A healthcare system accessible to all:
by Dr. Indika Weerasinghe
Consultant Orthopaedic Surgeon Vavuniya District General Hospital.
Email : email@example.com
Twenty-year-old Hashan from Kanadarawa, Medawachchiya was brought to the Accident Service of Vavuniya District General Hospital on the morning of 5thOctober 2020 following a fall from a coconut palm. He landed mostly on his back after falling from a height of 25 feet. The Suwa-Seriya free ambulance arrived at the site in five minutes and brought him to the hospital. Fortunately, there was no damage to his spinal cord, which would have paralysed his legs. But he had an unstable fracture of his spine along with multiple other injuries. His right leg was broken and the ankle dislocated. His left wrist was broken as well. This was a case of major trauma or poly-trauma, which needs multi-disciplinary care by several surgical specialities.
Despite multiple injuries, Hashan was conscious and alert as he has escaped head injury. Needless to say, his parents who were at the bedside, were devastated and in a state of shock. Hashan himself did not realise the gravity of the injury until his X-rays and other imaging was explained to him that morning. All of his fractures needed surgery as soon as he was stable enough for anaesthesia. Hashan’s father had two questions for the orthopaedic team.1) Is it possible to do all the surgeries in Vavuniya hospital? 2) How much is it going to cost him?
The answer to the first question was ‘yes’ and there was relief in his eyes upon hearing that. Transferring Heshan to Jaffna Teaching Hospital or Anuradhapura Teaching Hospital would have meant that family members would have to travel longer distances back and forth to care for Hashan. The answer to the second question was ‘the entire treatment will not cost a cent’. Hashan’s father looked skeptical hearing that as he understood that there will be multiple surgeries including one on the spine.
Two days later, after careful planning, Hashan had surgery to fix his spine. All implants and instruments were available in the hospital. Intra-operative X-ray machine was invaluable to complete the spinal surgery safely. Simultaneously, his right leg and ankle were fixed. His left wrist was not operated on that day to limit surgical stress on his body. Three days later he had his left wrist operated with a plate and screws. On post operative day 2, he was brought upright with a brace and was able to bear weight onto his left leg. After an uneventful recovery in ward 9 of Vavuniya Hospital, Hashan was discharged 10 days later.
Hashan is just another patient out of many thousands of Sri Lankans who receive free healthcare on a yearly basis fromgovernment hospitals around the island. His treatment was not groundbreaking, but what needs to be emphasized here is the cost the government bears through the Ministry of Health, to get people like Hashan back into the workforce after life changing trauma. Its easy to overlook the man-power, medicinal and equipment cost borne by the Ministry of Health to make Sri Lankan citizens like Hashan productive once again and contributing to the development of the country. The three surgeries he had and the hospital stay of two weeks would have cost around two million rupees in private hospital, which would have been much more than over what Hashan’s family would have been able to afford. But thanks to free universal healthcare in Sri Lanka, Hashan is back home today without his father having to sell his house to pay hospital bills.
To appreciate the benefit of free healthcare in Sri Lanka, it is important to compare our healthcare model with other countries. India also has a universal healthcare system but the private sector healthcare is dominant. Most health expenses are paid ‘out of pocket’ of patients and their families. Most people in rural areas does not have access to quality, affordable healthcare.
In the United Kingdom, the National Health Service (NHS) provides free healthcare to its people except for some charges associated with eye tests, dental care and prescriptions. The NHS is funded by the significant contribution tax payers make to the government. (If the annual income of a person in England is between 50,000 to 150,000 pounds, 40% is deducted as tax). It is that significant tax contribution that funds the National Health Service and its ‘free’ healthcare.
Healthcare costs in the United States are astronomically high. medical bills are the number one cause of bankruptcy in United States. This is despite the United States spending 16.9% of its GDP on health (2018).
According to Bloomberg health efficiency index, Hong Kong ranks number one as the most efficient healthcare model in the world. Hong Kong spends around 3% of its GDP on health and its citizens are provided with healthcare plans for a low cost. (Not for zero cost).It is a mixed medical economy with 43 public hospitals and 12 private hospitals.
I feel it is in that context we have to look at our free healthcare model which is unique to Sri Lanka. Like in Hong Kong, private sector contribution prevents overburdening of government healthcare delivery. But unlike in India, strong government sector healthcare delivery system reaches into rural areas like Kanadarawa, Medawachchiya where people like Hashan can get quality treatment at government hospitals absolutely free. And unlike in the United States, health costs are not over the roof expensive.
It is true that from time to time, there are shortages of medicines and equipment in government hospitals in Sri Lanka. But they are usually transient. Even for those shortages, there is a system to ‘Local Purchase’these drugs and equipment by using funds allocated to the government hospital.
So, I think it is fair to say that as a developing economy, Sri Lanka is doing its best to look after the health of its people. Therefore, it is the responsibility of all Sri Lankans to protect our universal free healthcare system and improve it further.
Strong on vocals
The group Mirage is very much alive, and kicking, as one would say!
