Opinion
Yes indeed, Hippocrates is turning in his grave

My mind time travelled thirty-seven years to the auditorium, Rahula College, Matara. Being one of the two surgeons at the Base Hospital I was a man in demand whom the service receivers respected. My good lady and I were seated in the VIP row of seats and when the curtain raised there was a man hanging from a lamp post in an ill lit left hand corner of the stage. The narrator was late the H.A.Perera and in his inimitable style and signature voice loudly exclaimed “this man hanging here was the last honest man in the country”. The stage play was Maghatha. This was a satirical play depicting the hight of corruption and lawlessness prevailing at the time.
Sri Lanka even at this moment of time is not any better. There will come a time when honesty and truthfulness would make one disqualified to continue to live here. The country is full of dishonest people. Finding an honest man might well prove an exercise that would put Kisa Gothamie in the shade.
It was Monday the 7th November 2022, a public holiday and I had to visit the NHSL,Colombo to see a man who is a distant relative of ours but more importantly a man who did some excellent salvage job for me to make a brand new bathroom screwed up by the previous workmen, up to scratch again. As a result, in a way, I am indebted to him. Having recently had some Deja vu of the thel polim yugaya, I ventured out to bus and walk the trip which I enjoyed very much as the buses were almost empty.
I got to the hospital all right but finding the ward I needed to visit would have been an uphill task if not for an ex-trainee of mine who is at present a top orthopaedic surgeon at the NHSL, whom I met at the Consultants’ lounge. He said “Sir things are very different compared with the time you were a Consultant here. Even after introducing yourself as an ex senior surgeon the response, you receive might embarrass, frustrate, or even anger you. So let me call the ward” and so he did.
It was a medical ward shared between two consultant physicians. There was an air of busyness about the place because they were probably on acute take. Ward had been partitioned into what they called ‘cubicles’ but they were more like solid rectangles or cuboids. Patients of both consultants seemed haphasardly distributed in each ‘cubicle’. Normally in such situations the responsible Physicians name is displayed on the wall at the head end of the bed. No such name boards were visible in this ward. There were three intern house officers on the ward. They knew which cubicle they were responsible for but would definitely have not known the details of patient distribution in the ward. Apparently, the consultants did independent ward rounds but from what I saw those must be reminiscent of the doctor in the house or doctor on the go series. This arrangement is ideal for the two consultants to take every other day off unofficially. I don’t know whether this happens, but I would be very surprised if it didn’t.
My patient’s ordeal exemplifies the degree of confusion that was prevailing amongst the Medical staff of this ward. He is a 51 year old previously healthy teetotaller building supervisor who was suddenly struck down with an acute coronary ailment six weeks ago. Though there has been some delay he eventually had a stent inserted into one of the main arteries of his heart. After a few days in the cardiology unit, he was discharged with a number of tablets and capsules to swallow on a daily basis. All was good till 04 November, when he developed pain under the rib cage radiating to the back of the chest and up between shoulder blades. For all intent and purposes, it was a cardiac (heart) pain and he should have been admitted to the cardiology ward. Not to be. He was bundled into this medical ward. An ECG done on admission had shown some new changes signifying reduced blood supply to a part of the heart with no biochemical evidence of permanent damage to that part of the heart. The biochemical marker of heart muscle damage is Troponin. Hence this condition is called Troponin negative Acute Coronary Syndrome. The medical team in consultation with the cardiology Registrar has started him on anticoagulants (blood thinners). ECG done next mane was normal. Thank goodness for that. Cardiology Registrar never saw the patient physically. Telemedicine at its peak!
Even after my talking to the Consultants personally who promised that a transfer to cardiology would happen, the patient continued to camp in the medical ward for a few more days before being discharged. The scenario made me feel that the Registrars functioned independently of the consultants or communication between senior and junior medical staff was happening only at a very low ebb. Either way it was a dismal state of affairs. I am not sure whether this patient’s management conforms to the accepted norms currently used in the developed world.
My visit was a little over 24 hours after all this had happened. Thanks to my ex-trainee, current Consultant Orthopaedic surgeon, I was greeted well by the doctor at the front desk who passed me on to the doctor my friend and ex-trainee had spoken to over the phone. She and the doctor in charge of the ‘cubicle’ escorted me to my patient. They were two lovely innocent looking girls who seemed trying to find their way around still.
