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Patient-centred care and CKDu

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Some observations on the occasion of World Kidney Day

By Prof. M.W. Amarasiri de Silva

(Inaugural Fellow, International Society of Nephrology 2018, Adjunct Professor at the University of Pittsburgh, USA, and Professor Emeritus, University of Peradeniya)

Today is World Kidney Day, and this year the principal focus is on patient-centred care for people living with kidney disease. This theme highlights the increasing recognition of the need to identify and address patients’ priorities, values, and goals in order to advance the research, practice, and policy designed to improve the quality of life of people suffering from chronic kidney disease. Regardless of the type of kidney disease or the approach to treatment adopted, patients want to live well, retain their social place, maintain some semblance of normality, and have a sense of control over their health and wellbeing. 

A patient-centred approach is one where the patients are treated as social individuals and enabled to take control of and improve their health. Thus, they become active participants in their care. Their biology becomes secondary in this process. Members of patients’ families and communities can continue to focus on them as people, rather than on their illness or disability. Support should concentrate on achieving the patients’ aspirations and be tailored to their needs and unique circumstances.

A patient-centred approach to health requires building public policy, creating supportive environments, facilitating community action, and developing and improving patients’ skills and knowledge of disease management. Overall, any such programme requires a complete reorientation of the treatment system. Those who work directly with patients at the District Secretariat (DS) Division level – the public health inspectors, public health nurses, nurses, hospital attendants, community workers, health educators, rural development officers, childcare officers, and others – should be directed towards a patient-centred approach, and trained in good communication skills and to address patient needs effectively. A patient-centred approach should address those with chronic disease of unknown aetiology (CKDu) within their family and community, and become an integral part of everyday life in the family and community. If CKDu sufferers are uprooted from their social setting and placed in a clinic-based environment, the treatment system becomes an artificial one with no link to the patient’s cultural milieu. Such treatment systems do not work satisfactorily.

In western societies, community health workers, working in communities, facilitate this process by assisting the medical specialists in hospitals. They visit the homes of patients and help their families to overcome problems through counselling. In Sri Lanka, such a link between the community/family and the hospital, focusing on the patient, is missing. Especially with regards to CKDu patients, establishing a connection between the community and the hospital is crucial. Such a link would help to alleviate the stigma attached to CKDu patients in the community and the neglect and isolation that many have to endure. Visits by hospital staff and paramedics to patients in their homes can improve the understanding of hospital staff about how patients live at home, what problems do they face at home and in the community. It would improve the commitment of patients towards their treatment. This would also improve their compliance with their medical regimen. A change in the treatment procedures from a hospital-based system to a patient-centred one is necessary, as the existing approach has had little impact in assisting CKDu patients in addressing their grievances and improving their quality of life, or in reducing the incidence of and death rates from the disease.

In a patient-centred approach to the treatment and care of CKDu patients, essential elements are community engagement and empowerment. Educating the patients and their families on disease risk factors and treatments is a prerequisite. In Sri Lanka, government programmes have invested in developing people’s understanding of the risk factors for CKDu but have not paid much attention to improving people’s knowledge of treatments and testing procedures. Therefore, most people in CKDu-affected areas have knowledge of the causes of CKDu, but have limited understanding of treatments. As a result, patients are not able to make an informed decision on the type of treatment that they should undergo or to discuss the subject with their medical professionals. They blindly accept (or reject) the type of treatment recommended by the doctors.  

In Sri Lanka, people’s knowledge of treatments for kidney disease is fragmentary. Their knowledge of things like blood transfusion is limited and is very hospital centred. Experience in other countries shows that patients on a home therapy or haemodialysis at home were more satisfied than those with in-centre haemodialysis. In Sri Lanka, haemodialysis at home has not been promoted.

