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The problems of life

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(from Venerable Nārada Mahāther’s THE BUDDHA AND HIS TEACHINGS)

Who? Whence? Whither? Why? What? are some important problems that affect all humanity.

1) Who is man? is our first question.

Let us proceed with what is self-evident and perceptible to all.

Man possesses a body which is seen either by our senses or by means of apparatus. This material body consists of forces and qualities which are in a state of constant flux.

Scientists find it difficult to define what matter is. Certain philosophers define “matter as that in which proceed the changes called motion, and motion as those changes which proceed in matter.”

The Pāli term for matter is Rūpa. It is explained as that which changes or disintegrates. That which manifests itself is also another explanation.

According to Buddhism there are four fundamental material elements. They are Pathavi, Āpo, Tejo, and Vāyo

Pathavi means the element of extension, the substratum of matter. Without it, objects cannot occupy space. The qualities of hardness and softness which are purely relative are two conditions of this element. This element of extension is present in earth, water, fire and air. For instance, the water above is supported by water below. It is this element of extension in conjunction with the element of motion (Vāyo) that produces the upward pressure. Heat or cold is the Tejo element, while fluidity is the Āpo element.

Āpo

is the element of cohesion. Unlike Pathavi it is intangible. It is this element which enables the scattered atoms of matter to cohere and thus gives us the idea of body.

Tejo

 is the element of heat. Cold is also a form of Tejo. Both heat and cold are included in Tejo because they possess the power of maturing bodies, or, in other words, the vitalising energy. Preservation and decay are due to this element.

Vāyo

 is the element of motion. The movements are caused by this element. Motion is regarded as the force or the generator of heat. Both motion and heat in the material realm correspond respectively to consciousness and Kamma in the mental.

These four powerful forces are inseparable and interrelated, but one element may preponderate over another, as, for instance, the element of extension preponderates in earth; cohesion, in water; heat, in fire; and motion, in air.

Thus, matter consists of forces and qualities which constantly change, not remaining the same even for two consecutive moments. According to Buddhism, matter endures only for 17 thought-moments. [2]

At the moment of birth, according to biology, man inherits from his parents an infinitesimally minute cell 30 millionth part of an inch across. “In the course of nine months this speck grows to a living bulk 15,000 million times greater than it was at outset. [3] This tiny chemico-physical cell is the physical foundation of man.

According to Buddhism sex is also determined at the moment of conception.

Combined with matter there is another important factor in this complex machinery of man. It is the mind. As such it pleases some learned writers to say that man is not Mind plus Body, but is a Mind-Body. Scientists declare that life emerges from matter and mind from life. But they do not give us a satisfactory explanation with regard to the development of the mind

Unlike the material body immaterial mind is invisible, but it could be sensed directly. An old couplet runs:-

“What is mind? No matter.What is matter? Never mind.”

We are aware of our thoughts and feelings and so forth by direct sensation, and we infer their existence in others by analogy.

There are several Pāli terms for mind. Mana, Citta, Vijgana the most noteworthy of them. Compare the Pāli root man, to think, with the English word man and the Pāli word Manussa which means he who has a developed consciousness.

In Buddhism no distinction is made between mind and consciousness. Both are used as synonymous terms. Mind may be defined as simply the awareness of an object since there is no agent or a soul that directs all activities. It consists of fleeting mental states which constantly arise and perish with lightning rapidity. “With birth for its source and death for its mouth it persistently flows on like a river receiving from the tributary streams of sense constant accretions to its flood.” Each momentary consciousness of this ever-changing life-stream, on passing away, transmits its whole energy, all the indelibly recorded impressions, to its successor. Every fresh consciousness therefore consists of the potentialities of its predecessors and something more. As all impressions are indelibly recorded in this ever-changing palimpsest-like mind, and as all potentialities are transmitted from life to life, irrespective of temporary physical disintegrations, reminiscence of past births or past incidents becomes a possibility. If memory depends solely on brain cells, it becomes an impossibility.

Like electricity mind is both a constructive and destructive powerful force. It is like a double-edged weapon that can equally be used either for good or evil. One single thought that arises in this invisible mind can even save or destroy the world. One such thought can either populate or depopulate a whole country. It is mind that creates one’s heaven. It is mind that creates one’s hell.

Ouspensky writes: “Concerning the latent energy contained in the phenomena of consciousness, i.e. in thoughts, feelings, desires, we discover that its potentiality is even more immeasurable, more boundless. From personal experience, from observation, from history, we know that ideas, feelings, desires, manifesting themselves, can liberate enormous quantities of energy, and create infinite series of phenomena. An idea can act for centuries and millennia and only grow and deepen, evoking ever new series of phenomena, liberating ever fresh energy. We know that thoughts continue to live and act when even the very name of the man who created them has been converted into a myth, like the names of the founders of ancient religions, the creators of the immortal poetical works of antiquity, heroes, leaders, and prophets. Their words are repeated by innumerable lips, their ideas are studied and commented upon.

“Undoubtedly each thought of a poet contains enormous potential force, like the power confined in a piece of coal or in a living cell, but infinitely more subtle, imponderable and potent. [4]”

Observe, for instance, the potential force that lies in the following significant words of the Buddha:

— Mano-pubbangāma dhammā ? mano – setthā – manomayā.Mind fore-runs deeds; mind is chief, and mind-made are they.

