Features
The role of education in reconciliation
By Anushka Kahandagamage
We have seen more blood than this small island can soak. The country has seen decades-long war and two youth insurrections (1971, 1988-89) with thousands of young lives lost. In the ‘post-war’ era, violence continues unabated in the attacks on Muslims and Christians, the Easter bombings, and countless horrifying incidents of everyday violence, exemplified most recently in the discovery of a woman’s decapitated body in a suitcase.
Ethnoreligious tensions smoulder under the ashes with no political solution in sight. Short-sighted political-economic policies have deepened societal hierarchies, while widening the gap between communities and atomizing the individual. Market-driven political campaigns are being carried forward by dominant political parties capitalizing on Sinhala-Buddhist majoritarian narratives. While their rhetoric has infiltrated most social and political institutions in the country, the education system has not escaped.
In fact, education institutions have served to produce, reproduce and sustain such hegemonic narratives. General educational curricula tend to glorify ‘Sinhala-Buddhist’ culture and stifle critical thinking and do not, for the most part, train students to critically engage in the learning process. For example, school history syllabuses uphold a majoritarian narrative, and do not compel students, or teachers, who are products of the same system, to reflect upon the multiple narratives and histories that explain where we are today. Marginal voices are silenced in the school textbooks to produce a dominant Sinhala Buddhist narrative, lending support to the creation of ‘official memory’ regarding the country’s history.
Modern conceptions of ethnicity are being imposed upon historical events that occurred centuries prior to reinforce the ethno-centric nation state, for example, by the depiction and glorification of King Dutugemunu as a ‘Sinhala Buddhist King’ who defeated the ‘Tamil King’ Elara. On the other hand, distorted representation of ethnic minorities in the text books has resulted in prejudice and stereotyping, while separating schools by language, ethnicity, and religion has further impeded cultural exchange. These gaps in education have ultimately fueled distrust and ignorance between ethno-religious communities with devastating results.
It is hardly surprising then that efforts at war-time peacebuilding, and even post-war reconciliation, have been largely externally driven, with minimal state support. In fact, peace negotiations and related processes have been consistently undermined by the state as conspiracies by the international community to damage the country’s sovereignty with little protest from the Sinhala-Buddhist majority. In the post-war context, Sinhala-Buddhist nationalist groups have converged to actively organize concerted attacks against Muslim communities, bringing masses of Sinhalese youth into their fold. These political efforts to divide and pit communities against each other encounter little or no ideological resistance.
The irony lies in that we do not seem to see the link between our pathological social conditions and our education system. At most, debates connecting the two have remained thinly confined to progressive circles. Instead of playing a vital role in building trust in the post-war context among our communities, the education system has served to perpetrate structural violence along class, gender, ethnic and other lines. On the other hand, political leaders discuss education primarily in relation to the economy or, more specifically, the education system has been scapegoated for the crisis in the economy.
Trapped by discourses of employability, the government has constructed the economic crisis as a crisis of education, highlighting, in particular, the education system’s inability to create ‘skilled’ workers to contribute to the tenuous ‘knowledge economy.’ It is too easy to make education ‘the problem’ (and solution) to the ‘crisis of the economy.’ Yet, the SLPP manifesto, which guides education policy, presents education as the problem for which the sole solution is STEM (Science, Technology, Engineering, and Mathematics) education.
In the section, ‘A System of Higher Education to produce Technocrats’, the SLPP manifesto focuses exclusively on producing ‘technocrats’ by enhancing STEM education and English as a soft skill, at the expense of Arts Education. Here, it is assumed that STEM education will solve the crisis in both economic and education arenas and lead the country towards so-called ‘economic development’. Although it is impossible to predict the future job market, and the present demand for labour in Sri Lanka appears to lie in the apparel industry and security services (Labour Demand Survey 2017), policymakers are focusing on developing IT ‘skills’ to produce task rabbits who are suitable for the gig economy.
Yet, arts education is widely recognized to be crucial for promoting co-existence. Indeed, the 2016 Consultation Taskforce on Reconciliation Mechanisms recommended the inclusion of subaltern and excluded narratives in history syllabuses, pointing to the urgency to move away from linear and hegemonic accounts of history, towards a critical engagement, with mutual understanding of the effects of growing up in a militarized, racially/ethnically-biased, patriarchal, heteronormative society.
The Consultation Taskforce also tasked the education system with addressing ethnoreligious tensions and widespread distrust among communities through a range of initiatives, such as school and university exchange programmes, language programmes, art forms, etc. They further recommended common programmes of study, such as International Relations at the universities, so that students could learn from experiences across the world. Many such recommendations never came to life; the economic imperatives for STEM education and the myth of unemployability have served to detract education debates from social issues, while further weakening Arts education.