Most CKDu patients undergo harrowing experiences in their communities and at home. They report a substantial drop in their quality of life. Their illness means that they cannot draw water from the dug well to wash or use the toilets with squatting pans. They are advised to install commodes in their toilets, but most CKDu patients cannot afford to do this. Many say that they cannot cultivate their rice paddy land, so they don’t get any income from agriculture. Although they are paid Rs. 5,000 by the government each month, that is not adequate for a family of five people to live an ordinary life. As CKDu patients find it difficult to use public transport, they have to hire a vehicle at a significant cost each time they visit the clinic. In many families, children have dropped out of school because their parents cannot afford to provide for their education. About 15% of CKDu patients in the villages live alone, with, in many cases, their wives having left them and gone to the Middle East for employment. Family members say that the CKDu patients have become demanding. Many CKDu patients and their family members display signs of depression and uneasiness.  

Those patients on dialysis need to attend the clinic once every three days. Many patients do not attend the clinics as required due to financial difficulties. Each visit to the clinic requires Rs. 2,000 to 3,000 for transportation, which is beyond many patients’ means, and therefore, after a few visits, they drop out of the dialysis programme. A patient told me, ‘the doctor told me that I have to get a kidney transplant. I am on the waiting list like many thousands of patients. I have no great hopes anyway. I undergo blood transfusion. I was asked to come to the clinic every third day, but I don’t have money to pay for a vehicle every time. I mortgaged my two acres of rice paddy two years ago, and the money has been spent on my treatment and food for the family’. 

A patient-centred approach should highlight how to improve the quality of life of CKDu patients and families. The quality of life for patients should become the dominant preoccupation in health promotion in CKDu communities. Essential health professionals, such as health educators, public health inspectors, and public health midwives, should take the lead in educating the CKDu-affected population about the management of patients at home and in their communities. They should discuss how behavioural changes could improve health, for example identifying the adverse effects of smoking and chewing tobacco. Referring to her husband, a CKDu patient, a woman said, ‘My husband smokes a lot. He smokes a bundle of beedi a day. One bundle of beedi is Rs. 100 and contains 25 beedis. He smokes them at night, early in the morning, and at work… However much I tell him to, he doesn’t stop’. Many patients do not regularly take the medication given by the clinic or attend their appointments as scheduled.

People surveyed during the course of my research were not very aware of the difference between CKD and CKDu. Most CKDu patients identified having diabetes and high blood pressure as risk factors for CKDu. They are risk factors for CKD, and CKDu develops due to other factors in the absence of diabetes and hypertension. Most end-stage patients did not know what treatment options were available for them, and preferred to stay and die at home. Compared to affluent families in the CKDu-affected communities, the paddy farmers who own less than two acres of rice paddy are less educated and lacking in CKDu-related health knowledge.

Any community empowerment programme, focusing on CKDu patients, should discuss the basics of kidney function, CKDu testing procedures, and the management of CKDu at home and in the community.

 

Recommendations:

A reorientation of the hospital-centred approach to a patient-centred one. This requires training local officers at the DS Division level. A programme for this has to be identified and discussed at ministerial level with the participation of Community Based Organisations in the area, patients, carers, medical and paramedical practitioners. A sociologist/anthropologist working in the area of community empowerment and participation would also be an asset.  

The introduction of home dialysis should be considered as a measure to enhance the community/family role in CKDu disease management. Home dialysis needs a cleanroom, which is hard to find in farmer households in CKDu-endemic areas. Therefore, for each Grama Niladhari Division, the government should consider building a spacious room in a central location and constructing all the facilities for patients to come and undergo dialysis. A community member should be trained to handle the procedures.  

To effectively address the increasing incidence of CKDu in the epidemic regions in Sri Lanka, a well-developed intervention and a community education programme, focusing on behavioural change, should be aimed at lower socioeconomic groups.

The government should strengthen the patient-centred approach to treatment and care. Although medical education programmes in the universities prioritize medical professionals’ role in treatment, patient-centred approaches are seldom discussed. The universities should focus on CKDu-affected districts when selecting villages for students’ intervention and training on a patient-centred approach. Departments of Community Medicine should take the lead in this direction. 