They were thorough with the patient’s condition but didn’t seem to know much logistics around it. They didn’t know if an official referral had been made to the cardiologist who performed the index procedure. They perused the notes but couldn’t find one. They didn’t know which of the two consultants was on call. No consultant has visited the ward on Sunday. I was there till past midday on Monday (07) and didn’t see any consultant doing a round. My patient told me no consultant had gone round the ward on the whole of Monday too. Apparently, the young sweet innocent doctor was not that innocent, after all. She had made a long scribble in the notes without asking the patient a single question and without examining him at all. What a country and what a department of health services!
My response to the two young ladies was this. “Doctors, as budding consultants please remember these are the most vulnerable of human beings because they are acutely unwell. It is our duty to do our best for them. Always try to recognise an urgent situation and treat it to prevent it becoming an emergency. Public holidays are public holidays in which microorganisms are still active causing infection, blood clots still form on ulcerated plaques inside arteries causing acute arterial insufficiency in different parts of the body including the heart, blood pressures and sugars still keep going up and down unconcerned and a whole lot of other known and unknown pathological processes still go on unrelenting. Hence, if you are rostered for the weekend or the public holiday, please make sure your services are physically available. When I was here at the NHSL about twenty years ago there used to be a weekend and public holiday roster made by a man called Mr. Gamage without whom the director felt crippled. There were no computers and printers installed. A simple cyclostyling machine did the job. All wards, all consultants all clinical and other departments received a copy each. So, everybody knew who was on call. Every on-call consultant did a full ward round in the morning. If an emergency cropped up with one of his patients (rarely the case) needing a re-operation he did it himself without handing it over to the casualty team. Exotic investigations and high-tech interventions may well be needed but not the bread and butter of patient care. Awareness, availability ability and empathy constitute holistic care. Please don’t hold them back. Shower your patient with all of the above and you would be a great doctor”. They listened to me so intently in pin-drop silence that they looked as if they were devotees listening to a sermon delivered by Ven. Narada Thero of Vajiraramaya in the distant past.
Unlike in my active working days, in this day and age, even consultants get paid for extra duty they perform. They do get paid for working on holidays as well. Those who get paid for work they haven’t done are as guilty as those who wilfully robbed the country to drag us into economic doldrums. Also, crimes can be perpetrated by commission or by omission. Those who hold back their services to the sick, when rostered, commit a grave crime by omission specially if the juniors who have been entrusted the boss’s job miss an urgent situation which later becomes an emergency to which the poor patient succumbs.
This is in stark contrast to the time I was a trainee and then a consultant and a trainer. The second half of my internship in 1973 was with a tough boss but a great obstetrician Dr. D. E. Gunatilleke, who was to become the Professor of Obstetrics and Gynaecology, University of Ceylon, Colombo, the following year. We had a post MRCOG (part l) Registrar (called SHO those days) who came down to the De Soysa Hospital for Women to take up the job from being MOH Atakalampanna, an area in the Ratnapura Health District. He was a gentleman par excellence too. Being an inexperienced trainee, he was very worried about taking the lead so I almost became his equal instead of his intern. He used to talk to the boss through me. This was one of our emergency admission days and we had already done four Caesarean sections for the night when we received a patient transferred from the Base Hospital, Horana with the baby lying crosswise and the mum in labour. Baby’s hand has prolapsed into mum’s vagina. Baby was still alive but in distress. My Registrar the late Dr. Shanthan Perera said, “Machan boss has just returned home after doing the fourth section. I don’t feel confident to call him. Could you please help me with this? I readily obliged as I had a great rapport with my boss. I picked up the phone and spoke to him. “Sir I am awfully sorry to bother you at this ungodly hour especially knowing you have just returned home from hospital. We got this young lady whose second pregnancy has been complicated by her going into labour with a transverse lie of the foetus, hand prolapse and foetal distress. I have resuscitated her with intravenous fluids and intermittent boluses of 50% dextrose. She is on oxygen and an indwelling catheter is showing a good urine output. I have got blood cross matched and the theatre is ready” “Don’t worry Janapriya, I will be there in 10 minutes” Lo and behold he was there in little over five minutes––he lived at Rosemead Place––did a Caesarean section and extracted a healthy baby. It was 5 am and the fifth Caesarean section was done and dusted! Time for a cat nap before the next day starts.
Those were the days. If I fall seriously ill, I will use my time machine and go back in time to be treated by one of those doctors and gentlemen. They had no flashy cars. They had no private practice or indeed extra duty payment or holiday pay. They had no CT and other scanners to help them with diagnostic work up. What they had in plenty were knowledge, skill, empathy and duty consciousness. They were honest, worked very hard and placed patient welfare at the pinnacle. Even a physically diminutive figure like the boss of mine I was referring to, stood head and shoulders above self-conceited big burley medical men of today proudly plying around in expensive top of the order automobiles.