Their lineup did undergo a few changes and now they have decided to present themselves as an all male group – operating without a female vocalist.
At the helm is Donald Pieries (drums and vocals), Trevin Joseph (percussion and vocals), Dilipa Deshan (bass and vocals), Toosha Rajarathna (keyboards and vocals), and Sudam Nanayakkara (lead guitar and vocals).
The plus factor, where the new lineup is concerned, is that all five members sing.
However, leader Donald did mention that if it’s a function, where a female vocalist is required, they would then feature a guest performer.
Mirage is a very experience outfit and they now do the Friday night scene at the Irish Pub, in Colombo, as well as private gigs.
Dichotomy of an urban-suburban New Year
Ushered in by the ‘coo-ee’ of the Koel and the swaying of Erabadu bunches, the Sinhala and Tamil New Year will dawn in the wee hours of April 14. With houses to clean, preparation of sweetmeats and last-minute shopping, times are hectic…. and the streets congested.
It is believed that New Year traditions predated the advent of Buddhism in the 3rd century BC. But Buddhism resulted in a re-interpretation of the existing New Year activities in a Buddhist light. Hinduism has co-existed with Buddhism over millennia and no serious contradiction in New Year rituals are observed among Buddhists and Hindus.
The local New Year is a complex mix of Indigenous, Astrological, Hindu, and Buddhist traditions. Hindu literature provides the New Year with its mythological backdrop. The Prince of Peace called Indradeva is said to descend upon the earth to ensure peace and happiness, in a white carriage wearing on his head a white floral crown seven cubits high. He first plunges, into a sea of milk, breaking earth’s gravity.
The timing of the Sinhala New Year coincides with the New Year celebrations of many traditional calendars of South and Southeast Asia. Astrologically, the New Year begins when the sun moves from the House of Pisces (Meena Rashiya) to the House of Aries (Mesha Rashiya) in the celestial sphere.
The New Year marks the end of the harvest season and spring. Consequently, for farming communities, the traditional New Year doubles as a harvest as well. It also coincides with one of two instances when the sun is directly above Sri Lanka. The month of Bak, which coincides with April, according to the Gregorian calendar, represents prosperity. Astrologers decide the modern day rituals based on auspicious times, which coincides with the transit of the Sun between ‘House of Pisces’ and ‘House of Aries’.
Consequently, the ending of the old year, and the beginning of the new year occur several hours apart, during the time of transit. This period is considered Nonegathe, which roughly translates to ‘neutral period’ or a period in which there are no auspicious times. During the Nonegathe, traditionally, people are encouraged to engage themselves in meritorious and religious activities, refraining from material pursuits. This year the Nonegathe begin at 8.09 pm on Tuesday, April 13, and continues till 8.57 am on 14. New Year dawns at the halfway point of the transit, ushered in bythe sound of fire crackers, to the woe of many a dog and cat of the neighbourhood. Cracker related accidents are a common occurrence during new year celebrations. Environmental and safety concerns aside, lighting crackers remain an integral part of the celebrations throughout Sri Lanka.
This year the Sinhala and Tamil New Year dawns on Wednesday, April 14, at 2.33 am. But ‘spring cleaning’ starts days before the dawn of the new year. Before the new year the floor of houses are washed clean, polished, walls are lime-washed or painted, drapes are washed, dried and rehang. The well of the house is drained either manually or using an electric water pump and would not be used until such time the water is drawn for first transaction. Sweetmeats are prepared, often at homes, although commercialization of the new year has encouraged most urbanites to buy such food items. Shopping is a big part of the new year. Crowds throng to clothing retailers by the thousands. Relatives, specially the kids, are bought clothes as presents.
Bathing for the old year takes place before the dawn of the new year. This year this particular auspicious time falls on April 12, to bathe in the essence of wood apple leaves. Abiding by the relevant auspicious times the hearth and an oil lamp are lit and pot of milk is set to boil upon the hearth. Milk rice, the first meal of the year, is prepared separate. Entering into the first business transaction and partaking of the first meal are also observed according to the given auspicious times. This year, the auspicious time for preparing of meals, milk rice and sweets using mung beans, falls on Wednesday, April 14 at 6.17 am, and is to be carried out dressed in light green, while facing east. Commencement of work, transactions and consumption of the first meal falls on Wednesday, April 14 at 7.41 am, to be observed while wearing light green and facing east.
The first transaction was traditionally done with the well. The woman of the house would draw water from the well and in exchange drop a few pieces of charcoal, flowers, coins, salt and dried chillies into the well, in certain regions a handful of paddy or rice is also thrown in for good measure. But this ritual is also dying out as few urban homes have wells within their premises. This is not a mere ritual and was traditionally carried out with the purification properties of charcoal in mind. The first water is preferably collected into an airtight container, and kept till the dawn of the next new year. It is believed that if the water in the container does not go down it would be a prosperous year. The rituals vary slightly based on the region. However, the essence of the celebrations remains the same.