A programme to address depression among CKDu patients, needs to be established. DS Division level officers appointed for community work should be trained to handle the psychological issues afflicting CKDu patients. The education and counselling of end-stage kidney patients are essential as many such people have refused to undergo dialysis or kidney transplants.

The basics of kidney function and the risk factors for CKDu should be taught to school pupils in areas where CKDu is endemic.



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Dialectics for a fast evolving scenario

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by Kumar David

“The question whether objective truth can be attributed to human thinking is not a question of theory; it is a practical question. Man must prove the truth — i.e. the reality and power, the ‘this-sidedness’ of his thinking in practice. The dispute over the reality or non-reality of thinking that is isolated from practice is a scholastic question”. Second Thesis on Feuerbach

Don’t turn away, this is not going to be a boring treatise in abstract Marxism. I will quickly get to my topic, which is that the political circumstances we are living through are evolving rapidly and we should be alert and adjust to changing situations. First however allow me a few paragraphs about Lenin’s most dynamic years, from February 1917 till he fell seriously ill in late 1921. He died in January 1924 due to complications from bullets lodged in him in Fanny Kaplan’s August 1918 assassination attempt. The February Revolution, (old Julian-style last week of February to early March, new Gregorian-style second week of March) took Lenin and the Bolshevik Party by surprise. When first the women and then the workers of Petrograd fired up leaderless demonstrations which overthrew the monarchy, the Bolsheviks who had prepared the proletariat for revolution for 30 years were stunned! Except Trotsky the general expectation among socialists was a Two Stage Revolution; first Tsarism would be replaced by the rule of the bourgeoisie, then it would be the turn of the subaltern classes – a common at the time static misreading of Marx’s dialectical thinking.

I see developments in Sri Lanka moving fast with unforeseen changes and a regime that most of us last year considered strong and stable, now tottering. Of course it’s going to fall tomorrow but it’s wobbling and the domestic environment is changing unpredictably. Catholics are visibly angry about an alleged “cover up of Easter bombing organisers” (https://www.youtube.com/watch?v=EA2Zl1mVrOo); the in the Buddhist clergy have counter-attacked the Cardinal (https://www.youtube.com/watch?v=OC0WcSiJiJs0). Farmers in several areas are on the warpath according to News First. Furthermore nobody foresaw in 2019 the havoc covid would wreak, and the ferocity of UNHRC denunciations was unexpected. It is true that red lights were flashing about debt servicing and that the economy was in hopeless straights, but the convergence of bad news has been more rapid than foreseen and the regime has quickly gone belly up. All who join a mission with a single simple objective, to protect democracy, perforce, have to adjust to a fast changing scenario. The ability to think and act on one’s feet is what makes Lenin of 1917-1921 interesting. He remains the star disciple of Sun Tzu’s Art of War, a fifth century BC classic on strategy. While shifting and manoeuvring Lenin never lost sight of his final objectives. This is why I call him the dialectic on two feet.

Often in this column I have referred to the dialectic as the scientific method; true but how boring! Yes true enough Darwin, the best example in science was an assiduous and utterly trustworthy accumulator of data but with a mind that was alive to how phenomena change and evolve. Gautama Buddha pointed out that nothing is permanent and that all things are evolving but it took Darwin to work out the precise mechanisms by which this was happening in biology. Still, the dialectics of science and nature are slow moving. It is not exciting, it won’t keep you awake at night. Conversely, jumping from Two-Stage theory to instant proletarian revolution on April 1, 1917, capturing state power in October in defiance of scholastic Marxism, pushing back against attempts to militarise the trade unions and the refusal to give the Germans whole swathes of land so as to commit to the treaty of Brest-Litovsk (on both Trotsky erred), and in 1921 forcing through the New Economic Policy, a key market oriented concession to capitalist farming, these were momentous strategic transitions, quite breathtaking.