It was Lord Moynihan, a pioneer surgeon who, seeing patients with advanced bladder cancer suffer with excruciating pain due to the cancer invading pelvic nerves said, “Lord, if you want to take me please do not take me through my bladder” I have modified this as per below,
Lord, if you want to take me please don’t torture me through the corridors of the hospitals of Sri Lanka, be it state run or privately owned but simply knock me down with a train, a bus, a lorry or a truck. I will accept it with grace and the drivers will go scot-free too.
Dr. M. M. Janapriya
Opinion
What is ‘Reparations’ in the context of Transitional Justice

It has been six years since the establishment of the Office for Reparations in Sri Lanka. There is however no clear understanding among many as to its mandate or role within the broader context of transitional justice in a country that seeks to recover from a civil conflict, promote reconciliation and ensure non recurrence. This article seeks to clarify the concept and highlight the statutory mandate of the Office for Reparations (“OR”) established in terms of the Office for Reparations Act, No, 38 of 2018 (“the OR Act”).
Reparations is one of the measures recognised within the broader context of Transitional Justice. Transitional Justice is defined by the United Nations as “the full range of processes and mechanisms associated with a society’s attempt to come to terms with a legacy of large-scale past abuses, in order to ensure accountability, serve justice and achieve reconciliation.” Interventions to address transitional justice challenges became necessary at the end of the North East conflict as Sri Lanka sought to restore democratic systems and promote unity among its multi ethnic and multi religious peoples.
Reparations in the context of human rights and humanitarian interventions, is granted to victims of conflict who have suffered harm, to alleviate their situation which has arisen consequent to the harm suffered as a result of conflict. It is accepted that some of these violations are irreparable and nothing granted by way of reparations can restore the status quo ante of the victim.
Among the basic tenets recognised in the transitional justice regime are the following-
(a) the State obligation to investigate and prosecute alleged perpetrators of gross violations of human rights and serious violations of international humanitarian law, including sexual violence, and to punish those found guilty;
(b) the right to know the truth about past abuses and the fate of disappeared persons; (c) the right to reparations for victims of gross violations of human rights and serious violations of international humanitarian law; and
(d) the State obligation to prevent, through different measures, the recurrence of such atrocities in the future.
The United Nations General Assembly adopted Resolution 60/147 on 16 December 2005 on “”
Each State identifies what mechanisms and interventions must be set in place to address these issues. There is no one size fits all formula to determine the methodologies that must be adopted by countries. Clearly, in Sri Lanka the establishment of the Office on Missing Persons (OMP) by Act No. 14 of 2016 was to deal with component (b) above and the establishment of the OR by the Act of 2018 was to deal with component (c) above. Neither of these institutions have responsibility for (a) above. Importantly, it must be noted that there is no expectation that the OR handles law enforcement functions to investigate and prosecute alleged perpetrators. Nor is the Office on Missing Persons (OMP) vested with that responsibility given that its principal mandate as set out in the statute is to search for and trace missing persons and to protect the rights and interests of missing persons and their relatives. Investigation and prosecution of alleged human rights violations are functions to be discharged by existing law enforcement Authorities that are adequately vested with powers to do so.
The OR Act came into operation on October 22nd, 2018 and was operationalised with effect from April 2019 with the appointment by the President of 5 Members on the recommendation of the Constitutional Council. Its provisions went beyond merely providing for monetary relief measures. It articulated the basis for granting relief and the macro level expectations. In its preamble it stated that the Constitution of Sri Lanka recognizes the inherent dignity and the equal and inalienable human rights of all Sri Lankans and recognized the obligation of the State to respect, secure and advance these rights. It also stated that a comprehensive reparations scheme which is anchored in the rights of all Sri Lankans to an effective remedy will contribute to the promotion of reconciliation for the well-being, and security of all Sri Lankans including future generations.
There was thus an acceptance that reparations were designed to contribute to the broader objective of reconciliation. In introducing the Bill, the then Prime Minister stated that ““
The OR Act provides for the grant of reparations to specified categories of victims, ie, persons who have suffered loss (ie. personal injury, death and damage to property) arising from the armed conflict that took place in the Northern and Eastern Provinces or its aftermath, or due to political unrest or civil disturbances or due to enforced disappearances. It established a regime to deal with past as well as future incidents.
