Features
SOS to rescue Sri Lanka’s dying healthcare
By Krishantha Prasad Cooray
Someone in Sri Lanka, right now as I write, is distraught because a child, a parent or a loved one has died, is dying or is seriously ill due to lack of medicine and medical care.Some die because doctors just cannot handle the overwhelming number of patients, or they simply cannot afford the eyewatering private hospital charges.
In a world of increasingly glaring disparities, we could dismiss such situations as inevitable, especially in a time of unprecedented economic stress, but such dismissal can only be defended if all necessary steps have been taken to ensure that what is possible can indeed be delivered. It is abundantly clear that this is not the case.
We are not talking about critical care necessitating costly drugs and sophisticated surgery, but non-serious medical situations that can be and have been treated successfully in Sri Lanka.
In a time of crisis hard choices must be made. Priorities must be revisited and revised. Cutbacks are inevitable even when it comes to areas that have previously been treated as untouchable. This is true of households, and it is true of nations. Consumption patterns quickly change in poorer households. Relative luxuries are shelved, but a lot of care is taken to make sure that nutrition and health are not compromised beyond certain minimum levels. This is not hard to understand. In the end it is life that counts. It is the same with a country. A nation without people is not a nation. A nation in which people are sick and cannot get the treatment is a sick nation. No amount of debt restructuring can cure such a nation.
Professionals jumping ship
Falling ill even with a minor malady has become a major matter. The severe dearth of medicines and medical equipment and the growing cost of health care constitute one side of the problem. The other side is the prevailing trend of medical professionals leaving the country, especially the most qualified and competent among them. In fact, we often hear of the accomplishments of Sri Lankan doctors currently domiciled or having citizenship in other countries. A massive loss in and of itself, but one that can easily get much worse considering that the best among those who chose to stay are contemplating leaving or have already left.
The bottom line is that we just cannot let our doctors go. Each and every one of us will one day be forced to put our lives in the hands of a doctor. A doctor is a treasure. Doctors and nurses are invaluable. We need them and they need to be protected.
Some short-sighted commentators who perhaps cannot see beyond the rupees and cents of things have seen this as a positive trend, considering the possibility of dollar and euro remittances. But what happens when the best healers leave the country? Aren’t they also the ones who set the standards? Aren’t they the principal mentors of the next generation of physicians? And since most of them are not going abroad just for employment but are actually migrating with their families, how much will they remit, if at all? When doctors leave, there’s a very negative message being sent to everyone including other professionals: ‘leave if you can!’
Sri Lankan medical professionals are second to none in the world. This is true of doctors and other categories in the health sector such as nurses and medical technicians. They work tirelessly in less-than-ideal conditions. Despite meagre resources and having to attend on an inordinate number of patients, they are one of the main reasons why Sri Lanka’s health system is the envy of her neighbours and countries in the same or even higher brackets of economic prosperity. While there are those who chide doctors for engaging in private practice, it is often forgotten that the vast majority of them consider their work in the state-run hospitals as their primary vocation, despite the comparatively small remuneration package.
They don’t neglect this work. They not only work but incur the wrath of some who forget that Sri Lanka is not an affluent country and are ignorant of the fact that doctors in such countries see a fraction of the patients our doctors attend to for a fraction of the salary. We should not forget that even though working under extremely trying circumstances Sri Lankan doctors are among the most accessible professionals in the world.
Let us recall the adage, ‘people leave managers, not companies.’ It is applicable here. The one thing that can make a dent in the ongoing ‘brain drain’ is strong, compelling, articulate, and empathetic leadership.
Captain lacks support from crew
The onus in this crisis-ridden climate falls directly on President Ranil Wickremesinghe. In his favour is the fact that he had the self-belief that there was no one else to take control of a sinking ship. He’s steadied it, picked a course and although it is still taking in a lot of water, there’s hope that it will remain afloat.