Bearded boring Bolshies 100 years ago, what’s it got to do with us you ask? I’ll tell you. The commonality is that quite unexpectedly we find ourselves in a very fast changing scenario. Lenin in 1917-1922, was an embodiment of the dialectic because he was able to think on his feet and keep his side united using his singular ability to deal with a swift change while the other side (sides to be more accurate) were confused and splintered. This is a useful example for those who seek a democratic, plural and united Sri Lanka because to date this side (I call it ‘we’) have managed to keep our message consistent and united while the ‘other’ side is splintering. President Gota bemoans his unpopularity and his inability to address challenges because “there is no unity” or some such words. I don’t have a clue what skulduggery is going on within the Royal Rajapaksa dynasty, though now is just the right time to make visible adjustments. The public is persuaded that Gota failed because he is inexperienced and his inner circle is dumb; Mahinda and Basil deftly keep out of the limelight. Less and less do you hear from those you marvelled 18 months ago that Gota as the incarnation of a strong leader who would lead Lanka to harmony and splendour? Lee Kuan Yew was a frequently quoted prototype. Where have all those people gone? On the other hand the opposition to an authoritarian new constitution, to excessive deployment of retired military brass and those worried that democracy is under threat (harassment of rights workers, fear in the mind of critics, damaging the judiciary) have succeeded in retaining a degree of commonality.

The shot in the arm for ‘our’ side was the UNHRC Commissioner’s Report and the Geneva Resolution which has de facto created a united front of Sri Lankan domestic forces and international opinion. The uprising in Burma and the opposition to authoritarianism in Sri Lanka must not allow themselves to be intimidated by reactionary nationalists who shriek about foreign support and anti-national traitors. International assistance should be accepted on our terms and in any case democracy is a universal clause. Remember that when the Germans offered to transport Lenin from Switzerland to Petrograd in a sealed train (“Like a bacillus” in Churchill’s words) he did not hesitate for a moment to accept the offer. The rest is history. In Burma as in Sri Lanka the defeat of the Junta or the containment of an assault on democracy are transnational tasks. “Patriotism is the last refuge of the scoundrel” when it is used to conceal the machinations of dictators.

You may recall Marx’s quip about standing Hegel on his head which in today’s language we would say has gone viral. It is about the relationship between real life on one hand and theories and philosophies on the other. Tamil agitation and at an extreme the LTTE was not an ideology of a separate state and Tamil cultural-civilisation finding expression in an uprising. Quite the converse, it was the practical conditions of a community creating such angst that it gave rise to extreme nationalism among a large number. That Sinhala-Buddhist chauvinist extremism which is holding this country hostage is about ancient civilisation, about hela jathika abimane is humbug. There were class, economic, employment in the late colonial capitalist and state economies, and education sectors which turned Sinhala blood blue with national pride. The nationalists who pontificate the opposite need to be stood on their heads. This critique of what is called the idealism (Ideas and philosophy is what determines the principal features of the real, material world) is very well known now and I think modern bourgeois sociology goes a long way towards recognising it.

What is perhaps not quite so well appreciated is that Marx was more a pupil than a critique of Hegel (not the post-Hegel epigenomes of course) in respect of the dialectic. He speaks of Hegel as a “mighty thinker” in the 1873 post-face to capital I. Certainly spurned the “the ill-humoured, arrogant, and mediocre epigones” who treated Hegel like “dead dog”. What Marx took away from Hegel was how to understand change, the dynamics of how change progresses. The conflicts and compromises in real social and human relations which at times mediate and at times determine how the history of societies evolves. The sociological companion to Darwinian evolution.

We are now live in a fruit salad world of international relations where three powers will decide our fate – over which we have little control – India, China and the US. They are each no doubt pondering what to do about our fruitcake regime. Competition among them to one side, it is in the interests of all three to unscramble this tabbouleh and avert this country’s descent into a failed-state abyss, which thankfully we have still not reached. It is not possible that they each do not have calculations up their sleeves about how to sort out this mess but an initiative from the regime itself proposing a via media to the UNHRC and to the aforementioned powers as proof that Lanka will accept its reconciliation-accountability responsibilities and will maintain a foreign policy balance which will not discomfit any great power will ease a compromise.