Mind or consciousness, according to Buddhism, arises at the very moment of conception, together with matter. Consciousness is therefore present in the foetus. This initial consciousness, technically known as rebirth-consciousness or relinking-consciousness (Patisandhi vijnna), is conditioned by past kamma of the person concerned. The subtle mental, intellectual, and moral differences that exist amongst mankind are due to this Kamma conditioned consciousness, the second factor of man.

To complete the trio that constitutes man there is a third factor, the phenomenon of life that vitalises both mind and matter. Due to the presence of life reproduction becomes possible. Life manifests itself both in physical and mental phenomena. In Pāli the two forms of life are termed Nāma jivitindriya and Rūpa jivitindriya — psychic and physical life.

Matter, mind, and life are therefore the three distinct factors that constitute man. With their combination a powerful force known as man with inconceivable possibilities comes into being. He becomes his own creator and destroyer. In him are found a rubbish-heap of evil and a storehouse of virtue. In him are found the worm, the brute, the man, the superman, the deva, the Brahma. Both criminal tendencies and saintly characteristics are dormant in him. He may either be a blessing or a curse to himself and others. In fact, man is a world by himself.

2) Whence? is our second question. How did man originate’?

Either there must be a beginning for man or there cannot be a beginning. Those who belong to the first school postulate a first cause, whether as a cosmic force or as an Almighty Being. Those who belong to the second school deny a first cause for, in common experience, the cause ever becomes the effect and the effect becomes the cause. In a circle of cause and effect a first cause is inconceivable. According to the former life has had a beginning; while according to the latter it is beginningless. In the opinion of some the conception of a first cause is as ridiculous as a round triangle.

According to the scientific standpoint, man is the direct product of the sperm and ovum cells provided by his parents. Scientists while asserting “Omne vivum ex vivo”--all life from life, maintain, that mind and life evolved from the lifeless.

Now, from the scientific standpoint, man is absolutely parent-born. As such life precedes life. With regard to the origin of the first protoplasm of life, or “colloid” (whichever we please to call it), scientists plead ignorance.

According to Buddhism, man is born from the matrix of action (kammayoni). Parents merely provide man with a material layer. As such being precedes being. At the moment of conception, it is Kamma that conditions the initial consciousness that vitalizes the foetus. It is this invisible Kammic energy generated from the past birth that produces mental phenomena and the phenomenon of life in an already extant physical phenomenon, to complete the trio that constitutes man.

Dealing with the conception of beings the Buddha states:

“Where three are found in combination, there a germ of life is planted. If mother and father come together, but it is not the mother’s period, and the ‘being-to-be born’ (gandhabba) is not present, then no germ of life is planted. If mother and father come together, and it is the mother’s period, but the ‘being-to-be-born’ is not present, then again, no germ of life is planted. If mother and father come together, and it is the mother’s period, and the ‘being-to-bc-born’ is also present, then, by the combination of these three, a germ of life is there planted.”

Here Gandhabba (= gantabba) refers to a suitable being ready to be born in that particular womb. This term is used only in this particular connection, and must not be mistaken for a permanent soul.

For a being to be born here a being must die somewhere. The birth of a being corresponds to the death of a being in a past life; just as, in conventional terms, the rising of the sun in one place means the setting of the sun in another place.

The Buddha states: “a first beginning of beings who, obstructed by ignorance and fettered by craving, wander and fare on, is not to be perceived.”

This life-stream flows ad infinitum as long as it is fed with the muddy waters of ignorance and craving. When these two are completely cut off, then only does the life-stream cease to flow; rebirth ends as in the case of Buddhas and Arahants. An ultimate beginning of this life-stream cannot be determined, as a stage cannot be perceived when this life force was not fraught with ignorance and craving.

The Buddha has here referred merely to the beginning of the life-stream of living beings. It is left to scientists to speculate on the origin and the evolution of the universe.

3) Whither? is our third question.

Where goes man?

According to ancient materialism which, in Pāli and Samskrit, is known as Lokāyata, man is annihilated after death, leaving behind him any force generated by him. “Man is composed of four elements. When man dies the earthy element returns and relapses into the earth; the watery element returns into the water; the fiery element returns into the fire; the airy element returns into the air, the senses pass into space.

Wise and fools alike, when the body dissolves. are cut off, perish, do not exist any longer. There is no other world. Death is the end of all. This present world alone is real.

The so-called eternal heaven and hell are the inventions of imposters.

Materialists believe only in what is cognizable by the senses. As such matter alone is real. The ultimate principles are the four elements — earth, water, fire and air. The self-conscious life mysteriously springs forth from them, just as the genie makes its appearance when Aladdin rubs his lamp. The brain secretes thought just as liver secretes bile.

In the view of materialists the belief in the other world, as Sri Radhakrishna states, “is a sign of mendaciousness, feminism, weakness, cowardice and dishonesty.”

According to Christianity there is no past for man. The present is only a preparation for two eternities of heaven and hell. Whether they are viewed as places or states man has for his future endless felicity in heaven or endless suffering in hell. Man is therefore not annihilated after death, but his essence goes to eternity.

“Whoever,” as Schopenhaeur says, “regards himself as having become out of nothing must also think that he will again become nothing; or that an eternity has passed before he was, and then a second eternity had begun, through which he will never cease to be, is a monstrous thought.”