On the downside is the fact that he’s playing a lone hand for all intents and purposes. He has no team worth that name. So, it is a solo game. He’s a man with a country to worry about, walking a tight rope that is suspended over an abyss while detractors at either end tweak the rope. To use a cricketing analogy, he’s the only one in the team who can be called a halfway decent batsman and halfway decent bowler; except that he must keep wickets, coach the team and chase the red cherry simply because the fielders seem to have sprung roots.
All the more reason for the president, handicapped as he is, to take matters into his own hands. The time for outsourcing responsibility for the health sector is long past. He can and must speak to the medical fraternity. It is unlikely they’ll listen or be moved by anyone else. The President himself has to convince them of the plans to turn things around, what has been done, what is going to be done, and why their support at this hour is so crucial for the well-being of the country and its citizens.
Such an address is necessary but certainly far from sufficient. The health sector serves the public, but it includes private enterprises. We have channeling services, dispensaries, all kinds of clinics, laboratories, nursing homes, care giving outfits and fully fledged hospitals. These too are faced with the same human resources problems. On the other hand, the potential for the expansion of this segment of the sector, the setting up of new private hospitals for example, needs to be explored and facilitated. If the market is expanded leading to greater competition, private health care might become more affordable and therefore more accessible to a larger share of Lankans.
With proper policy backing, there’s nothing to stop reputed universities the world over partnering such private hospitals to train doctors, nurses, and other medical professionals. For all this, the regulatory mechanism needs to be revisited and streamlined. Again, the onus is on the president. He can and must take the initiative to create the conditions. He can and must lay the foundation to turn Sri Lanka into a medical tourism hub for the region where all these facilities are complemented by the focused and planned development of the indigenous medical system in the country.
The same goes for the pharmaceutical sector. The question of affordability can be resolved to a great extent if competition is encouraged, and mechanisms set in place to ensure standards. Resolving the criminally tragic situation prevailing in the NMRA – a direct result of interference by incompetent politicians – is an urgent must. Conditions can be created to encourage investors, local and otherwise, to set up such industries here in Sri Lanka. The ‘greener pastures’ that medical professionals seek abroad can be ‘grown’ right here in this island.
All hands on deck
The President could start by talking to the business leaders in and out of the health sector. They need to be convinced that the problem is serious, and he is serious about not just resolving immediate issues but setting the wheels in motion to make things work in the long run.
The President has to convince the professionals that it is worthwhile fighting this battle. He must give them a reason to stay. He has to say it and do it. He must show vision and develop a plan based on this vision. He must demonstrate commitment to execute this plan. He must put together a team that can support him. He must set deadlines and work towards meeting them. Dispatching acquaintances to deputise for him in the matter of investigating random allegations will just not do it. Simply put, problems of this nature cannot be outsourced.
There’s someone somewhere grieving over a loved one who passed away or is about to because of a condition that would have been curable if curable ailments of the system had been sorted out. The dying person or the person who died could be you or me. You or I could be the person grieving. It is nothing but a tragedy when someone cannot buy medicine for a child or a parent. It is downright uncivilized in fact. Only those in such situations truly understand the dimensions of the tragedy.
Unfortunately medical professionals are fighting a difficult battle, a battle which could be won if the relevant authorities opened their eyes, used their brains, and showed some kind of leadership. Politicians don’t need our health system. When they are unwell, they seek treatment not in our hospitals but abroad. The absolute majority of our people do not have that choice. They will live or die here. Can the President deliver for them?
By Basab Dasgupta
The most disruptive and divisive series of events that I have seen during my life in the US was what happened after George Floyd’s death while in police custody in Minnesota in 2020.Widespread protests and violence, destruction of businesses, surge of Black Lives Matter (BLM) movement, attack on police officers, call to defund the police which in turn led to an increase in criminal activities in big cities, burning of American flags all continued for months. It turned the clock back decades as far as the racial harmony between blacks and whites was concerned.