It is not my intention to propose educational reforms which neglect the economy entirely, but rather draw attention to the implications of approaching education solely as a means for ‘economic development’ particularly in our fragile post-war context. No doubt education has to cater to the economic needs of society, but the world has come a long way since ‘development’ was reduced to the ‘economy’. Contemporary approaches to development are much broader with far-reaching goals and meanings beyond the economy. Education should be a vehicle for achieving larger social goals through the development of creative capabilities and peaceful co-existence, which could, in turn, facilitate realizing economic goals within a society that is not plagued by violence.
Kuppi is a politics and a pedagogy happening on the margins of the lecture hall that parodies, subverts and simultaneously reaffirms social hierarchies.
Anushka Kahandagamage is a PhD student in Sociology, South Asian University, New Delhi.
Features
Transformations in Sri Lankan social sciences: From early to modern anthropology
by Amarasiri de Silva
Before the 1970s, anthropology in Sri Lanka, as an academic discipline, was relatively confined to a few studies. The country had only a few trained anthropologists, and the scope of anthropological research needed to be expanded. This reflected a broader trend in the social sciences in Sri Lanka, where subjects like sociology and anthropology are still required to be fully institutionalized or widely pursued. However, the discipline began to change significantly in the subsequent decades, particularly with the expansion of the departments of Sociology at major universities in Sri Lanka.
The expansion of the departments of Sociology in Sri Lanka’s universities was a pivotal development in the history of social sciences in the country. This expansion increased the number of students who could study sociology and diversified the subjects and research areas that could be explored within the discipline. Sociology was increasingly offered as a special degree, attracting many students interested in studying the social fabric of the country.
This shift in academic focus led to a significant increase in students pursuing higher education in sociology. After successfully completing their undergraduate degrees, with first and second classes, many of these students pursued advanced degrees, including PhDs, at prestigious universities abroad. The most common destinations for these students were India, Australia, the United Kingdom, and the United States, where they could receive training in the latest methodologies and theoretical frameworks in anthropology and the social sciences.
The exposure to foreign academic environments had a profound impact on the way sociology was studied and practiced in Sri Lankan universities. Students who went abroad for their PhDs were exposed to many theoretical perspectives and research methodologies that they brought back a wealth of knowledge and expertise, which they applied to their research and teaching in Sri Lanka.
One of the most significant contributions of these post 1970 foreign-trained sociologists was their emphasis on empirical research and fieldwork, and applied orientation in research. Unlike earlier generations of sociologists and anthropologists who often relied on theoretical analysis of classical anthropology, these new scholars emphasized the importance of gathering data from the field on social change and social problems. This approach led to a surge in applied anthropological and sociological studies conducted in Sri Lankan villages, as these scholars sought to understand the social dynamics of rural life in the country.
The focus of these studies reflected both the new methodologies introduced to these scholars and the distinct social and cultural landscape of Sri Lanka. With most of the population residing in rural areas, understanding village dynamics was essential to comprehending the broader social fabric of the country. Some scholars concentrated on the intricacies of caste, while others explored the rise of class and its impact on social formation, stratification and political behaviour.
By documenting various aspects of village life—such as kinship structures, economic activities, religious practices, and social hierarchies—their research provided valuable insights into how traditional social structures were being preserved or transformed amid modernization and economic change. Additionally, some researchers turned their attention to marginalized communities, including deprived caste groups and ethnic enclaves, highlighting their unique challenges and contributions to the social structure.
The documentation of village studies also significantly impacted the development of anthropology as a discipline in Sri Lanka. Although many of these scholars identified as sociologists, their research often overlapped with anthropological concerns, particularly in their focus on culture, tradition, and social organization. As a result, the line between sociology and anthropology became increasingly blurred, leading to a more integrated approach to the study of social life in Sri Lanka.
The early anthropological and sociological research conducted in Sri Lanka during this period laid the foundation for future studies. The emphasis on fieldwork and empirical research became a hallmark of Sri Lankan sociology, and many of the methodologies and theoretical perspectives introduced by these scholars continue to influence research in the country today.
Moreover, the focus on village studies has impacted how rural life is understood in Sri Lanka. The detailed documentation of village life has provided a valuable record of the social and cultural changes that have occurred in the country over the past few decades. These studies have also contributed to a deeper understanding of how global processes, such as economic development and cultural exchange, have impacted local communities in Sri Lanka.