In pursuance of its mandate, the OR commenced its work by formulating its policies and guidelines after conducting stakeholder consultations in several regions of the country. The consultations revealed similar needs among the aggrieved persons, be they inhabitants in the North, East, South or West of the country and are common to the wider communities as a whole, and consequently, although some of the interventions that can be offered as reparations are those that are needed by the wider community, the increased vulnerability of the victims of conflict were identified to recognise that their needs be addressed as a priority. The Policy document was laid before Parliament and can be accessed via the OR website at www.reparations.gov.lk. The Policy identifies 8 areas of interventions.
The COVID pandemic and staff shortages that were imposed during the economic crisis across government, impacted the work of the OR. Within these constraints OR decided to implement activities that were considered to be most meaningful to the aggrieved communities.
As regards the victims of the North East conflict, the focus was on providing interventions that empowered the people. The Members of the OR accepted that handouts by way of monetary grants while useful to a limited extent will however not empower victims, but knowledge transfer and skills development programmes that will enhance capacities to undertake sustainable revenue generating activities will be meaningful. Hence, while some amount of financial grants were made, more importantly activities to provide psychosocial support and support livelihood development were implemented. A psycho social support programme especially designed for the post conflict victim community was carried out in some parts of the country with the assistance of the UN through the IOM, and livelihood development programmes were implemented, as a priority. In pursuance of its gender sensitive approach, programmes to empower women to cultivate skills that generate sustainable income generation activities were designed and implemented.
The categories of victims that received monetary relief from the OR have included victims of the North East conflict, victims of the Easter Bomb Attack Of 2019 and victims of the 2022 civil disturbances. Details of monetary relief granted to all categories of victims can be found on the OR website.
In January 2023, the OR was mandated by the Supreme Court to establish a Victim Fund to receive monies ordered by the Supreme Court to be paid by respondents in Fundamental Rights litigation, and to formulate a scheme for disbursements and to make grants thereform. Schemes to provide grants to families of those who died, to persons injured, to children for secondary school education support, to students for tertiary education support and to vulnerable elders, were formulated and disbursements made from the Victim Fund. All of these tasks have been handled and details can be accessed via the OR website. Reports on monies credited to the Fund and disbursements made are also periodically submitted to the Supreme Court.
The OR has completed 6 years since its establishment in April 2019, and while there was a period of inactivity during the COVID pandemic and staff constraints impacted its work due to the economic crisis that the country went through, all of which are common to all of government institutions, the OR has been able to complete a significant workload, including the completion of monetary grants to applicants from the North East conflict. Details may be accessed via the website.
by Dhara Wijayatilake,
Attorney at Law and Chairperson Office for Reparations
Opinion
Four generations

Surasena was a scraggy boy with a runny nose, most of the time. He came to school sometimes, when he was well enough. Coughs and colds were a part of him. The entire school had an enrolment of less than 100; attendance varied from about 80 to about 100. Enrolment fell as students dropped out as they grew older: in grade V, there were usually 6 or 7 students, mostly boys. Most students were in Kindergarten, the Lower and the Upper. There were six teachers, one female, who was the principal’s wife, and both came from about 75 km away. They lived in the principal’s quarters with no other suitable house they could rent in the village. There was one English teacher, a man who cycled daily from a considerable distance. He was remarkably regular. He was the class teacher for Grade III and taught English in grades III, IV and V. He had had no special training in teaching English, or any other language and his final year students could hardly write the English alphabet without error. The parents of the children were mostly illiterate and hardly came to school after they had brought their child for admission. Surasena’s illiterate parents saw no function they could serve in the school. Teachers did the teaching.
Although Surasena was irregular in attendance, he picked up what was taught in class without any effort. When the end-of-term tests came, if he were present, he always came first in class. One teacher noticed this and spoke to the principal. The teacher thought that the boy was bright enough to win a scholarship if the gaps in his knowledge of arithmetic could be filled. Because the boy had come to school only when he was well, there were large gaps in his competence, especially in arithmetic. The young teacher took up the challenge, and when the results came, the boy had done well. So began a venture, which few had set out on then. One scholarship after another carried him to the highest centre of learning in his discipline, where he earned the highest degree any university could award.
Then a career: compromising among several objectives and laying aside many objections, Surasena decided to work for the world’s primary intergovernmental organisation. In doing so, he chose to live in the richest city in the world. Rich cities offer citizens many and varied services unavailable in less sophisticated habitats: theatres, concert halls, public libraries, high quality schools, universities, good sanitation and sophisticated architecture. Surasena chose to send their children to a unique school where both students and teachers came from many parts of the world. When the children prepared to go to university, each of them found her/himself in the first percentile of intellectual ability. Each chose to attend the highest quality colleges and universities. Their first jobs were with the Securities and Exchange Commission and the Federal Reserve System, both the highest-level regulatory agencies in that country. They eventually changed their careers and residences. One took up to law in New York City and the other a professorship in a state university.