I must confess that I failed to be too sympathetic towards this movement. I strongly felt that the need for law enforcement is one of our top-most priorities and statistically speaking, there would be more black arrests because crimes are rampant in pre-dominantly black neighbourhoods. I thought that the police officer Derek Chauvin was doing his job in his effort to subdue George Floyd a known criminal with a long rap sheet. Yes, he might have used excessive force but that may have been explained by the situation. Even black conservative commentators like Candace Owens were critical of all the anti-establishment activities.
As part of my dislike for the BLM movement, I was intensely against all woke activism including football player Colin Köpenick’s refusal to stand during national anthems, Hollywood’s encouragement to make more racially inclusive movies featuring more black actors, Joe Biden’s choice for Vice President and Supreme Court judge nominee, combination of BLM with LGBTQ+ movements under the rainbow flag and the entire mantra of “diversity and inclusivity”.
My views changed almost overnight a few days ago when I heard the news of a 23-year-old graduate student, Jaahnavi Kandula of Indian origin, being run over by a police car in Seattle while crossing the street. The accident happened on 23 January 2023, but the video from the bodycam of a police officer was just released. The car was being driven by Kevin Dave who was on an emergency call and driving at 74 mph in a zone with 25 mph speed limit.
There was a photograph of the girl so cute, so innocent, so full of optimism for a bright future; she was going to graduate in December. Tears came to my eyes thinking of my own daughter at that age and the heartbreak of the girl’s parents.
It was shocking and horrific, but such tragic accidents do happen every day in America, and I could shrug it off as another act of God that I would never understand. However, the worst part was the comment of one of the police officers. It was reported that a police officer Daniel Auderer, who happens to be the vice president of the Seattle Police Officers’ Guild, laughed at the incident and made comments like “It’s a regular person”, “there is not much value to her life”, “just write a check for $11000” during a call to Mike Solan, the president of the guild. This was all caught on the body cam video.
I could not believe what I was reading and went to YouTube to see if the video had been posted. Sure enough, I found multiple clips, each containing the comments and laughter. It was not some mumbling and giggling; comments were loud and clear.
The chilling part was the laughter. It was evil, it was as if Satan himself was laughing. It was sickening. Equally shocking was what happened after the incident was brought to the attention of superiors. Daniel reportedly confessed to making those comments but explained away his reaction by claiming that he was laughing not at the dead girl but at how the lawyers would now jump into action arguing about “value of life”. Nothing happened to the officers, not even a suspension for a few days.
The decision was that there was no need to hold Kevin guilty or initiate a criminal investigation. Despite a suspicion that Kevin was under the influence of drugs, Daniel vindicated him by lying on his behalf that he was travelling at 50 mph, a manageable speed for a trained driver, and he was not impaired the so-called “blue wall of silence”.
Daniel was obviously stupid to minimize the value of this girl’s life. I am sure that he did not know that the current President of India is a woman in a country which also elected a woman prime minister in the largest democratic country almost 60 years ago. He does not know that some of the most important positions in the world today are held by Indian women, such as the Assistant Director General of WHO and chief economist of IMF. He probably did not know how to distinguish a woman of Indian origin from other women of colour.
He could not have any appreciation for a young woman coming here for higher studies leaving her family behind so that she could get a good job and help her family live a better life.
As I started to digest the whole episode, it gradually dawned on me. This police officer may not be an isolated example. Many of the other 600,000+ policemen probably share a similar background and attitude. Daniel is a bully, a racist, an uneducated person and brazen enough to openly make such statements because he is used to making such comments.
This is perhaps not surprising. Who wants to be a policeman? Clearly, he must be physically fit and strong. He cannot be well-educated because then he would have chosen a different profession. Who else would want to risk his life every day? He must be a bully because his job is to track down criminals. He is a racist because he has seen in his job that there are more people of colour who are arrested for suspicion of a crime. He probably grew up in an equally uneducated and unsophisticated family environment. We probably only get people like him to join the force.
The policemen in this country supposedly go through regular sensitivity training on race-related issues and how to be objective. Clearly expense for such training is being wasted in Seattle.
