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SLMC in crisis

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The recent release of the report of a panel of inquiry that probed the affairs of the Sri Lanka Medical Council (SLMC) and the subsequent removal of its President and four members by the Minister of Health has brought to the surface many problems concerning this important statutory body. It is well known that the inquiry was initiated by a complaint made by the office-bearers of a powerful trade union who happen to be members of the council.

Many deficiencies, shortcomings and irregularities in the report itself have been exposed. The impartiality of the inquiring panel has also come into question. It appears that the inquiry, meant to be of a fact-finding nature, had erroneously recommended punitive action.

The confusion in the minds of many regarding the difference between the Sri Lanka Medical Council (SLMC) and the Sri Lanka Medical Association (SLMA) should be clarified at the outset.

The SLMC is a statutory body established, in 1924, on the Medical Ordinance based on the same format as the General Medical Council (GMC) of Great Britain. It is tasked primarily with ensuring the safety of the general public seeking medical treatment from doctors registered by the council. It does so by maintaining the standards of medical education and by supervision and disciplinary control of medical practitioners of all categories. The public are encouraged to bring any complaints, supported by affidavits, regarding the actions of the practitioners to the SLMC. It is illegal to practise allopathic medicine in the country without first getting registered with the SLMC.

The SLMA, on the other hand, is an association of doctors of all categories dealing with academic matters, and bringing doctors updated with advances in medicine for Continued Professional Development (CPD). Its membership is voluntary, not compulsory, and is open to all graduate medical practitioners registered with the SLMC. It plays an advocacy role in various health issues affecting the people, as well as assisting the government in matters of health policy. At present, it is actively involved with the health authorities in attempts to control the Covid pandemic. It promotes ethical practice of medicine.

As already mentioned, the SLMC is based on a Medical Ordinance 96 years old. Naturally, much amendment is necessary to suit the current requirements. Such changes have been formulated and proposed to the Ministers of Health, the ultimate authority, by the SLMC at various times during the past two decades. Unfortunately, no action has been taken in implementing them. This has led to the various allegations levelled against the Council, often for no fault of theirs.

At present, the SLMC is composed of 25 members: the Director General of Health Services (ex-officio), the Deans or their representatives of the nine medical faculties in the country, eight graduate doctors registered in the main section 67 of the Ordinance, elected by vote, one representative each of the dental practitioners and registered medical practitioners and the President and four members nominated by the Minister of Health.

Many controversies have arisen due to this composition. Much criticism has been raised about the way the elections are conducted to select the eight graduate members. The trade unions like the GMOA with a large membership have a near monopoly of getting their members elected to fill these posts. They conduct their campaigns like in national elections, spending vast resources at their disposal, in bringing bus loads of doctors to Colombo for voting and even intimidating opposing contestants. At present, the GMOA President is an elected member of the SLMC along with three other office-bearers of his union. Being a vociferous trade union, the GMOA does its utmost to impose its will on council decisions. On several occasions, they have been reprimanded by the President of the SLMC for disrupting the council proceedings.

The current controversy concerns the five members, including the President nominated by the Minister of Health. Although the Minister is the nominating authority, the Ordinance does not allow her to remove them until five years have lapsed since their appointments. (This situation is similar to that which empowers the President of the country to appoint judges of the apex courts, but he has no authority to remove them.) The recent dismissal of the President and four members is therefore considered illegal.

Reasons given for such action based on an adverse report of the panel of inquiry referred to the above are worth further analysis. As mentioned already, allegations were brought in mainly by the GMOA:

1. Improper conduct of disciplinary inquiries. As a significant number of the accused naturally happen to be GMOA members purely because of their vast membership, there is a conflict of interest if GMOA members in the council are to sit on disciplinary committees. Thus, barring them from sitting on such committees has caused much dissatisfaction among the union members.

2. Delay in conducting the ERPM examination for foreign qualified doctors. This is an ongoing problem. The examination schedule has been disrupted this year due to the Covid related restrictions. Matters have been made worse over the years by different groups of candidates getting court injunctions preventing the holding of examinations for various reasons. The examination branch of the SLMC has been working round the clock, headed by a respected emeritus professor of the Colombo Medical Faculty, with long term experience in conducting medical examinations. The high rate of failure at this examination is due to many reasons. It cannot be blamed on the examination process. The format of the examination has been improved on several occasions over the years. No doubt an ever-increasing number of candidates and a paucity of available examiners cause several logistical problems. Unreasonable calls from the politicians and others to do away with the examination altogether have been resisted effectively so far. In one instance, when the Minister indicated that a crisis situation had arisen due to the high rate of failures, the SLMC pointed out that a graver crisis would arise if poorly trained doctors are allowed to practise medicine!