The adherents of Hinduism who believe in a past and present do not state that man is annihilated after death. Nor do they say that man is eternalized after death. They believe in an endless series of past and future births. In their opinion the life-stream of man flows ad infinitum as long as it is propelled by the force of Kamma, one’s actions. In due course the essence of man may be reabsorbed into Ultimate Reality (Paramātma) from which his soul emanated.

Buddhism believes in the present. With the present as the basis it argues the past and future. Just as an electric light is the outward manifestation of invisible electric energy even so man is merely the outward manifestation of an invisible energy known as Kamma. The bulb may break, and the light may be extinguished, but the current remains and the light may be reproduced in another bulb. In the same way the Kammic force remains undisturbed by the disintegration of the physical body, and the passing away of the present consciousness leads to the arising of a fresh one in another birth. Here the electric current is like the Kammic force, and the bulb may be compared to the egg-cell provided by the parents.

Past Kamma conditions the present birth; and present Kamma, in combination with past Kamma, conditions the future. The present is the offspring of the past, and becomes in turn the parent of the future.

Death is therefore not the complete annihilation of man, for though that particular life span ended, the force which hitherto actuated it is not destroyed.

After death the life-flux of man continues ad infinitum as long as it is fed with the waters of ignorance and craving. In conventional terms man need not necessarily be born as a man because humans are not the only living beings. Moreover, earth, an almost insignificant speck in the universe, is not the only place in which he will seek rebirth. He may be born in other habitable planes as well. [6]

If man wishes to put and end to this repeated series of births, he can do so as the Buddha and Arahants have done by realizing Nibbāna, the complete cessation of all forms of craving.

Where does man go? He can go wherever he wills or likes if he is fit for it. If, with no particular wish, he leaves his path to be prepared by the course of events, he will go to the place or state he fully deserves in accordance with his Kamma.

4) Why? is our last question.

Why is man? Is there a purpose in life? This is rather a controversial question.

What is the materialistic standpoint? Scientists answer:

“Has life purpose? What, or where, or when?Out of space came Universe, came Sun,Came Earth, came Life, came Man, and more must come.But as to Purpose: whose or whence? Why, None.”

As materialists confine themselves purely to sense-data and the present material welfare ignoring all spiritual values, they hold a view diametrically opposite to that of moralists. In their opinion there is no purposer — hence there cannot be a purpose. Non-theists, to which category belong Buddhists as well, do not believe in a creative purposer.

“Who colours wonderfully the peacocks, or who makes the cuckoos coo so well?” This is one of the chief arguments of the materialists to attribute everything to the natural order of things.

“Eat, drink, and be merry, for death comes to all, closing our lives,” appears to be the ethical ideal of their system. In their opinion, as Sri Radhakrishna writes: “Virtue is a delusion and enjoyment is the only reality. Death is the end of life. Religion is a foolish aberration, a mental disease. There was a distrust of everything good, high, pure, and compassionate. The theory stands for sensualism and selfishness and the gross affirmation of the loud will. There is no need to control passion and instinct, since they are nature’s legacy to men. “

Sarvadarsana Sangraha says:

“While life is yours, live joyously,None can escape Death’s searching eye;When once this frame of ours they burn,How shall it e’er again return? [8]”

“While life remains let a man live happily, let him feed on ghee even though he runs in debt.”

Now let us turn towards science to get a solution to the question “why.”

It should be noted that “science is a study of things, a study of what is and that religion is a study of ideals, a study of what should be.”

Sir J. Arthur Thompson maintains that science is incomplete because it cannot answer the question why.

Dealing with cosmic Purpose, Bertrand Russell states three kinds of views — theistic, pantheistic, and emergent. “The first”, he writes, “holds that God created the world and decreed the laws of nature because he foresaw that in time some good would be evolved. In this view purpose exists consciously in the mind of the Creator, who remains external to His creation.

“In the ‘pantheistic’ form, God is not external to the universe, but is merely the universe considered as a whole. There cannot therefore be an act of creation, but there is a kind of creative force in the universe, which causes it to develop according to a plan which this creative force may be said to have had in mind throughout the process.

“In the ’emergent’ form the purpose is more blind. At an earlier stage, nothing in the universe foresees a later stage, but a kind of blind impulsion leads to those changes which bring more developed forms into existence, so that, in some rather obscure sense, the end is implicit in the beginning. [9]”

We offer no comments. These are merely the views of different religionists and great thinkers.

Whether there is a cosmic purpose or not a question arises as to the usefulness of the tapeworm, snakes, mosquitoes and so forth, and for the existence of rabies. How does one account for the problem of evil? Are earthquakes, floods, pestilences, and wars designed?

Expressing his own view about Cosmic Purpose, Russell boldly declares: “Why in any case, this glorification of man? How about lions and tigers? They destroy fewer animals or human lives than we do, and they are much more beautiful than we are. How about ants? They manage the Corporate State much better than any Fascist. Would not a world of nightingales and larks and deer be better than our human world of cruelty and injustice and war?

The believers in cosmic purpose make much of our supposed intelligence, but their writings make one doubt it. If I were granted omnipotence, and millions of years to experiment in, I should not think Man much to boast of as the final result of all my efforts. “

What is the purpose of life according to different religions?

According to Hinduism the purpose of life is “to be one with Brahma” or “to be re-absorbed in the Divine Essence from which his soul emanated.”