The Double-Paksa (two Rajapaksa) regime must forget about enacting a divisive new constitution to claw power into the grasp of the Executive; if firing military sorts already hired for top slots is infeasible at least it must give an undertaking that there will be no more sounding brass speaking in garbled tongues; it must put scientists in charge of pandemic control and win, as Biden seems to be doing; dump this squalid and reckless foreign policy team; it must stop manipulating the judiciary and halt asinine Presidential Commission circuses; it must stop pandering to extremists since this impedes a deal with the minorities. All this is doable if the executive is restructured and a plural orientation is adopted. If the government wishes to pull itself up by its bootstraps it must undertake the policy changes outlined in this para, restructure its personnel, pray much harder and offer trays of mangoes to the deities superintending Sri Lanka. The $64K question is whether Gota has the appetite for this healthy and fruitful menu. Those with no confidence that Gota’s Executive, Mahinda’s government or Basil-in-waiting can extricate themselves from their predicaments, must plan and act on their own outside this purview. The sole self-imposed condition is that change must be constitutional; what’s the point of a fight for democracy if one begins by abrogating it?

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S. A. Welgama – A man amongst men

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On the one hundred and tenth birth anniversary of my father-in -law S.A.Welgama I pen this tribute with much affection and pride.Affection as he was a second father to me and pride as he was a man amongst men;a man who stood tall and erect,a man unbowed ,unconquered and unsullied.Of him I could truthfully echo Marcus Aurelius, Emperor of Rome,”let men see,let them know a real man,a man who lives as he was meant to live”.

EARLY LIFE

He was born in the hamlet of Ovitigala,in the verdant county of Pasdun Korale,the county of five yojana (sixty kms in Vedic measure),created by Parakramabahu the Great,by draining the basin of Kalu Ganga.

His mother was fair and comely and taught in the village school ,and the father a farmer tilled his own land.SAW never forgot his roots and even at the height of his fame and wealth would often say,I’m the son of a poor farmer.This alone would have tagged him for greatness, for according to John Ruskin “the first test of a truly great man is his humility.”

The origins of the Welgama clan are shrouded in the mists of time.One school of thought says that they were the caretakers of the Welgama vehera in Kinniya ,Trincomalee.Grateful kings had donated land to them in distant South.The stupa was built by King Devanampiyatissa in the third century B.C.and remained unscathed till the end of the Polonnaruwa era.Even the Chola marauders,who razed all they saw ,left it alone as it was a place of worship for Hindu devotees as well,the Navatar Kovil.

Another school is of the view that they were soldiers in the service of the Sinhala kings as evidenced by their ge name Welgama Hewage.This is likely too as the Welgamas were tall and had a martial bearing.

They migrated to the villages of Ihala (upper) and Pahala (lower) Welgama villages separated by a fast flowing river.This could only be forded by a ferry ,until SAW persuaded a friendly minister of state to build a bridge.

SAW had his early schooling in the Ovitigala village.His heart was ,however not in books but in machines and motor vehicles.Many a day he played truant with his classmates,one of whom was to later become an eminent Buddhist monk and a mentor to me and my brother.When I was being screened as a prospective son -in-law ,he made enquiries, from his friend the Rev Kevitiyagala Dhammasidhi.The priest had categorically stated ,’Sir do not look any further,he is the best of the best’.My fate was sealed.

 

ENTREPRENEUR

While still a teenager he apprenticed himself to a local workshop and then came over to Colombo to gain further experience and skills.He had fifty cents in his pocket.The friend who accompanied him returned to the village after two days.But SAW soldiered on and joined the workshop of an English engineer.He worked long and hard and became a master of his trade and also earned the respect and goodwill of his employer,whose pet name for him was Pattison.

Being thrifty he regularly added his wages to a till which was well hidden.With his savings and some help he bought a car for the then princely sum of two thousand rupees ,and plied it for hire between Gampaha and Kaluthara.