My Exposure to Anthropological Fieldwork
My journey into the world of anthropology began during my master’s degree research in Mirissa, a fishing village located in the southern province of Sri Lanka. Having been born and raised in an agricultural village, Batapola in the Galle District, my exposure to the coastal environment of Mirissa was an entirely new and transformative experience.
The transition from an agricultural backdrop to a coastal fishing community presented a set of unique challenges that I had never encountered before. In Mirissa, I was introduced to the intricacies of various fishing methods, a completely different form of livelihood compared to the farming practices I was familiar with. Learning about the techniques used in the capture of fish, the handling and processing of the catch, and the complex networks involved in fish marketing, crew formation, etc., required me to immerse myself deeply into the everyday lives of the villagers.
Beyond the technical aspects, understanding the lives of the fishermen and their families offered profound insights into the social fabric of coastal communities. I observed how the rhythms of life in Mirissa were intimately tied to the sea, shaping the village’s economy and the community’s cultural and social structures. The challenges faced by these families, their resilience, and how they navigated the uncertainties of their occupation became focal points of my research.
This experience in Mirissa not only broadened my understanding of Sri Lanka’s diverse socio-economic landscapes but also deepened my appreciation for the complexity and richness of anthropological research. Through this fieldwork, I realized the importance of adapting to new environments and the necessity of approaching research with sensitivity and respect for the communities involved.
One of the challenges I encountered during my research in Mirissa was establishing the parameters of social change in Mirissa, particularly with the introduction of mechanized boats, or the three-and-a-half-ton boats, which began to replace the traditional outrigger canoes with sails. It quickly became apparent that this technological shift was not merely a matter of economic or practical change but had profound social implications for the village. When mechanized boats were first introduced in the 1950s, the villagers were skeptical about the viability of this new technology. Some recipients even destroyed the freely given boats by submerging them in the sea. Out of the roughly 40 boats distributed to the deep-sea fishing community, only one remained operational at the time of my research. The others were either sold or damaged.
I observed that the village was divided into distinct social categories, based on the method of fishing. Some fished in the deep sea using mechanized boats or canoes (Ruwal oru), and those engaged in shallow sea fishing using beach seine nets (Ma Dal). These two communities, within the village, were highly divergent, with a strong sense of identity tied to their respective fishing practices.
The social divide between these groups was evident not only in their daily activities but also in their social interactions. Intermarriage between the two communities was rare, a reflection of the deep-seated cultural and social differences that had developed over time. Additionally, this division was spatially manifested within the village itself. The deep-sea fishermen resided by the sea in an area known as Badugoda, where they had easy access to the ocean. In contrast, the beach seine fishermen lived by the main road, a location that offered them convenient access to the beaches allocated for their fishing practices.
This geographical separation further reinforced the social boundaries between the two groups, creating distinct sections within the village, each with its traditions, practices, and way of life. Understanding this complex social landscape was crucial to my research, as it highlighted the intricate ways technological and economic changes can influence social structures and relationships within a community.
I commenced my research in the beach seine section of the village in the early 1970s. Through a mutual friend, I was introduced to Mr. Nilaweera, a schoolteacher in the village. Mr. Nilaweera played a pivotal role in helping me settle into the community. He assisted me in finding a place to live—an empty house with basic furniture that he kindly provided. Understanding the challenges of living alone in a new environment, Mr. Nilaweera also arranged for an older woman to cook for me. She prepared delicious meals, often including fresh fish caught in the beach seine nets, or embul thiyal using Alagodu maalu which added to the authenticity of my experience.
To further support my research, Mr. Nilaweera introduced me to two key informants—one from the beach seine fishing community, near Mr. Nilaweera’s house, and the other from the deep-sea fishing community in Badugoda. These informants were invaluable to my work; both were highly knowledgeable and willing to share their insights. They patiently answered all my questions, explaining even the minutest details about the village’s social dynamics, fishing practices, and the distinctions between the two communities. Their guidance was instrumental in deepening my understanding of Mirissa’s complex social fabric.
Mr. Gilbert Weerasuriya, the informant from the beach seine community, possessed knowledge far surpassed that of many average villagers. He provided me with a detailed account of how beach seine nets were introduced to the village and traced the history of their evolution. He explained the traditional method of fishing, using these nets, describing how fish were caught by encircling shoals near the shore.
The first nets were made of coir and coconut leaves, which later used hemp thread to make the nets. The madiya, or the deep end of the net where the fish gets caught, is woven with hemp, while the side nets were made with coir lines.