I immediately thought of the BLM movement. Suddenly, I understood the rage and frustration of all the African American people joining the movement. I can now believe that the black folks are indeed stopped in much larg-er proportion than their white counterparts for minor offenses. I now believe that police have a very low assessment of their lives. I now believe in stories of police abuse and brutality.
I do not know how the Indian government or the Indian American community will react to this incident. I read headlines like “Biden Administration has promised swift action” and numerous comments expressing outrage and disgust below every YouTube post. Some are demanding “accountability”, but what does it mean? Should the police officer be fired? Should he be tried in a court of law like Derek? Should the police union be dismantled? Indians are peaceful people; they are not going to protest at the State capitol or burn police cars. I suspect that nothing will happen to Kevin or Daniel and the incident will gradually be forgotten.
What can I do? Should I join the BLM movement and encourage its leaders to generalize the name “BLM” to include Brown lives matter? I am sure that Mexicans will join in that effort. Should I say, “Enough with America” and go back to India? Should I organize a protest in front of a local police station? (The Statesman/ANN)
Today I just write to release my anger and to see if “a pen is mightier than a sword”.
(The writer, a physicist who worked in industry and academia, is a Bengali settled in America.)
There was a pall of silence over who accompanied our President to the Big Apple for the Big Meeting of the United Nations. Hence our curiosity was roused, minds scratched around for news. Cassandra WhatsApped a good friend of hers now living in California and asked her whether she knew who accompanied our Prez.
We thought in these hard times only the very essential and relevant to the occasion VIPs would be taken along: a lean contingent would be Prez Wckremesinghe’s orders. Cassandra hurried to her computer and googled. Plenty on President Ranil Wickremasinghe’s address to the UN General Assembly on 21 Sept., which was on the theme, “Rebuilding trust and reigniting solidarity and its relevance to Sri Lanka’s recent challenges.” Reading many articles Cass gathered that Prez RW had dealt with the country’s economic and other travails; global geopolitical landscape; climate action taken and to be taken; carbon reduction et al in his address at UNGA.
It was stated in one article that the Prez was accompanied by Minister of Foreign Affairs Ali Sabry, Secretary to the President E M S B Ekanayake, Foreign Secretary Aruni Wijewardena and other senior officials of the Ministry of Foreign Affairs. So, she rested her mind that no extraneous hangers-on had accompanied the Prez.
Then came a newspaper write up that MPs Rohitha Abeygunewardena and Mahindananda Aluthgamage were in the contingent – stalwarts of the SLPP. What use were they in the context of the topics on which the Prez made his UN address? Were they experts on any issues that would have been discussed at side meetings? Experts on economics, geopolitical matters, climate change, balance of world power? NO! It seemed to be a pure (or rather impure) peace-making gesture and to keep quiet two demanders for Cabinet positions.
Sops to Cerberus in the way of a plane ride to and from, and a stay in one of the more expensive hotels in the Big Apple? Can you believe that the MPs and two die-hard Pohottu MPs and previous ministers want a joy ride and will do anything to get one? Also, that we poor Sri Lankans, suffering such slings and arrows of bad fortune in a bankrupt country with soaring prices to be paid for even the water we drink, food we so niggardly eat and electricity we so sparingly use have paid for these two to junket? We have to fork out taxes, even those with nothing to show as assets. And where does a huge amount of this collected money go? To pay for pleasure junkets for those we feel have no right to go to the UN General Assembly.
When Mahinda Rajapaksa was the President, he would take a huge group of persons who in the majority were completely redundant and of no use at all to these UN General Assembly annual gatherings. A worker in the UN in New York commented that most of those who went along dispersed soon after they had landed, in a fleet of cars hired for the visit, making a vehicle-hiring Sri Lankan in the US rich. Most of them were not even present when the Sri Lankan president made his address.
At least, they could have helped to reduce the mass of empty seats in the UN Assembly hall. Thus, it was surmised that he was repaying his catchers for being loyal to him – at our expense. No dissent, whether loud or soft, then. No one dared question why or wherefores. No one wanted to be taken on a white van ride; or worse, taken on the final journey. Cassandra must add here that a couple of brave women journos did speak up.