As the war clouds gathered in the horizon in the late 1930s he sensed an opportunity in road haulage and this became his trademark.At one stage he owned and controlled over one hundred and fifty trucks and became a trusted agent of the colonial government;transporting goods to and from the Colombo harbour to the massive godowns built in anticipation of wartime food shortages.SAW and Sons became synonymous with road freight.With foresight he bought land at Panchikawatte,an emerging commercial hub for his headquarters.Later with the help of his son Nimal he extended this to a much larger holding.

A prized possession of his was the luxury tourist bus,which he imported when Mr J.R.Jayawardene inaugurated the push for tourism.This was used for family outings too and Kanthi and I remember vividly the visit to his estate with business associates.We also accompanied a group of visiting American cardiologists and spouses to Kandy.On the way ,the ladies started a singsong

to which we had to respond.My contribution was “My Bonnie lies over the ocean” which I had learnt at school.Our guide was a personable young man who later married a young French traveller and settled down in France.Although his fluency in English was not optimal Father saw in him the makings of a good escort.

Having reached the top of the greasy pole ,he knew the value of skills and hard work.He instilled these into the many young men he trained.They were accepted anywhere.The truck drivers employed by him needed two licences;one from the department of motor transport and one from him.He would personally conduct the driving test.In later years his son Mahinda assumed this role.

He had a fondness for new cars especially Mercedes.An exception to the run of Mercedes was the Holden Statesman which he purchased after the Non-Aligned Leaders conference in Colombo.When it was due for repainting,the original colour Salamanca red was not available in SriLanka.Kanthi and I shipped it from Brisbane where we were then living.

The first occasion we met was when he arrived at our house in his magnificent Mercedes.He was accompanied by his beautiful wife Beatrice and his eldest son Melvin.An imposing man dressed in an immaculate white sarong and shirt he was keen to meet the young lad who had been highly recommended as a prospective son in law.After the usual pleasantries ,I joined Melvin who became a close friend.SAW had been much moved that I too was dressed in sarong and shirt.

An interesting quirk of his was the insistence ,that all his vehicle registration numbers should end with the figure five.It’s likely that his birthday being on the fifth of April,this to him was an auspicious number.The denizens of Panchikawatte named him the ‘‘Agata Pahe Mudalali i.e the tycoon with number five at the end.”

Being a man of the soil ,land was at the core of his soul,and he invested in a rubber estate in Kahawatte and then a two hundred and fifty acre rubber plantation” the Deniston” in Mathugama.For the children he bought land in the most fashionable suburb in Colombo and also in Nuwara Eliya a block adjacent to the venerable Grand Hotel.Kanthi and I once spent a night at Deniston in the hilltop estate bungalow.He had arranged for us to be blessed with a ” thovil”, a devil dance ceremony to dispel any unseen hands harassing us; this went on all night.We were exhausted before the performers ,although their colourful costumes,masks,gyrations and the drumming held us spellbound.

About the same time as his rise, there was a group of Sinhala businessmen who too made their mark.They were all southerners who began their careers at the bottom of the pile.SAW and Nawaloka mudalali (H.D.Dharmadasa) were the unofficial leaders of this closely knit cluster.They too never forgot their roots and were all noted for their conviviality,philanthropy and vivacity.Two of their major projects were the Ranweta the gold fence around the Sri Maha Bodhiya and the first coronary care unit in Ceylon.The Sri Maha Bodhiya is the only living relic of the Buddha who attained enlightenment in the shade of the parent tree in BodhGaya.It is the oldest ,historically documented tree in the world.The coronary care unit was built at the instigation of Dr Ivor Obeysekare ,the first cardiologist of Ceylon and a former chief of mine.

SAW was a mover and shaker and associated with the highest in the land.J.R.Jayawardane the first executive president of SriLanka was a good friend and was an attesting witness at all the weddings of his children.He did have friends across the political spectrum including ,Maithripala Senanayake the benign deputy to Mrs Bandaranaike and Peter Kueneman,the sophisticated Cambridge educated leader of the Communist party.Though he “walked with Kings ,he did not lose the common touch” and was equally at home with the masses in villages and the busy bazaars of Colombo.