Later in the 1950s nylon was introduced for beach seine nets, and the catch doubled with the new nets. According to him, the beach seine canoe fishermen originally came from the Coromandel Coast, in India, and eventually settled in beach communities, like Negombo and Mirissa, in Sri Lanka. He noted that similar fishing practices can also be found in coastal communities across India. Interestingly, the early beach seiners in these Sri Lankan communities spoke an Indian language, like Telugu, remnants of which were still present in the songs they sing while hauling the seine nets.
My search in the archives revealed that villagers in and around Mirissa had names ending in “Naide,” a corrupted form of an Indian name. In India, particularly in regions like Maharashtra or Karnataka, “Naide” could be a variant or misspelling of the surname “Naidu,” common among Telugu-speaking people. These family names can be found in school thomboos maintained by the Dutch.
In 1948, at Mirissa, there were only three groups of fishermen: beach seine fishermen, deep sea fishermen, and inshore fishermen. The total number of seine nets in 1947 was 242, owned by a group of 108 fishermen. The deep-sea canoes numbered around 50, operated by about 150 people. Inshore fishing was done in small dugout canoes known as Kuda Oru, with about 20 of them at that time. When I conducted my fieldwork, the numbers had dwindled. There were only six beach seine nets, about 50 deep sea fishermen operated boats and a few Kuda Oru operated by a handful of fishermen.
The process of beach seine fishing involved a large canoe that carried the nets out to sea. The fishermen would then lay the nets in a half-circle, encircling the shoal of fish. Once the nets were in place, the two ends of the circled net were handed over to two groups of fishermen, who began hauling the nets from the shore. At the centre of this operation was the lead fisherman, known as the “mannadirala,” who directed the entire process. The mannadirala would give precise instructions to the hauling groups, ensuring that they drew the net at a specific speed to prevent the fish from escaping through the net. His role was crucial, as the success of the catch depended on the mannalirala’s expertise in coordinating the efforts of the fishermen and controlling the net’s movement.
The beach seine net is owned in shares by various people in the village, and the shoal of fish brought to shore is distributed according to these share ownerships. One-fourth of the catch is allocated to the crew members, known as the “thandukarayo,” (rowers or peddlers) who undertake the challenging task of going out in the canoe to encircle the shoal of fish. Another one-fourth is given to the fishermen responsible for hauling the net at the two ends. A third portion is allocated to the individuals responsible for maintaining the net and the canoe.
The remaining portion is then divided among the shareholders. This division of shares occurs in monetary terms after the fish is sold to vendors and merchants in a process known as “vendesiya.” Additionally, it’s customary for every villager who participated in the fishing activity, even if they are not shareholders, to receive a few fish as a token of appreciation for their contribution. After the fish haul is taken to the shore, people like the mannadirala sort out the fish, separating the big ones from others, like sprats/anchovies or harmless fish. Fish suitable for the family, such as those beneficial for breastfeeding mothers, like kiri boollo, were taken home by the mannadirala and other key individuals.
I was particularly interested in tracing the history of deep-sea canoes, and my interviews with the key informant from the deep-sea fishing community proved invaluable in this regard. This informant, whose knowledge and wisdom were so widely respected that the villagers called him “Soulbury Sami” (Lord Soulbury), was a central figure in the community. Deep-sea fishermen frequently sought his advice on fishing grounds (hantan) and other aspects of deep-sea fishing.
One of the key questions I posed to him was about the number of canoes used for deep-sea fishing before the introduction of mechanized boats. His response was both simple and ingenious. Squatting on the beach, he explained that he could vividly recall who had parked their canoes on his deep-sea canoe’s right and left sides. He took a stick and drew the canoe the family-owned, saying, “This was our oruwa.” Then he drew two similar canoes on each side of his canoe drawn on the beach and said, “I can tell you who owned these two canoes parked beside ours.” He then suggested that I use this method as a starting point. By asking the families who had parked their canoes beside his about their neighbouring canoes, I could piece together a complete picture of the canoe ownership at that time.
This method was remarkably effective. By following his advice and speaking with the families involved, I eventually compiled a list of 48 canoes parked on the beach during the 1940s. This simple yet systematic approach gave me a clear and comprehensive understanding of the deep-sea fishing community’s history before the advent of mechanized boats.
Mirissa has now transformed from a quiet fishing village into a vibrant tourist hub over the past few decades. Once known for its beach seine fishing traditions, the village of Mirissa has evolved significantly over time. The introduction of three-and-a-half-ton boats and trollers modernized its fishing industry, moving the community from traditional fishing methods to more advanced deep-sea fishing. However, over the years, tourism has gradually overtaken fishing as the primary source of livelihood for many villagers. This shift highlights the community’s remarkable adaptability in embracing new opportunities, transforming from a primarily fishing-based economy into a thriving tourist destination.
