jayawickrama to withdraw the cabinet paper.
The Bar also refused to participate in the legal aid scheme. Jayawickrama’s response was to say that he would create a brigade of “barefoot lawyers” like barefoot doctors. Years later he said the proposal wasn’t a serious one, the remark was made in terrorem, meant to frighten the bar into becoming more generous with legal aid.
-
Editorial6 days agoProbe Sallay’s complaint
-
News2 days agoCIABOC summons Yoshitha over his participation in British Navy training programme
-
News4 days agoLocal firms move millions of dollars overseas for phantom imports: Govt.
-
Midweek Review4 days agoJuly 09: An inexcusable overall security failure and exceptional contingency plan
-
Opinion5 days agoCould Sri Lanka once again face an economic crisis similar to 2022?
-
News4 days agoAI raises concerns over arrest of Sallay and rapper under PTA
-
News5 days agoSallay refuses to end hunger strike unless probe is taken out of CID led by Shani
-
Latest News5 days agoIran and Israel say they will pause strikes but warn of retaliation if ceasefire breached again