3. Inability to maintain minimum standards for entry into foreign medical colleges. It was realized way back in 2011 that some students had gone abroad for medical education without even passing the GCE advanced level examination. These students have returned with their medical degrees. The SLMC could not disqualify them from sitting the ERPM exam, as such retrospective action was deemed illegal. However, corrective action has been taken to establish minimum standards for entry to medical schools. Up to now the courts have rejected applying such criteria without being passed by an Act of Parliament. Various proposals for such action have been ignored or delayed by the political authorities. The provisions were at last passed by an Act of Parliament a few weeks ago. Thus, it is unjustifiable to blame the SLMC for such deficiencies and delays.

The political authorities, over the years, have attempted to interfere with the vital functions performed by the SLMC. Requests for lowering the pass marks at qualifying exams, register foreign medical specialists with substandard qualifications, and recognition of local and foreign private medical colleges with many deficiencies were successfully resisted by the SLMC. In one instance, the lady president was forced to resign when she did not comply, as there was no provision in the ordinance for her removal. So far, the SLMC has been able act honourably due to the non interference by those in authority, guaranteed by the Ordinance.

The present situation where the Minister single-handedly and illegally removed five members, including its President, is bound to have serious repercussions for the future. It is not a question of the suitability or otherwise of the personalities who were removed or those who replaced them. It is the illegal violation of the independence and autonomy of a statutory body. Hence it is essential that this decision is reversed and status quo restored.

Once that is done the amendments to the Medical Ordinance should be framed and implemented without any further delay. Changing the composition of the SLMC, the way the members are selected or elected, and the inclusion of respected non-medical professionals are among the priorities to enable the SLMC to discharge its duties to the general public at large. If the current situation prevails, the SLMC will be a toothless tiger serving the selfish interests of politicians. Ensuring that the medical profession is well regulated maintaining high ethical standards, thus safeguarding the interests of the general public will be the least of their concerns.

 

A Former Member of the SLMC

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Opinion

Is government in self-destructive mode?

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The government seems to have forgotten the two main factors that propelled it to power. One factor was the threat to the national interest that developed due to the evil deeds of the previous government in their disastrous tenure, and the other is the deleterious effect the ruined economy had on the poor people. Governments which never forget what helped them come to power and face electoral debacles.

Of the two political parties that had governed this country, the SLFP is more nationalistic and the UNP is more neo-liberal and pro-West. The latter governed this country from 2015 to 2019, and adopted policies that made the country almost a vassal of the West, and also ruined the economy by robbing the Central Bank. Nobody wants to invest in a country where the government robs its own central bank. Further, that government colluded with the separatists and Western powers to hound the war- winning armed forces. Those misdeeds on the one hand caused an upsurge of nationalism among the middle class and the professionals, and severe hardship among the poor. These two groups that account for more than two thirds of the population could easily be rallied against the government, as never before.

The electoral system that was in operation was not expected to allow anything more than a thin majority, but given the people’s frustration now SLPP won with a huge majority. The economy and nationalism are the two main factors that decide elections in Sri Lanka. Here it is the economy of the poor people, the large majority, that matters. This is evident from the fact that during the period 2010 to 2015 all economic parameters like the GDP, debt ratio, inflation, etc were favourable but the SLFP government lost the election, because their development effort, notwithstanding all indices, did not help the poor people. It seems those big projects that resulted in good economic indices like a high GDP, did not alleviate the hardship of the poor.

This government has the opportunity to base its economic policies on nationalism, to help those who improve the lives of the less affluent. More than 60% of people who voted for this government are poor rural people. The government should have focused on these people.

More than 70% of people live in the villages and are sustained by an agricultural economy. Yet, the government in its recent budget has allocated less than 6% to the development of agriculture. Although it has stopped the import of some goods that could be produced locally, and this has helped the local farmers to some extent, much more should have been done for the development of agriculture.

Not enough is done to initiate the local manufacture of seeds, fertilizer, aggro-chemicals, storage and machinery. At least 20% of the budget should have been allocated for the agriculture, plantations and fisheries sectors. These are the major areas of the economy that need to be developed to improve the living conditions of the rural population. It will also lessen our dependence on foreign imports.