According to Judaism, Christianity and Islam, it is “to glorify God and to enjoy Him forever.”

Will an average person of any religion be prepared to give up his earthly life, to which he tenaciously clings, for immortality in their ultimate havens of peace?

Very doubtful, indeed!

* * *

Now, how does Buddhism answer the question “why?”

Buddhism denies the existence of a Creator. As such from a Buddhist standpoint there cannot be a fore-ordained purpose. Nor does Buddhism advocate fatalism, determinism, or pre-destination which controls man’s future independent of his free actions. In such a case freewill becomes an absolute farce and life becomes purely mechanistic.

To a large extent man’s actions are more or less mechanistic, being influenced by his own doings, upbringing, environment and so forth. But to a certain extent man can exercise his freewill. A person, for instance, falling from a cliff will be attracted to the ground just as an inanimate stone would. In this case he cannot use his freewill although he has a mind unlike the stone. If he were to climb a cliff, he could certainly use his freewill and act as he likes. A stone, on the contrary, is not free to do so of its own accord. Man has the power to choose between right and wrong, good and bad. Man can either be hostile or friendly to himself and others. It all depends on his mind and its development.

Although there is no specific purpose in man’s existence, yet man is free to have some purpose in life.

What, therefore, is the purpose of life?

Ouspensky writes “Some say that the meaning of life is in service, in the surrender of self, in self-sacrifice, in the sacrifice of everything, even life itself. Others declare that the meaning of life is in the delight of it, relieved against ‘the expectation of the final horror of death.’ Some say that the meaning of life is in perfection, and the creation of a better future beyond the grave, or in future life for ourselves. Others say that the meaning of life is in the approach to non-existence; still others, that the meaning of life is in the perfection of the race, in the organization of life on earth; while there are those who deny the possibility of even attempting to know its meaning.”

Criticising all these views the learned writer says:–“The fault of all these explanations consists in the fact that they all attempt to discover the meaning of life outside of itself, either in the nature of humanity, or in some problematical existence beyond the grave, or again in the evolution of the Ego throughout many successive incarnations — always in something outside of the present life of man. But if instead of thus speculating about it, men would simply look within themselves, then they would see that in reality the meaning of life is not after all so obscure. It consists in knowledge. “

In the opinion of a Buddhist, the purpose of life is Supreme Enlightenment (Sambodhi), i.e. understanding of oneself as one really is. This may be achieved through sublime conduct, mental culture, and penetrative insight; or in other words, through service and perfection.

In service are included boundless loving-kindness, compassion, and absolute selflessness which prompt man to be of service to others. Perfection embraces absolute purity and absolute wisdom.



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Features

Preventing the Preventable; Preserving healthcare services

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Recent address by
Dr. Sarath Gamini De Silva
to the Galle Medical Association

It is indeed my privilege and pleasure to be given this opportunity to address the members of the Galle Medical Association (GMA). I am grateful to the President and the Council of the GMA for inviting me as the guest of honour at the inauguration ceremony of your annual academic sessions.

Coming here today is like getting back to my roots again. I was born and bred in Galle and had my entire primary and secondary education at Richmond College. Between 1982 and 1995 I was associated with the GMA in my capacity, first as a senior lecturer in medicine for two years and then for nine years as a Consultant Physician at the Teaching Hospital, Karapitiya.

I was the President of the Galle Medical Association in 1994.My colleague Prof. Ariyananda and I were the first two senior lecturers in the Dept. of Medicine, with Prof. Hettiarachchi as the head. We knew almost every student in the first few batches by name, taking a personal interest in their welfare, to make sure that they did well as doctors.

The academic and non-academic staff took it up as a personal challenge to prove that the Ruhuna Medical Faculty, though rather hastily established, was second to none in the island. Looking back, we can be happy that all did very well, most of them becoming very competent specialists in various fields, later on, and are providing an exemplary service here and abroad.

We started in the dilapidated buildings at Mahamodera and then moved into modern facilities at Karapitiya, which at that time was still a building site. The long-established Galle Clinical Society later merged with the relatively new Galle Medical Association under the presidency of the late Prof. Tommy Wickremanayake, the Dean of the Medical Faculty, at that time. This wonderful auditorium, named after him, is a tribute to the late Professor’s energy and determination to see that we had the best facilities in the Southern Province. He took me round this building site on several occasions, and I once nearly had an accidental fall trying to mount this stage, only half built at that time. Today I feel quite confident standing here on a firm foundation, a podium graced by many medical luminaries over more than 40 glorious years, in the service of medical education.

The Galle Medical Association has done justice to the ideals and aspirations of its founders. As a life member, I receive regular information of your activities. The Association is meeting amply the academic and non-academic needs of its membership. Your lecture series on beyond medicine; religious and sports activities, musical programmes, leisure trips, etc., would provide much relaxation outside the exhausting routine of medical practice. Your annual academic programme is not second to that of many professional Colleges and Associations based in Colombo or elsewhere in the country. This wide array of activities is indicative of an Association keen on providing an all-round service to its members and their families, as well as to the medical students. My congratulations to all concerned.

Your theme this year, “Preventing the Preventable,” is very timely. With the economic crisis we are experiencing, the age old saying “Prevention is better than cure” is more relevant today than ever before. Certainly, true in the case of prevention of diseases, I am concentrating today on other aspects of healthcare the doctors have overlooked and to a great extent failed to prevent their decline.