Anointing of oil is another major ritual of the New Year celebrations. It falls on Saturday, April 17 at 7.16 am, and is done wearing blue, facing south, with nuga leaves placed on the head and Karada leaves at the feet. Oil is to be applied mixed with extracts of Nuga leaves. The auspicious time for setting out for professional occupations falls on Monday, April 19 at 6.39 am, while dressed in white, by consuming a meal of milk rice mixed with ghee, while facing South.
Traditionally, women played Raban during this time, but such practices are slowly being weaned out by urbanization and commercialisation of the New Year. Neighbours are visited with platters of sweetmeats, bananas, Kevum (oil cake) and Kokis (a crispy sweetmeat) usually delivered by children. The dichotomy of the urban and village life is obvious here too, where in the suburbs and the village outdoor celebrations are preferred and the city opts for more private parties.
New Year games: Integral part of New Year Celebrations
Food, games and rituals make a better part of New Year celebrations. One major perk of Avurudu is the festivals that are organised in each neighbourhood in its celebration. Observing all the rituals, like boiling milk, partaking of the first meal, anointing of oil, setting off to work, are, no doubt exciting, but much looked-forward-to is the local Avurudu Uthsawaya.
Avurudu Krida or New Year games are categorised as indoor and outdoor games. All indoor games are played on the floor and outdoor games played during the Avurudu Uthsava or New Year festival, with the whole neighbourhood taking part. Some of the indoor games are Pancha Dameema, Olinda Keliya and Cadju Dameema. Outdoor games include Kotta pora, Onchili pedeema, Raban geseema, Kana mutti bindeema, Placing the eye on the elephant, Coconut grating competition, Bun-eating competition, Lime-on-spoon race, Kamba adeema (Tug-o-War) and Lissana gaha nageema (climbing the greased pole). And what’s an Avurudhu Uthsava sans an Avurudu Kumari pageant, minus the usual drama that high profile beauty pageants of the day entail, of course.
A salient point of New Year games is that there are no age categories. Although there are games reserved for children such as blowing of balloons, races and soft drinks drinking contests, most other games are not age based.
Kotta pora aka pillow fights are not the kind the average teenagers fight out with their siblings, on plush beds. This is a serious game, wherein players have to balance themselves on a horizontal log in a seated position. With one hand tied behind their back and wielding the pillow with the other, players have to knock the opponent off balance. Whoever knocks the opponent off the log first, wins. The game is usually played over a muddy pit, so the loser goes home with a mud bath.
Climbing the greased pole is fun to watch, but cannot be fun to take part in. A flag is tied to the end of a timber pole-fixed to the ground and greased along the whole length. The objective of the players is to climb the pole, referred to as the ‘tree’, and bring down the flag. Retrieving the flag is never achieved on the first climb. It takes multiple climbers removing some of the grease at a time, so someone could finally retrieve the flag.
Who knew that scraping coconut could be made into an interesting game? During the Avurudu coconut scraping competition, women sit on coconut scraper stools and try to scrape a coconut as fast as possible. The one who finishes first wins. These maybe Avurudu games, but they are taken quite seriously. The grated coconut is inspected for clumps and those with ungrated clumps are disqualified.
Coconut palm weaving is another interesting contest that is exclusive to women. However men are by no means discouraged from entering such contests and, in fact, few men do. Participants are given equally measured coconut fronds and the one who finishes first wins.
Kana Mutti Bindima involves breaking one of many water filled clay pots hung overhead, using a long wooden beam. Placing the eye on the elephant is another game played while blindfolded. An elephant is drawn on a black or white board and the blindfolded person has to spot the eye of the elephant. Another competition involves feeding the partner yoghurt or curd while blindfolded.
The Banis-eating contest involves eating tea buns tied to a string. Contestants run to the buns with their hands tied behind their backs and have to eat buns hanging from a string, on their knees. The one who finishes his or her bun first, wins. Kamba adeema or Tug-o-War pits two teams against each other in a test of strength. Teams pull on opposite ends of a rope, with the goal being to bring the rope a certain distance in one direction against the force of the opposing team’s pull.
Participants of the lime-on-spoon race have to run a certain distance while balancing a lime on a spoon, with the handle in their mouths. The first person to cross the finish line without dropping the lime wins. The sack race and the three-legged race are equally fun to watch and to take part in. In the sack race, participants get into jute sacks and hop for the finish line. The first one over, wins. In the three-legged race one leg of each pair of participants are tied together and the duo must reach the finish line by synchronising their running, else they would trip over their own feet.
Pancha Dameema is an indoor game played in two groups, using five small shells, a coconut shell and a game board. Olinda is another indoor board game, normally played by two players. The board has nine holes, four beads each. The player who collects the most number of seeds win.
This is the verse sung while playing the game:
“Olinda thibenne koi koi dese,
Olinda thibenne bangali dese…
Genath hadanne koi koi dese,
Genath hadanne Sinhala dese…”
Six nabbed with over 100 kg of ‘Ice’
Happy New Year!
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