At the age of sixty five he handed over the control of the trucking company to his sons,but still supervised the estate.The weekly sojourn in the plantation became his greatest pleasure and relaxation.Meandering around ,he may have got to know every tree and shrub,hillock ,valley and stream and mingling with the Indian Tamil workers and villagers gave him a lot of satisfaction.The elder brother whom he adored,lived in a homestead and sharing the customary village fare with him at lunch gave him much gratification.The Sunday visit to the estate was a ritual he maintained till the last week of his life.The bracing air ,the soft breezes ,the solitude and the rural populace seemed to revitalize him.The work was challenging but less so because of his passion and enthusiasm for the land and the labour.

He epitomised Henry Wadsworth Longfellow’s words that “The heights by great men achieved and kept were not attained by sudden flight,but they while their companions slept,were toiling upward in the night.”

 

FAMILY

Unexpectedly,at the age of thirty three,he met a beautiful Kandyan teenager Beatrice Hidellarachchi.It was akin to Adam meeting Eve and was love at first sight.

 

Like John Milton,in “Paradise Lost”

“He saw grace in all her steps,

Heaven in her eyes,

In every gesture,dignity and love”

 

Beatrice being the cynosure of all eyes and adoration,delighted him ,and he encouraged her to dress herself in haut-monde finery.

It was a marriage made in heaven.and their happy partnership lasted till his passing away in 1990.

There were ten children in the family,five boys and five girls.He was a strict but adoring father.They were all brought up according to conventional Sinhala Buddhist values.Having missed out on a formal education,he made certain that they went to the highest ranking schools regardless of the denomination.For boys ,he chose S.Thomas’s College the famed school by the sea.Girls were admitted to the Holy Family Convent as he had the highest respect and admiration for the Catholic nuns and their discipline.But he also ensured that they got a Buddhist grounding through the Sunday school at the Vajiraramaya temple which was well known for its pious and erudite monks.

He would have loved for one or more of them to become doctors;instead he got two sons in law who achieved eminence in their specialties of medicine.However two sons became leading business men and chartered accountants.Another a prominent politician and one more a German trained gemologist.The youngest son Nalin was sent across to London ,while we were there, for further studies.

He did have reservations about girls attending universities ,but sent them to finishing schools where they became versed in social graces and upper class cultural rites.Later on he relented and permitted the youngest daughter Pradeepika to study at the Colombo Law school.

As he grew older he mellowed and relished having a drink with Mahinda and me.The faithful domestic Gamini brought his bottle of whiskey and he poured the pegs to all of of us himself.In our younger days we never imbibed with our elders.When he desired company ,he went to the Automobile Association or the Angler’s club.One night he spied us,the two eldest sons in law enjoying a drink in the confines of a car ,with our wives and sent us a round of drinks and a tray of devilled prawns which was a specialty of the AA.

He was a believer in rebirth and would say with conviction that Kanthi his second daughter was the reincarnation of his beloved mother,perhaps because she looked after him like a mother;and Nalin the youngest son,the reincarnation of his father.While on a trip to India ,he insisted on selecting Kanthi’s wedding saree himself ,while mother selected sarees for the other daughters.Kanthi’s saree was more expensive than all the others.

A special relationship too was with his second granddaughter Sadia.I reproduce what she wrote.

“He loved to put his dark arm against mine and tell me we were the same colour.We were.

He called me Podi Sriyani.( Loku Sriyani was his daughter).

He was a wonderfully patient and loving grandfather.He had a warm hug which made you feel loved and how I loved sitting on his lap.It felt like a very safe place to be.

He had a twinkle in his eye and always wore his hat.He had good taste and style.I had a feeling that he had some great stories to share ,but that I was too young to hear them…

He was magic.I still miss that magic.”

 

PHILANTHROPY

SAW was large hearted and munificent primarily to but not exclusively to his village ,villagers and less affluent relatives. A monk told us how ,even Beatrice was not aware of the monthly emoluments he dispensed to the needy.