This small but picturesque destination now boasts over a hundred hotels and boutique accommodations, offering various lodging options for visitors from all over the world. The trajectory of change and transition from being a fishing community focused on beach seine techniques—where nets were dragged ashore by hand—to deep-sea fishing and ultimately to tourism is remarkable. Today, Mirissa is known not for its fishing but for its breathtaking beaches, lush greenery, and panoramic views, making it a must-visit destination in Sri Lanka.
Mirissa’s natural beauty is complemented by an array of activities that attract adventure enthusiasts and nature lovers alike. Whale watching has become one of the village’s most prominent draws, with local boat operators offering tours where visitors can witness the magnificent blue whales, sperm whales, and dolphins in their natural habitat. Additionally, surfing and snorkeling are among the key attractions.
Tourism has brought prosperity to the local community, which depends less on traditional fishing and more on hospitality and tourism services. Many locals earn their livelihoods by operating guesthouses, hotels, and restaurants or by offering services like guided boat tours for whale watching, renting surfboards, and providing transportation for tourists. The once-close connection to the sea, driven by fishing, is now maintained through tourism, as the ocean remains central to the lives of the villagers, albeit in a different way.
Mirissa’s development into a tourist village has not only created economic opportunities. Still, it has also become a cultural melting pot where visitors can experience authentic Sri Lankan traditions, cuisine such as embul thiyal alongside the comforts of modern urban foods. This seamless blend of natural beauty, adventure, and cultural richness makes Mirissa a unique and beloved destination for travellers worldwide.
Features
Bridging the Workforce Gap:A comparative analysis of global and Sri Lankan labour force participation
by Lalin I De Silva
Labour force participation is crucial for economic growth, with global rates typically ranging from 60% to 70% of the working-age population (ages 15-64). However, Sri Lanka faces significant challenges that inhibit its ability to reach these benchmarks, including outdated labour laws, demographic changes, and socio-economic barriers. This article compares the global labour force participation structure with that of Sri Lanka, highlighting key gaps and offering HRM-centred solutions to enhance workforce engagement, productivity, and sustainable economic development.
The Gap: Global vs. Sri Lanka
Globally, countries experience workforce participation rates between 40% and 50% of the total population engaged in labour. Countries with strong labour policies often report higher participation due to a focus on education, flexible labour laws, and favourable economic conditions. Conversely, Sri Lanka’s labour force participation rate (LFPR) falls significantly below this average, particularly in rural areas and among women. Contributing factors include:
· High Informal Economy: A significant number of workers operate in the informal sector, leading to underreported employment figures.
· Gender Inequality
: Cultural and structural barriers restrict female participation in the workforce.
· Aging Population
: An increasing proportion of older individuals places additional demands on the working-age demographic.
· Rigid Labour Laws
: Outdated regulations discourage formal employment opportunities, limiting job market flexibility.
· Limited Vocational Training
: Insufficient training opportunities leave many workers unprepared for modern industry demands.
Design Thinking Approach to HRM Solutions:
To bridge the workforce participation gap in Sri Lanka, a strategic, design-thinking approach is essential. This involves empathizing with stakeholders, defining problems, ideating solutions, prototyping initiatives, and testing their effectiveness. Below are key recommendations rooted in this approach:
1. Revising Labour Laws
· Empathy: Engage with employees and employers to understand their needs.
· Define
: Identify specific barriers within existing labour laws that restrict participation.
· Ideate
: Propose flexible working hours and part-time job options.
· Prototype
: Pilot modern labour reforms in selected sectors.
· Test
: Evaluate the impact on participation rates and adjust policies accordingly.
2. Female Workforce Engagement
· Empathy
: Gather insights from women about their challenges in joining the workforce.
· Define
: Recognize policies that hinder gender equality in employment.
· Ideate
: Develop initiatives that provide maternity benefits, childcare, and equal pay.
· Prototype
: Implement these initiatives in targeted industries.
· Test
: Measure female participation rates and refine the approach based on feedback.
3. Vocational Training and Skill Development
· Empathy
: Consult with industries to understand skill gaps.
· Define
: Pinpoint the skills most in demand.
· Ideate
: Create training programmes aligned with industry needs.
· Prototype
: Launch pilot training sessions in collaboration with local businesses.
· Test
: Assess the effectiveness of these programmes in increasing employability.
4. Youth Engagement
· Empathy
: Interview young people to identify barriers to workforce entry.
· Define
: Highlight gaps between education and employment.
· Ideate
: Establish programmes linking education to job opportunities.
· Prototype
: Initiate partnerships with educational institutions and industries.
· Test
: Track the outcomes of these collaborations on youth participation rates.