And to think there was a replay of this junketing in 2023, though reduced, under a Prez who understands well the plight the country is in and the need to save every rupee of government money. However, junketing was offered at the country’s expense. And by order of Prez RW. The two mentioned are very rich politicians.
Being suspicious
Cassandra experienced a happening that showed her how wary people are now, and untrusting. It is a natural outcome of the type of person the Sri Lankan is thought to be in these much-changed times. Do you remember when even in Middle East airports the Sri Lankan passport was treated with utter disdain and suspicion? Cass recalls that en route to Britain she had her passport and other Sri Lankan travellers’ passports confiscated on entry to the airport in Dubai and handed back only when the plane was re-boarding. She squirmed with embarrassment and resentment, but realised it was all because Sri Lankans had behaved shamefully dishonest and thus all Sri Lankans were branded untrustworthy.
Cass bought some tickets to enjoy a singing and dancing of Julius Caesar. The thousands she gave the young girl were found to be short. Saying she would get the balance from her driver, she instinctively took the tickets and was about to step out when she noticed the consternation of the box office girl. Suspicion, she realised, that she would not return. Cass apologised, placed the tickets on the counter, went out to get the Rs 500 needed and then, retrieving her tickets, commented it was so sad that the young one could not trust this old dame. She assured her it was no fault of hers; she was doing her duty, but people nowadays had killed the trust that was a given in years gone by. Even an absolutely honest and honourable person, grey-haired maybe and dignified, is treated with suspicion. What a sad state of affairs! But we ourselves are to blame since cheating and dishonesty are strong features of the present-day islanders of the Pearl of the Indian Ocean.
By Dr Mohan Jayatilake Consultant Cardiologist
Every year on the 29th of September, World Heart day is observed to raise awareness about cardiovascular disease (CVD), which is heart diseases and strokes. As heart diseases are a leading cause of death in the world people must be educated about them and the timely prevention to achieve this goal. World Heart day commenced in 1999 through the joint efforts of World Health Organization (WHO) and the World Heart Federation (WHF).
The theme of the World Heart Day 2023 is “Use Heart, Know Heart” emphasizing the importance of healthcare worldwide. This year’s campaign focuses on the essential step of knowing your heart first. The World Heart Federation has created this day to raise awareness about cardiovascular diseases.
The key message of World Heart Day this year aims to encourage people to look after themselves, others and nature as well. Putting a coordinated effort to improve ones’ own lifestyle and diet and motivating others to do the same can lead to a reduced number of CVD cases.
Heart diseases and strokes are the worlds’ leading cause of death claiming 17.9 million lives every year. According to WHO statistics 82% of deaths coming in from low and middle income countries are due to lack of resources.
Since a healthy heart is the gateway to a healthy life it is important to ensure the health of your heart. With the growing number of heart patients worldwide it has become a cause of concern since of late.The day is observed by organising events worldwide to make people aware about the warning signs of heart disease so that people can take steps accordingly to avoid this disease.
Together with members of WHF spread the news that at least 80% of premature deaths from heart disease and strokes could be avoided if main risk factors such as heavy smoking, unhealthy diet, reduced physical activity (sedentary lifestyle), stressful lifestyle, psychological issues, hypertension, diabetic and heavy alcoholism are controlled. Being obese and overweight, BMI (Body Mass Index) more than 25, is found to be one of the main risk factors that may harm your heart. Air pollution also can lead to coronary artery disease and stroke, chronic obstructive pulmonary disease and lung cancer as short term and long term effects.
Fortunately now we have almost come out of COVID 19 pandemic which caused more vulnerable patients having severe cardiovascular events.
Events of the World Heart Day 2023
There are numerous events at the national and international level promoted by WHF. They disseminate information and hold discussions of various heart ailments at different platforms. Some of them like posters, podcasts and forums are quite popular. The day is marked by providing free fitness check-ups, fundraises, walks, runs, concerts and sporting events. All such events encourage people to stay active and be aware of their health.