Further, if more money is invested in this sector, it may be possible even to give employment to those workers who are returning from abroad due to Covid, and also reduce the number of people leaving the country for semi-slavery, which is a disgrace to the country, not to mention its adverse social impact.

This is the time for this government to lay the groundwork for the development of the rural economy, health, education, household income, housing, sanitation, availability of potable water etc. It has not allocated sufficient funds for the education of poor people. Economy cannot be improved without developing education. Rural schools lack basic facilities like toilets, pipe- borne water, electricity, buildings. We have seen on TV children and teachers holding umbrellas during classes as roofs are leaking. By developing the national economy the government can “kill two birds with one stone”. Economy of the poor could be improved without compromising the national interest. A national economy would make optimum use of natural and human resources. Experts need not be imported for simple development work and also for solving connected problems. For instance, entomologists need not be brought from abroad to deal with the problem created by the Sena caterpillar. Governments may not have to sell or lease valuable national assets like the harbours, airports, industries sector, if those are better managed. This government pledged in its election campaign to protect the national assets. But now it seems to have forgotten that promise. 6.9 million people who voted for it are disappointed. This is another reason why the government is losing its popularity. No foreign power should be allowed to force the government to sell the country’s national assets. In the context of today’s global geopolitics, Sri Lanka is in a position to resist such pressure.

Further, surely, we cannot be lacking in technical and managerial expertise to run state enterprises. If we are short of money, it is better to wait till we improve our economy and are in a position to find the money. Someday things will improve and we will be able to operate them profitably. If we sell even 49% that is almost half, and we may never get it back. Another area that the government has failed is the environment protection sphere. Unscrupulous racketeers are allowed to do much damage to forests, wetlands, lagoons and other valuable ecosystems which are detected only after the damage is done. Are the officials responsible for looking after these national assets blind, or are their palms well-oiled or are politicians behind these activities. These activities are anti-national and are viewed as such by the people. Unless the government remembers that 6.9 million voted for it, most of them the rural poor, and realizes quickly that the lives of rural people have to be developed based on national economic policies, which make optimum use of natural and human resources available in the country, look after national assets and protect the environment, it will be in trouble come the next election.

N.A.de S. AMARATUNGA

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The ‘Sena’ Caterpillar invasion: Where are we heading?

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By PROF. ROHAN RAJAPAKSE

Emeritus Professor of Entomology, University of Ruhuna

This is a continuation of the previous article written by me, published in The Island on 19 Jan 2021. (Fall Armyworm: Strategies for Effective Management). I also wrote about this pest in 2019 and I have emphasised the following: The Fall armyworm – FAW (Spodoptera frugiperda known as sena caterpillar) female is a strong flier capable of flying more than 100 KMs per day, nearly 500Km of flying during lifetime, depositing 1500 eggs an average. The other factors that are centered on FAW are: FAW consumes many different crops but prefers Maize; also it spreads quickly across large geographical areas, and can persist throughout the year.

The FAW, originated in the Americas, invaded the Africans in 2016, and was detected in the Indian subcontinent, in 2017, and believe the FAW naturally migrated to Sri Lanka, from India, in 2018. Sri Lanka lost the initial opportunity in 2018, as we were not adequately prepared to stop the spread, although the Department of Agriculture did some work; but the FAW was present in all SL districts, except Nuwara-Eliya and Jaffna. The ban on cultivating maize, in the following year helped to contain the spread, but now it is spreading again, confirming the belief that once FAW invaded it will stay.

Hence what are the strategies available now? As we emphasized, the management of FAW has to be centered on Short, Mid and Long-term strategies.

 

Short-Term Strategies:

Destruction of FAW eggs found on leaves and developing whorl by hand. The middle level expertise in the Department, such as Agricultural Instructors, KVS and the development and Project Assistants, recently recruited to the Government service, along with the farmers, should be trained to detect the eggs and destroy them immediately on the ground. If we miss this opportunity, the eggs will mature and tiny first instars larvae could be seen. At this stage, the only opportunity is to apply a Department of Agriculture approved chemical pesticide, using a knapsack sprayer or power sprayer at the recommended dilution. The names of the recommended pesticides are available with all research and extension officers of the Department of Agriculture.

It is also recommended that no single strategy of FAW pest control will yield strategic results. The employment of Integrated Pest Management Strategies should be carried out, such as combining Chemical control with cultural and sanitary control practices, which will give satisfactory control. When the larvae are small, proper timing and spray of pesticides are critical for elimination of this pest.