5. Retirement and Senior Workforce
· Empathy
: Understand the perspectives of older employees regarding retirement.
· Define
: Identify opportunities for older individuals to contribute economically.
· Ideate
: Propose part-time roles and consultancy opportunities for seniors.
· Prototype
: Create initiatives within organizations that allow for these roles.
· Test
: Monitor the impact on both the economy and the retirees’ quality of life.
Conclusion
Sri Lanka’s labour force participation rates are suboptimal compared to global standards due to various socio-economic and structural factors. By adopting a design-thinking approach to HRM interventions—modernizing labour laws, empowering women, investing in skill development, and enhancing labour market flexibility—Sri Lanka can unlock its economic potential. A proactive stance in these areas will not only improve labour force participation rates but also enhance productivity and foster sustainable economic growth.
References·
World Bank. (2023). World Development Report: The Changing Nature of Work. Washington, DC: World Bank Publications.
· ILO. (2022). Global Employment Trends 2022: Navigating the Impact of the COVID-19 Pandemic. Geneva: International Labour Organization.
· Asian Development Bank. (2021). Sri Lanka: Labour Market and Employment Policy Review. Manila: Asian Development Bank.
· UNDP. (2020). Human Development Report 2020: The Next Frontier: Human Development and the Anthropocene. New York: United Nations Development Programme.
(Lalin I De Silva, Value Chain Journalist of former Senior Planter, Agricultural Advisor / Consultant, Secretary General of The Ceylon Planters Society, Editor of The Ceylon Planters Society Bulletin and freelance journalist.)
Features
Medical Humanities:an interdisciplinary approach to holistic health
The Department of Medical Humanities at the University of Colombo’s Medical Faculty is another groundbreaking initiative by the institution as the pioneer of the discipline here at home and in South Asia. In an interview with the Sunday Island, Clinical Psychologist and Head of the Department of Medical Humanities, Dr. Santushi Amarasuriya elucidates on how this discipline, which is gaining momentum the world over, explores human experiences of health and illness drawing from a spectrum of other social and aesthetic branches.
Following are the excerpts:
BY RANDIMA ATTYGALLE
Q: Could you please share the ‘story’ behind the establishment of the Department of Medical Humanities at the Colombo Medical Faculty?
A:The Department of Medical Humanities was established in 2016 in response to global trends which recognize the role of medical humanities in medical education. It helps medical practitioners to reorient themselves into a holistic and person-centered approach to health care. There was also a general recognition of the impact of burnout and resultant empathy-deficits among medical practitioners, with medical humanities seen as a mechanism through which doctors can understand, reflect upon and deal with such issues. It is in recognition of all this that our Department was established.
Medical humanities lies at the intersection of medicine and humanities. It draws from various disciplines; from literature and philosophy to ethics and arts. The scope of medical humanities is very broad and therefore we find varying definitions of it. How we define it here at the Colombo Medical Faculty, is as ‘humanities in the pursuit of improving the well being and achieving goals in medical education.’ Our goal is to use medical humanities to foster compassionate care, professionalism and ethical practice among medical and other health care professionals, whilst also being sensitive to the socio-cultural context in Sri Lanka.
If we look at the specific history of how the department came into being, one of the highlights was when a brand-new stream called the Behavioural Sciences Stream, first conceptualized by Prof. Nalaka Mendis, was established within the curriculum of our Faculty in 1995. This was a pioneering effort that recognized the transition of the medical model of illness, which focused primarily on biological factors, into what is known as the bio-psychosocial model of health and illness in the late 70s. This latter model takes a more holistic approach and recognizes that there are psychological and social elements that also determine the outcomes of an illness.
Then, during a revision of the Behavioural Sciences Stream curriculum in 2013, Prof. Panduka Karunanayake proposed the establishment of a Medical Humanities Unit. The ensuing discussions led to Prof. Godwin Constantine proposing the establishment of a department. Subsequently, Prof. Saroj Jayasinghe, who was the Chairperson of the Behavioural Sciences Stream at the time became the driving force in establishing the Department in 2016, becoming its founder Head.
I was the first permanent academic staff member to have been recruited to the Behavioural Sciences Stream in 2006 and after the establishment of the Department of Medical Humanities in 2016, I came on board as its first Senior Lecturer.
Q: Could you elaborate on the nature of the learning enabled for the medical student by the Department and how medical humanities help students to brave a demanding curriculum with empathy and kindness?
A: Our main teaching input is through the Humanities, Society and Professional Stream, previously known as the Behavioural Sciences Stream. We provide input into areas of personality development and psychology, communication skills, ethical practice, professionalism, and humaneness, utilizing different teaching methodologies.