Preventing the Preventable; Preserving the Healthcare Services is my concern today.

All the remarkable achievements in the fields of communicable and non-communicable diseases, with world acclaimed health indices, are now being nullified by the economic crisis in which the healthcare services appear to be caught unawares. The shortage of drugs and other equipment, costing more and more with every passing day, has made it near impossible to give proper treatment to needy patients. I will not be surprised to hear of deaths due to lack of treatment in the near future. We already hear allegations, though authorities keep refusing to accept their responsibility, of deaths due to poor quality of drugs hastily imported to overcome shortages in a poorly planned system.

This is compounded by poor household incomes, high transport costs and other difficulties the patients experience in seeking medical care.

While most of the blame for this unfortunate situation falls on poor planning and corruption by the rulers, the medical profession, too, has failed in preventing this calamity. They have contributed by their irrational prescription habits, doing unnecessary investigations and the like, leading to a high cost in the delivery of healthcare. Irrational prescriptions contribute in a big way to multidrug resistance to antibiotics, as well. Poorly regulated private practice by doctors needs an overhaul. Exorbitant fees charged by some specialists are the talking point in the society. I need not bore you with details which should be well known to all of you by now.

We as a profession should not allow ourselves to be exploited by the profit-oriented private healthcare services and the pharmaceutical industry. The patients are compelled to pay a heavy price for our shortcomings in this regard. Thus, by our inaction in dealing with such, we have failed to prevent the gradual deterioration of the respect the society has for the profession.

Has the medical profession knowingly or unknowingly colluded with the misdeeds of the politicians? As an example, I wish the institutions, like the drug regulatory authority, NMRA, did more to prevent corruption and irregularities in the procurement of drugs. They have remained mostly silent knowing very well how their decisions regarding the registration of drugs are overruled or circumvented by politicians and administrators with ulterior motives.

Functioning of the Sri Lanka Medical Council is being looked down upon by many in the profession itself. The amendments to the Act governing the SLMC has been proposed over many years to broad base its membership to include non-medical professionals and make it more effective in its primary duties of regularizing medical practice, maintaining discipline in the profession and maintaining good standards of medical education. Politicians have so far failed to enact them. With poor standards of medical education, due to shortages in staff and other facilities in hastily established new medical schools, SLMC has been largely silent on these aspects. At present it appears that the medical trade unions and indirectly the political influence are hampering its proper functioning. As a result the SLMC remains mainly a body for holding the ERPM for foreign medical graduates and registering the medical practitioners. Our professional associations should be more involved in its affairs and add their voice for reforms.

I have been a member of the SLMC for 10 years in the past. But your chief guest as its immediate past president, who was removed from the post in a most unprofessional way by the politicians, with perhaps the connivance of our own colleagues, will be in a better position to address these issues. That action initiated by our own professional colleagues has now established a precedent for the Health Minister to have a bigger say in the SLMC affairs, seriously undermining its autonomy.

In my address to the Colombo Medical Congress a year ago, I stressed how our Professional Colleges and Associations kept a blind eye without getting involved and having their say in the administration of the health service. Even when there was an uprising asking for a system change, the medical profession remained largely silent without adding their voice. This was in stark contrast to the legal profession who stood up with the people asking for justice. By remaining ‘respectable’, confining ourselves to academic activity only, we have allowed our efforts at improving services to the public and training postgraduates to become meaningless. As a result, we are now spending tax payers’ money for training specialists for service abroad. With an unprecedented exodus of locally trained doctors and other healthcare staff, we are helping richer countries to serve their citizens better. The world-acclaimed health indices we have achieved by hard work over the years are becoming irrelevant with rampant malnutrition and other maladies affecting a significant proportion of the people.

Even the few medical men who dared to warn the authorities publicly on impending childhood malnutrition in their area had to face disciplinary action. The services of an alumnus of the Ruhuna medical faculty have been terminated as a result. Unfortunately, there is hardly any protest heard from the trade unions or other medical organizations against such action, at a time when elsewhere numerous unlawful activities and rampant corruption remain unpunished.

As much as the people are asking for all 225 in the Parliament to be thrown out, there are loud whispers in the society that the medical profession, too, is corrupt exploiting the people in various ways. There is no use in our grumbling about any shortcomings of doctors and incidents of medical negligence being highlighted in mass media regularly. Naturally, the good work done by the doctors will not be talked about with praise as that is the minimum the society expects from us.

It is high time our annual conferences and other meetings had a regular session or symposia on various aspects of the doctor in society, discussing our own faults and ways of rectifying them. All Colleges, especially those dealing with clinical disciplines coming into direct contact with the public daily, should communicate regularly with their members on these issues. They should also keep a close watch on the activities of health-related institutions like the SLMC and the NMRA already referred to, and intervene where necessary, without waiting till it is too late.

Thus, prevention in broader terms involves not only prevention of diseases but also prevention of other irregularities in the administration of health and questionable practices of our own colleagues that have a direct bearing on the health of the people. The medical profession, despite its many shortcomings, is still respected and influential. Our strong voice will be heard by the rulers, medical administrators and the general public.With these thoughts let me conclude by wishing you all a very successful and enjoyable annual sessions. I wish you all a very good evening.

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Features

Ambiguity of National Evaluation Policy?

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President Ranil Wickremesinghe at the recent inauguration of the National Evaluation Policy.