Global leaders recognise the urgency to give priority to prevention and control of heart diseases and other non-communicable diseases (NCD).Which include cancer, diabetic, and chronic lung diseases.
How to contribute to observance of the event on World Heart Day
By undergoing heart health check at a center near you.
By managing your weight and keeping BMI index under control with less than 25.
By trying to stay active through different physical activities
By attending seminars to learn about different life saving activities like CPR
By attending fitness lectures and lessons of healthy living
According to this year theme also, use your heart for the betterment of others’ heart, by taking following steps to reduce the burden of heart disease. Stop smoking – Cigarette smokers are 2 to 4 times more prone to get heart diseases and strokes than non-smokers. Passive smoking inside the house will also harm your own heart and your family health, causing cardiovascular disease.
Avoid alcohol – Stressful conditions in life can lead to use of alcohol and smoking. Meditation, yoga, music or involvement with any other aesthetic will help to minimize stress and to move away from alcohol.
Healthy diet at home
Limit saturated fats and trans fats
Limit salt and sugar intake
Consume plenty of fruits and vegetables
Unhealthy diet is one of the main causes of obesity, diabetic and cardiovascular diseases. Rapid urbanisation, changing lifestyle and easy access of fast food have made the dietary pattern unhealthy.
Animal products mainly beef, pork and poultry with skin, mutton, lard, butter, cheese carry lot of saturated fats. Avoid having trans fats which are in baked, processed and fried food items, certain margarines and spreads. Take lean meats, poultry without skin, low fat dairy products, fish and nuts with vegetable oil in moderation.
Regular Exercise
Adults should do at least 150 minutes of moderately intensive physical activity or at least 75 minutes of high intensive physical activity per week. Families should limit the amount of time spent in front of TV or continuous reading to less than 2 hours a day in a seated position. Exercises should be a regular part of life.
Lose weight
World is now facing visible epidemic of obesity. It affects your cardiovascular health and also affect your wellbeing.To lose weight, do regular exercises, have healthy diet, cut down starch and sugar and alcohol. Have plenty of fruits and vegetables.
Manage stress
Psychological health can affect your cardio vascular health. Regular exercise and practice relaxation, reading, being with friends and family, adequate sleep, various hobbies maintain the positive attitude towards stress free life.
Know your numbers
Visit your doctor or health care professional, check your blood pressure regularly and take steps to control it and take regular medication.Know your cholesterol- high cholesterol is another factor for cardiovascular disease. Check regularly and control with dietary measures and medication. Know your blood sugar- Diabetic is another major factor for cardiovascular disease. Diet control, medication and professional advice required to control it.
Know your warning signs
To know the symptoms of CVD will help your survival because earlier the treatment better the chances of survival. Chest pain of tightening or burning in nature with pain radiating down the upper limbs or to the neck and jaw or back, associated with sweating and nausea are your warning signs.
Sudden weakness of limbs, slurring of speech, deviation of mouth, double vision could be due to a stroke. Knowing these symptoms and seeking urgent medical attention allow you to get treatment early to prevent life threatening complications.
Take your medicine regularly and correctly
If you are already diagnosed with heart disease or with stroke, taking your medication regularly will reduce another similar episode in future.
Breast feeding and lifelong health
Breast feeding is the best form of nutrition for newborn and infants according to WHO. Increasing public awareness is important. Infants who are breastfed tend to have lower cholesterol and blood pressure as well as lower rates of obesity.
Both undernourished and over nourished early in life can increase the risk of developing cardio vascular diseases. Maternal obesity during pregnancy has been associated with obesity in children which also increase the cardiovascular disease risk.
As always our emphasis will be on improving heart health across all nations in adult male and female as well as children. By adopting lifestyle changes, people all over the world can have longer and better lives through the prevention and control of heart disease and stroke. This was highlighted on this most important day to persuade people on maintain a healthy lifestyle.
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