The Diyapattugama junior school,now named S.A.Welgama junior school was given a large assembly hall.He built a new Stupa at the Ovitigala temple;Kanthi and I joined in this meritorious deed by gifting the “Chuda Manikya” the large crystal placed at its very top.Electricity was provided to the shrine and its environs.The Bodhi tree in the temple (the prathana ,i.e supplication,Bodhi) was brought by him from Bodhgaya.

After his passing away Beatrice built a maternity home in his memory in the village of Wettawe.This had been a cherished ambition of his.His own mother is said to have succumbed at childbirth,and he wanted the impoverished women of his village to have easy access to modern medical facilities.

SAW of course provided employment to hundreds of villagers at his establishments.

 

RETIREMENT.

In retirement he indulged in travel which he had long denied himself.He wanted to ” walk where he had never been and wonder at the beauty of this world”Kanthi and I were lucky that we were able to host him in Britain and also in USA.The long morning walks,the coach trips and the sundowners ,while the ladies cooked supper ,brought us closer in a way not conceivable before.He revelled in the sights and history of UK Germany and Switzerland and also Disneyland and Hawaii.One of the highlights was his visit to the Mercedes factory in Stuttgart.The automated production of his favourite cars enthralled him.Caravans enticed him,as did the miniature trains he rode in a fun park in Newcastle upon Tyne.He did not care much for shopping ,although Mother and Kanthi dragged him along,and grumble that he had become a ‘nattambi’,a carrier of goods.I feel however he secretly enjoyed seeing Beatrice buying apparel and wares unavailable in Ceylon at that time of austerity.For him ,all he wanted was a couple of hats.

The beauty of the Lake District,the Black Forest and Switzerland and the ancient cities of London Edinburgh and Freiburg fascinated him.

He was indeed a man for all seasons.

We rejoice in a life lived to the fullest and that we were blessed to be touched by this great man.

 

Kumar Gunawardane

Emeritus Consultant Cardiologist

The Townsville University Hospital.

I acknowledge the help of Ven Suriyagoda Siri Dhamma,Nimal and Mahinda Welgama and Sadia Samarasinghe.

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Some thoughts on Geneva

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I  was  saddened  by  the  events  in  Geneva having thought we were  a  popular  country  and  our  people  well  thought  of internationally.To  think  that  only  11  countries    supported  us in Geneva  was  indeed  a   cause  for  alarm  and  distress. Maybe the  want  us  to  take  a  step  back  and  think of how to make Sri Lanka a  better    place.

Reams have been written about  this  resolution by erudite  men  and  women. There  is  a  common  theme  running through all  of this: the  UNHCR  is  against  us; the  western  countries  have  ganged  up  against  us. I beg to disagree.

Let us look  at  this  resolution  dispassionately. The high commisioner  has     made  note  of  the  very  things    we    ourselves don’t  like about recent happenings in our country. Did we  want  all  Muslim  Covid  dead  to  be  cremated?  No. Once  the  WHO  okay was  given,   we  all agreed that religious customs may be followed.

Did  we want  our  civil  administration to  be  invaded  by  the  military? No. Our   civil  adminitrtion  is  not  the  world’s  best  but  we  have  no  great  issues over that.   A  military  presence  has  not  resulted in a  marked  improvement  either. The public service meanders lazily as  of  yore.

As  for  killing  of  prisoners, what happened in Mahara is unfortunate. Surely there must  be  other  ways  of  dealing  with  rioting  prisoners than  killing them? There are other pitfalls we could have  avoided  had  we  been  less  arrogant  and  a  little  more  submissive. After all we are  in  UNHCR  on our  own volition 

Our political leaders  are  very  visible  in  the  Buddhist  scene, frequenting  temples, prostrating themselves before Bodhi  trees and participating  in  Buddhist rituals. All that is well  and  good. At  the  same  time  I  wish  they  would  embrace the Dasa Raja Dharma edict on governance of  King  Asoka. We  will then have  fewer problems    with  the  likes  of  UNHRC.  

 

Padmini Nanayakkara,

Colombo-3.

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