By Dr Laksiri Fernando

For the second time, Ranil Wickremesinghe has inaugurated a National Evaluation Policy (NEP) for Sri Lanka. The first one was in 2018 and also in September at the Global Parliamentarians Forum for Evaluation (GPFE) held in Colombo. As its website said, “The National Evaluation Policy (NEP) of Sri Lanka, was launched by Prime Minister Ranil Wickremesinghe at ‘EvalColombo 2018,’ the first ever global conference on evaluation organized by the Global Parliamentarians Forum for Evaluation (GPFE).”

Blocked Website?   

He inaugurated the same or a different one as the President of Sri Lanka on 8 September 2023 at Temple Trees with the participation of some key Ministers, Officials and Foreign Delegates. The Presidential Secretariat’s website quite genuinely titled the posting of the speech as “Sri Lanka’s long-awaited National Evaluation Policy finally commences after seven years.” However, there was no policy document posted on the website. When I searched on the President’s website (president.gov.lk) the following was the message I got.

“Sorry, you have been blocked. You are unable to access president.gov.lk.”

It is still difficult for me to figure out why I have been blocked. Is it a technical error or a political decision? Is the website closed to everyone or only for me? My primary objective was to see the details of what they called ‘National Evaluation Policy Implementation Framework.’ That is what the President mentioned in the Speech.

However, on the website of the Ministry of Finance, Economic Stabilization and National Policies, (Ministry of Finance – Sri lanka (treasury.gov.lk) there was a pdf titled, the ‘National Evaluation Policy of Sri Lanka.’ It is only a four-page document even without page numbers or a date. Two pages were devoted to a long glossary and references. There were five references all being websites accessed in 2017. This is quite intriguing.

For Good Governance

A National Evaluation Policy (NEP) is part of good governance. In the case of Sri Lanka, such evaluations should particularly address corruption and misuse of funds. Without an NEP, governance accountability to the people and to the international community cannot be achieved. In 2009, the UNDP (United Nations Development Program) said, “There is general consensus that evaluating the performance of public policy is an important instrument for good governance. There is, however, a gap between this general agreement and the actual implementation, use and sustainability of monitoring and evaluation (M&E) systems, processes, and tools on the ground.”

This was after an international conference held on the subject in Casablanca (Morocco) in December 2009. Sri Lanka participated at the conference represented by the Director General of the Ministry of Finance and Planning, Velayuthan Sivagnanasothy. He presented a well-prepared paper, titled “Sri Lanka: National Monitoring and Evaluation System: Experiences, Challenges and the Way Forward.”  As Sivagnanasothy assured, there was a national monitoring and evaluation system in Sri Lanka at that time. I also can remember its existence participating at several meetings and conferences as the Director of the National Centre for Advanced Studies (NCAS) and a Director of the Colombo Stock Exchange (CSE).

It is possible that the above situation changed when unreliable persons like Mahinda Rajapaksa and Basil Rajapaksa became controlling the country’s Ministry of Finance. A large number of projects were undertaken with foreign loans without an evaluation of the project plans and the progress of their implementation. When countries like Norway, Canada, Japan, and Australia gave aid, grants, or loans to Sri Lanka, they themselves conducted their independent evaluations. However, there were some other countries and agencies who didn’t want this requirement. This is one reason why and how Sri Lanka became heavily indebted and failed to repay loans.

Avoiding politicisation  

There is no question that national evaluation policies can easily become politicised. The best way to avoid the infection is to develop these policies independently and as part of management science/studies. There can be an independent commission on national evaluation. Project planning, management, monitoring, and evaluation are already subjects taught in universities. There are a good number of Sri Lankan people who are qualified in this field at least at the graduate level. What is needed is to introduce postgraduate degrees and develop the subject to be useful to the country and others.

Various sectors in Sri Lanka should have clear national policy/policies. In 2012 the World Bank published a book titled ‘Building Better Policies’ focusing mainly on monitoring and evaluation. It is fully available online (Building Better Policies – Google Books).  It says in the foreword, “This book is useful to anyone who cares about the quality of public policies and who wants to learn and understand how public policies and programs can be shaped with the objective of improving people’s welfare.”

The report in the Presidential Secretariat’s website on the so-called inauguration says, “The President acknowledged a significant void in Sri Lanka’s governance system – the absence of a national policy.” This is very true as the immediate circumstances categorically revealed the situation.

On the day of ‘inauguration of NEP,’ it was reported “Sri Lanka will be transformed into an education hub in South Asia,” an assertion made by the Minister of State for Education, Dr. Suren Raghavan. People are not unknown to various dreams of ‘hubs’ declared by different politicians from time to time. Raghavan cannot be the same type given his educational and professional background. Yet, he has also stated “the focus of the new education reforms is on creating a system that enables students studying in the arts stream to attain a bachelor’s degree in science.” This is completely intriguing and no further information was given on how it could be done.

Four days later, Dr Wijeyadasa Rajapakshe made a similar declaration about educational reforms and said, “vocational institutions to be given the same recognition as universities.” Wijeyadasa Rajapakshe primarily is the Minister of Justice, Prison Affairs and Constitutional Reforms. However, he is also the Chairman of the Parliamentary Special Committee on the Expansion of Higher Education and perhaps he made this statement in that capacity.