If I were to address the topic of empathy that you highlighted, many of our activities try to cultivate this skill in students. However, I would say it is not easy to develop. Many studies have shown that when medical students reach the third year, which is when they start their clinical rotations and need empathy the most, there is actually a decline of it. This is referred to as the ‘devil in the third year’. Many reasons are attributed to this. For example, what was hypothetical is now actually real and students are suddenly overwhelmed with a higher level of responsibility because now they are taking care of real people. There is also a marked increase in workload and it could also be the lack of role models. All this might lead to a decline in empathy. But we must remember that empathy is a hard job, stepping into another person’s shoes and understanding their problems, such as what is making them distressed. To make it even more challenging, it would be multiple patients whose shoes they have to step into and that can be really exhausting.
As a human being, your natural defense mechanism would be to detach yourself and not be empathetic. Therefore, what we try to do is to recalibrate, talk about and reinforce the importance of it.
Q: Could you please explain how the wide range of disciplines coming under medical humanities is translated into actual practice by physicians?
A: One of the methodologies that we have adopted is to use narratives in medicine. Very early in the students’ career, we ask them to go and draw from patients their personal story, and NOT their clinical history. This helps to cultivate a holistic approach to medicine. As a clinician, when you take a clinical history, you are very cognizant that there is a lot more going on for the patient than merely their disease.
A simple exercise that some international institutions utilize is to take students on a gallery visit where they are asked to study portraits to sharpen their finer observational skills; they start learning to notice certain physical signs or certain subtle cues that may have escaped attention. Therefore, at the point of their interaction with patients, they become more attuned to reading many nonverbal cues. For example, take a well-known painting like the Mona Lisa. Closer observation reveals her pale complexion, swollen hands and puffiness around her eyes, which can be used to hypothesize possible ailments she may have suffered from.
Similarly, certain films can be used to create a stimulating dialogue about patient-experiences. They are able to trigger strong emotional reactions and then also provide a safe space to discuss difficult topics which may be inaccessible if only relying on personal experiences. Another tool that I personally find fascinating, that is adopted by some of our colleagues in the region, is the use of the ‘spectator’ concept within forum theatre, where the spectators have the opportunity to intervene and become the actors to change the outcomes of stories depicting difficult situations.
This highlights and empowers the students in their future roles as reflective change agents. Medical students can also be helped to actually step into the patient’s shoes and share the experience of the patient. For example, what is it like to be wheelchair-bound or lack the use of a limb so that they could relate to a patient’s situation better. There is a wide array of methodologies, and this is important given the diversity of student preferences.
Q Is it justifiable to say that this interdisciplinary approach has gained momentum today as the innate ‘humane humaneness’ coupled with professionalism which was found in the good old doctor of yesteryear is largely eroding today, replaced by a stereotypical fact-finder?
A: The importance of humaneness in medical care is well recognized now. The concept of person-centred or patient-centered care is known to a medical student and medical curricula all over the world are adopting these concepts now. If you ask a medical student what empathy is, they will regurgitate the definition and they also know it is important. I would argue that maybe in the good old days these definitions might have been rather alien, but the values these definitions entail may have been innate in most physicians.
That is not to say that there aren’t many students with such skills today. But previously, medical professionals might have had time to actually cultivate these abilities and skills; they might have been able to immerse themselves in the arts. Whereas now, the landscape is very different due to the sheer volume of information to digest, too many competing demands and so forth. Therefore, it becomes a matter of prioritization and many are driven to only focus on the more tangible and measurable elements.
A second reason is the structure of our education. If you take the A-Levels, it’s a rat race to get into the medical faculty and how you get there is by knowing all the information to answer the questions. Along the way you may not have had time for extensive reflection or contemplation. The student who comes to us is trained in that way. So, when they take a clinical history, they may be more driven to simply gather data and make a diagnosis. They forget the holistic nature of the interaction along the way.
Q: Do you think the relevance of medical humanities is unprecedented today given the shift in socio-economic dynamics in society?
A: As a country we have faced several calamities and the most recent one is the economic crisis. Along with it there are several other problems that our people have to face: a significant number is impoverished and there has been a lack of medical supplies and an exodus in the medical profession itself. So, if you think about the professionals working today, they are overloaded with work, and this can lead to a sense of helplessness and frustration.
If you place it within Maslow’s hierarchy of needs, they may be struggling to meet basic needs. So higher-level needs like compassion and empathy start to look more like “nice-to-haves” than necessities, given that they are trying to deliver in a context that is resource-poor. It really is a balancing act. Therefore, it is often all too easy to satisfy ourselves with aggregate numbers. For instance, we say there are low rates of infant mortality and few maternal deaths. But what we might overlook in those aggregates is the experience that the patient has had in this whole process. What we do in our curriculum is re calibrate and remind them of what is finally needed.