 

Mid-Term Strategies

: It is of paramount importance to understand that elimination of these dangerous pests are to be carried out jointly by the Government and Provincial Councils for effective control. The US University researchers, after working jointly with USDA, have identified the effective parasitoids, and they have released millions of parasitoids using the federal government facilities and the Universities in Florida, Georgia, and South Carolina.

Sri Lanka should avail this opportunity by writing to the authorities of the USDA, and arranging to import the strategic parasitoids, already identified to suit tropical countries, such as Sri Lanka.

This reminds me of the imports of eggs. Larval and pupal parasitoids from Indonesia, Malaysia, and establishment of those parasitoids in the WP and Coconut Research Institute to eliminate the Coconut leaf boring caterpillar Promecotheca cumingii n early and mid -70s in Western Province, which is in practical operative till now.

 

Long-Term Strategies:

Sri Lanka should declare an Emergency if it wants to eleminate the pest. Maize is a staple food of many African countries. The Long-term strategies are early detection of the pest, stopping its spread, and initiation of research programmers to import tolerant varieties, and granting permission to import such tolerant varieties produced by SEEDS giants, such as Monsanto.

However, these could be controversial. The Director General of Agriculture should be the leader and chief executive of this strategy, and no one should undermine his authority, as we witnessed a team of Rwandan experts, from Ghana, coming here and advising farmers without the knowledge of the DG, and even the Minister himself. Still no one knows what sort of pesticidesethese Rwandan Experts have recommended?

(The writer is Former Senior Professor of Agriculture Biology, University of Ruhuna. Received his PhD in Entomology from the University of Florida, USA, in 1985, on a research assistantship. The title of this thesis is on the Fall armyworm, its parasitoids and Ecology for effective management)

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Opinion

How to avoid water shortages and power cuts

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A section of the Southern Expressway affected by floods (file photo)

 

It is a strange thing in this country with so many rivers flowing into the sea right round the island, as soon as the rains cease there is a drought and there are thousands affected with no possibility of getting anything out of what they have cultivated, be it rice or vegetables. And while the rains last there are a number of places that get inundated with roads impassable and people displaced from their abodes.

If one recalls the history of this blessed isle it was King Parakramabahu the Great who said that not a drop of water should be allowed to go into the sea without being made use of. That was the era when Sri Lanka exported rice to other neighbouring countries. How did they do this? They had neither sophisticated equipment nor machines that are available now. They also did not have the help of foreign qualified experts. But with whatever skills they had they were able to achieve what they wanted. All this was done by conserving the water from the seasonal rains the island had.

The weather patterns have changed and now we do not get rain as stated in our books on Geography. What we learnt from the books was that the south western monsoon will be from around May to end August/ beginning September. The North eastern monsoon brings rain from November to February. In between these two monsoons there will be convectional rain in the months of April and October. Does the rainy seasons occur as in the book now? Not at all. The weather patterns have changed completely. The farmers are not sure as to when the rains would come, unlike in the good old days.

The rains are unpredicatable. When it rains it pours for a short period. But in that short period there are floods and roads, paddy fields and houses get inundated. The rains cease and the flooding subsides. The authorities have forgotten what happened and they get back to their normal routine until the rains strike again with the same results.

Then there is a prolonged period of drought. Now the reverse happens. There is no water to cultivate and in some areas no water to drink. What has been cultivated has withered away. The farmers are in a quandary as they are unable to pay back the loans they have obtained to cultivate with the hope of repaying after the harvest.

When there is heavy rain for a long period the reservoirs and tanks swell up and then the sluice gates are open to let the excess water out. This water that is let out just gushes out and goes into the sea without being made use of at all. Why is it not possible for the irrigation authorities to have tanks at a lower level to collect the excess water and make use of this water too? There is such a large amount of water that is released like this which can be made use of for cultivation when there is no rain.

The large amount of water carried by the Kalu Ganga has been flowing into the sea from time immemorial without being used for anything other than for people to bathe and bathe their animals. This is a source where the water can be conserved and if possible diverted to the dry zone to assist the farmers in their cultivation.

Even in the city of Colombo when it rains heavily we have seen the same areas getting flooded. This has been the case for a long time. But so far nothing has been done and come the next rain we will experience the same problem. This is so in the areas in Galle, Ratnapura, etc.

It is time the relevant authorities looked into this and do the needful to conserve the large amount of water that flows into the ocean without being made use of. It may be possible to use this water not only for agriculture but also for generation of hydro power. If this can be done, this island will never have to face water cuts and power cuts.

 

HM Nissanka Warakaulle

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