Conclusion

What is clear from these statements and declarations is that the present government or politicians in general in the country do not have any idea of expanding the university or higher education system. Renaming vocational institutions like Technical Colleges as universities is not a solution. Quality of higher education and integrity should be preserved. Also, giving the arts students just BSc degrees is not a solution for the problems associated with that stream. Sciences and social sciences should be promoted and developed. Immediate evaluation of the whole educational system is necessary. There can be an independent commission on the subject with capable people. Most important is the promotion of the English medium in higher education without discriminating against anyone who wants to study in the Sinhala or Tamil medium.

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Aviation safety and human element

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By Capt. G A Fernando
gafplane@sltnet.lk
RCyAF/ SLAF, Air Ceylon, Air Lanka, SIA and SriLankan Airlines.
Former Crew Resource Management (CRM) Facilitator, Singapore Airlines Ltd.
Member, Independent Air Accident Investigation Pool 

(The first part of this article appeared in The Island of 18 Sept., 2023)

In 1982, an Air Florida Boeing 737 crashed into the Potomac River, Washington D.C., after takeoff from Washington National Airport in icing conditions. Erroneous engine thrust readings (higher than actual), and the co-pilot’s lack of assertiveness in communicating his concern and comments about aircraft performance during the take-off run were among the factors cited (NTSB/AAR 82- 08).

Experts say that one needs to be ‘aggressively’ safe. All communications (verbal or written) and standard operating procedures (SOPs) should be proactive, predictive and preventive. Some of the accidents mentioned could have been prevented.

As can be seen in the diagram shown, the SHELL boundaries are not smooth but inherently full of serrations, and much effort is needed to interact efficiently and seamlessly. Some experts stress that it is Communication in the form of SOPs that ‘lubricate’ the system for smooth interaction between elements’ while the captain (team leader) sets the tone. In fact, where air safety is concerned, Capt. Tony Kern, a human factors expert, says in his book Redefining Airmanship that to maintain air safety, it is imperative that the team leader knows himself, knows his team, knows his aircraft and equipment, knows his mission and, above all, evaluates the risks involved with the task at hand.There can be problems with the interaction within the team (Liveware and Liveware). Sometimes the Captain (Leader) has to be an expert in conflict resolution! (See Figure 01)

Threats and Hazards

Almost every situation in life is full of ‘threats’. When it involves one personally, it becomes a ‘hazard’. In the aviation context, if there is a flock of birds in the vicinity of an aircraft, they constitute a ‘threat’. However, if that flock of birds starts crossing the flight path of the aircraft, it becomes a ‘hazard’ and avoidance action needs to be taken. Remember the ‘Miracle on the Hudson’? The engines failed because of bird ingestion.

 Many airports, too, contain manmade threats and hazards which are usually eliminated only after an accident. In fact, pilots say that blood has to be spilt for changes for the better to occur. At many airports high-rise or security-sensitive buildings are built without planning, and no consideration given to air safety, thus violating the law.

The Ratmalana International Airport is a case in point. On the landing approach from the Attidiya side there is the Parliament and Akuregoda Military Headquarters which are prohibited over flying areas. In the vicinity of the Ratmalana International Airport, there is the Kotelawala Defence Academy and Hospital. At the Galle Road end a solid wall creates a hazard for landing and departing aircraft. Elsewhere, at the Puttalam-Palavi airbase a cement factory is in line with the runway, whilst at China Bay-Trincomalee the silos of a flour mill obstruct landing and take-off paths. These hazards at the latter two airports render them useless as ‘alternate’ (alternative) international airports. If sufficient thought had been given to air safety planning, the loss-making Mattala Rajapaksa International Airport in the Hambantota District would never have been built.

The Swiss Cheese Model

Just as one proverbial swallow doesn’t make a summer, one error alone will not create an incident or an accident. Rather, it will be caused by a chain of unsafe events not picked up by the system. The triviality of one such potentially disastrous cause or lapse is echoed in the words of a poem from the 17th century, later popularised by Benjamin Franklin in his Poor Richard’s Almanac: (See Figure 02)

Reasons for accident occurrences are similar. In fact, the Toyota Corporation asks ‘why’ at least five times when determining the ‘root cause’ of a problem.Aircrew members are regularly taught to recognise unsafe patterns highlighted in past accident investigations, so as to nip them in the bud if and when identified.

Professor James Reason postulated the ‘Swiss Cheese’ model, which states that in any organisation, the layers of safety and security controls in place should be able to block, or cover, one another, to prevent accidents. But unfortunately, there are random holes of all sizes in these layers, like slices of Swiss cheese. Hence, the possibility that with the presence of latent conditions and active failures, these holes will align and allow a potentially dangerous situation or practice to go through without being trapped, thus creating an accident or incident. (See Figure 03)

As illustrated in Reason’s ‘Swiss Cheese’ diagram, latent failures of the system are those that compromise safety, having existed and been taken for granted for short or long periods of time; active failures are immediate, unsafe human acts. In fact, the crew (human element) is the last line of defence before an accident or incident occurs.

To illustrate these points, I shall revisit the 9-foot/3-meter concrete wall that was erected several years ago at the Galle Road end of the runway at Ratmalana International Airport.