Q: Today many patients lament that doctors are ‘poor communicators’, that their body language often doesn’t foster a sense of comfort and security in a patient. How does medical humanities envisage to address this so that doctors can be better communicators?
A: As a Faculty, we all endorse the importance of communication skills, and the input is given at different stages not only through our Humanities, Society and Professionalism Stream (HSPS) but through the other teaching arms as well. Interestingly, many students know the science behind communication practices, such as starting with an open-ended question, but they may not know HOW to do it. There’s a lot of art in asking a question. Although they may not have the innate gift of being effective communicators, with the right training, they can be developed into very successful ones.
In some of our activities we use different works of art, such as movies, paintings, poems, stories and so forth. In the recent past, we have used the painting titled ‘The Doctor’ by Luke Fildes. In the painting, a doctor is hovering over an ill child and we ask the students to interpret what’s going on. A lot is being communicated in this visual such as the stance of the doctor, the nonverbal behaviour, and in the background are the child’s parents who have entrusted the child to the doctor’s care. So just asking the students to analyze it and talk about it helps them to reflect. We use many other such methodologies to foster good communication in future doctors.
Another tool we often use is role-play. We recently launched a Communication Skills Master Class under the guidance of Prof. Dinithi Fernando, the current Chairperson of the HSPS, to give more muscle to the enhancement of communication skills.
Q: What are Sri Lanka’s strengths as a multi-cultural and a hospitable nation that medical humanities could draw from?
A: We are a collective community and helping another human being in distress, is very much a part of our culture. It comes very naturally and that translates into the process of healing a patient in distress. Kindness and compassion are key messages that are collectively shared by all our religions practiced here at home. If you consider kindness, I think of it at two levels: people whose core is kind and those who superficially reflect kind behaviour such as talking in a nice way and similar social graces. But this second category may not be kind deep down. Now if you think about our cultural orientation, it is that first one which is emphasized- kindness at the core. What we are trying to harness is a natural or deeply culturally-endorsed tendency.
Another example is the cultural sensitivity that we may already possess. We have students coming from different contexts and different experiences. They already recognize the existence of ‘health pluralism’ and that the patient’s conceptualizations of illness and treatment encompass a wide range of practices and beliefs that are not directly relevant to western medical practice. Therefore, it is just a matter of reminding them of these to help them to be more empathetic about patient experiences.
Q: What are the collaborations the Department has forged with professionals outside the medical stream to cultivate a sense of appreciation in aesthetics in future doctors?
A: One good example is our Humanitas programme. This is the brainchild of Prof. Panduka Karunanayake. The Latin term humanitas translates into human nature, civilization and kindness and relates to what it is that makes us human. In this programme we address various human issues – be it a current crisis or a problem like a heart break.
Prof. Karunanayake’s objective in launching this programme was to trigger an emotional reaction and let the other cognitive processes occur on their own. The Humanitas programme is solely directed by Dr. Santhushya Fernando who is a Senior Lecturer in our Department, where she gets in different artists from musicians to poets to talk about such issues and reflect and share their vulnerabilities, giving flavour to the programme. The programme has received very good reviews and all credit for this must go to Dr. Fernando who has spearheaded this programme with passion and enthusiasm.
Similarly, we have been fortunate to receive generous support from the academics of the University of Visual and Performing Arts who have not only made wonderful contributions to the Humanitas programme but to many other activities of the Department.
Q: What inspiration does the Colombo Faculty offer other medical faculties in the country in terms of recognizing medical humanities and what are the future plans of your Department to give a further thrust to medical humanities?
A: Even in terms of the Behavioural Sciences Stream, we were pioneers and all other faculties have now adopted it under different names. It is heartening to note that many of the medical faculties here have taken a cue from our experience. Although they may not have a dedicated department to the discipline, many have incorporated these ideas into their curriculum.
In terms of expansion, we have many plans which are aligned with the goals of our Department such as using the humanities to facilitate health education and training, initiating research by drawing from best practices which could be replicated here at home and also to enrich our curriculum. We plan to explore on how to enable more patient-friendly environments so that our future doctors can actually translate the concepts espoused by the humanities, into actual practice and also explore the role of the discipline in developing therapies or interventions to promote health.
The department has now been allocated a larger space within the Faculty to grow and expand but lacks facilities to make it an occupiable space. We are seeking donations from philanthropists and wellwishers to make this project a reality.
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