This wall could be regarded as a man-made hazard. The runway is 1,833 metres (6,014 feet) in length, not long enough by worldwide standards for a so-called ‘international airport’. By international law, at a pre calculated critical speed (known as the go/no-go speed) pilots are allowed only two seconds in which to make a critical decision whether to stop or continue the take-off. According to calculations by the Boeing Company, a decision to stop any later than two seconds (called ‘dither time’) will result in an aircraft reaching the end of the runway at a speed of 60 knots (69 mph).

On a rainy day, if pilots of a medium-sized aircraft decide to abort the take-off three seconds late, they are unable to stop within the paved runway, with deployment of maximum braking and other stopping devices such as reverse thrust, and the aircraft will ‘overrun’. Because the grass in the overrun area is wet and slippery, the brakes are rendered ineffective. Consequently, in the case of Ratmalana, the aircraft will definitely impact the wall and perhaps catch fire as fuel tanks are usually full during departure.

So, the delay in making a decision to reject the take-off rather than continue would be an ‘active’ failure by the crew. The presence of a solid wall at Ratmalana is the presence of a ‘latent’ condition caused by the Airports Authorities. Although the wall is an ‘accident waiting to happen’, the Sri Lanka Air Force (SLAF), which earns ‘welfare’ money from advertisements on the wall, stubbornly refuses to replace it with a frangible fence, that would break on impact and reduce damage to an over-running aircraft and even vehicular traffic on the Galle Road.

Returning to Reason’s ‘Swiss Cheese’ postulation, air accident investigators usually work backwards from the incident/accident, using the ‘model’ to find the root cause, unsafe acts and any failed defences. The best witnesses are, of course, the crew themselves, although they may not want to voluntarily give information if a punitive attitude is adopted by accident investigators and the authorities. It is a long-held belief that the crew involved are damned if they tell the truth and damned if they don’t. In the recent past in Sri Lanka, the Law and the Police were quick to ‘criminalise’ air accidents. Almost two years ago the accountable manager and chief engineer were arrested and remanded for failure to prevent an accident. That is another story.

The protocol should be for an independent team to do a non-punitive inquiry, and if and only if elements of negligence are highlighted in the final accident report, then the law should take its course under the direction and oversight of the Attorney-General. In short, the authorities in Sri Lanka need to get their act together and conduct themselves in a professional, impartial, fair-minded manner.

Accidents don’t only happen to “other people”, and with threats everywhere we have to learn to mitigate and manage them. While it is human to err, could we eliminate error completely? I think not. But pilots can learn to trap and minimise their ability to make errors by using their team effectively, including pre- and post-flight briefings. A common question that should continue to be asked is: “Could we have (as a team) done things better?”

Will automation of some tasks help? Instructors often repeat the adage, “Fly the aircraft and don’t allow the aircraft to fly you.” Conversely, “The aircraft flies by itself. You assist it to fly”. I believe it is the level of automation that matters, depending on circumstances.Bernard Ziegler, a French pilot and engineer who served in Airbus Industrie as senior vice president for engineering – and was the son of Airbus founder Henri Ziegler – was well known for his evangelical zeal for the application of computerised control systems in Airbus airplanes, commencing with the revolutionary A320 airliner. Bernard Ziegler attempted to design the human out of the flight deck in Airbus’s so-called ‘fly-by-wire’ airplanes, which in their early days were involved in a series of incidents and fatal accidents, due mainly to the mismatch of the man/machine interface. So much so that the A320 was called the ‘Scare-bus’ in jest. Even today many Airbus pilots are heard to ask while flying, in perplexed tones: “What is it doing now?” or “I have never seen this happen before.”

A more recent story is that of the Boeing 737 MAX. When I flew the basic Boeing 737-200 many years ago, our Irish instructor called it the ‘thinking man’s aircraft’, a perfect match between man and machine. Somehow, due to design quirks in the newly designed 737 MAX, an automatic system called MCAS (Manoeuvring Characteristics Augmentation System) was incorporated. If the aircraft got into an unusual and unsafe nose-up attitude, MCAS would be automatically activated and lower the nose to a safer angle.

Unfortunately, during the somewhat rushed introduction of the 737 MAX onto the market, many airline crews were not sufficiently trained in how to override the system – if MCAS was activated due to false indications from, say, a computer or instrument malfunction. Worse still, some airlines’ pilots were not even told that their new airplanes were fitted with such a system, and therefore unaware of what to do if and when MCAS became activated for no apparent reason. This ignorance, through no fault of the pilots, resulted in two disastrous MAX crashes, in Indonesia and Ethiopia, with a total loss of 346 lives.

As the ‘cold hard facts’ later emerged, it became apparent that although the ‘MAX’ was arguably a totally new type of aircraft, it was designated as a Boeing 737-800 to minimise legal crew-training time on the type. This extra training was seen as an undesirable burden for Boeing’s customer airlines, who would have to withdraw captains and first officers from the line for training, thus incurring loss of productivity and revenue for the airlines.

Boeing’s intent was, therefore, for the training (non-productive) period to be as short as possible. But in practice corners were dangerously cut. The US regulator, the Federal Aviation Administration (FAA) – in this case the ‘human element’ – went along with the manufacturer’s sales and training programme, which ultimately resulted in incidents, accidents, and loss of life.

In summary, statistics show that although accidents have decreased to a small percentage in terms of flights and hours flown, the number of certified air operators is also increasing, which causes the number of accidents to increase. Difficult as it is to contemplate, it wouldn’t be wrong to say that the potential exists for more human factor-based accidents to occur in future.

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