Two young men in the fourth generation have completed secondary school and are in universities studying engineering.
An illiterate family goes to university. A family that lived in a coconut leaf thatched hut in a remote village lives in good housing in choice parts of cities, large and small. A boy who had only rice ration books in his home dispersed his collection of nearly one thousand books to several universities. A man who had never seen a play on a stage goes to Broadway and Carnegie Hall regularly. A young man in the fourth generation plays the saxophone at the Lincoln Centre. A family in the first generation that had not ventured beyond its native district, in the second generation, travels the world over. With different destinations and varied byways, these paths have been traversed by thousands of individuals and families in our society. A different and much larger cohort of our labour force, young, healthy and literate, has been pushed out of our economy.
I have used a fictional name to avoid embarrassing individuals. The rest of the narrative is factual. These sequences are repeated many thousands of times in this country, a highly mobile society. Neither poverty nor social position or habitat in town nor country bars children of ability from going where they wish. (One last habitat is systematically denied access to the high roads. One expects these roads to open literally and metaphorically, in short order.) We have had several employees in our household who used their earnings to pay for their children’s education at university. A few weeks back, one of those children graduated from a prestigious medical faculty in the country. A child in another family is in university studying mathematics. I reckon that is not an uncommon or infrequent occurrence.
It is one thing to move up the education ladder and another to find mobility within the economy. The space at the top is created in the economy and not in schools. It is an easy and common confusion to think that young men and women cannot find employment because they studied the wrong subjects at school or university. No matter what they learnt at school and university, they will be unemployed so long as there is no demand for labour. And the demand for labour is a function of the structure and the level of activity in the economy, not of the education system. Well into the second half of the 19th century, the founders of Dartmouth College declared, ‘though our great objective was to erect a seminary for educating ministers of the gospel, yet we hope that it will be a means of raising up men that will be useful in other learned professions- ornaments of the state as well as the church.’ And the United States was rushing to be the largest economy in the world. From 1929 to about 1936, there was high unemployment in most capitalist economies because economic activity fell disastrously and not because there was something suddenly wrong with education in those countries. Millions of rural folk in China and India, with no special education or training, marched to factories, when entrepreneurs opened workplaces for them. In both instances, the cause of unemployment is a lack of demand for labour. In China and India, demand arose when enterprises, both national and international, were created to produce goods and services. For markets in rich countries. Workers from Lanka took planes to workplaces overseas, where there was demand for them. Others remain unemployed in this country, because there are no enterprises that can pay competitive wages.
That brings us to the woeful inadequacy of interpleural activity in this country. The provision of health and sanitation and education in this country has been primarily the government’s responsibility. They have been resounding successes. Their success has had expected consequences on population changes. Our governments have systematically invested in peasant agriculture, placing populations from crowded areas in less densely populated areas. During the last 20 years or so, governments have invested, at exorbitant cost, in infrastructure development. The main visible enterprises in the private sector are in finance, construction and the manufacture of garments. Garment manufacturing is a low productivity activity (shoved out of high productivity economies), and there is severe competition for market shares. China (+Taiwan), Malaysia and India have employed millions of people in manufacturing high-wage products for markets in growing markets. To make matters worse, ground conditions in Lanka over a long period have been inimical to foreign enterprises. In the early 1960s, whatever foreign enterprises were inherited from colonial times were nationalized. Since then, the fate of attempts to establish foreign enterprises has not been bright. Every successive government, during the last few decades, has declared itself welcoming foreign investment. There were no takers. Foreign capital that came created disabling debt. In a society notoriously lacking entrepreneurial talent and overrun with corruption, debt inflows will create problems. We must grow enterprises (not wayside kade, which is a common sign of underemployment) and decide to create conditions that truly welcome foreign investment to provide full-time time well-paying jobs.
An education system by itself can do little to create employment, except in teaching.
by An Observer
Opinion
Lesson from the Pope

Pope Francis passed away on 21st of April at the age of 88. The College of Cardinals commenced the process for the selection of the next Pope. This could take up to five days, during which time the Cardinals are completely confined, within the assigned quarters, provided with meals and comforts of a high-end hotel.
Not surprisingly, most of the Popes have been Italians. However, Pope John Paul II, was of Polish origin, and was succeeded by the (German) Pope Benedict XVI who retired in 2013, on grounds of ill-health. At the time of writing this, it has been announced that a new Pope has been voted in by the Electoral College of Cardinals. He has chosen the title of “Pope Leo XIV.” He became the first American to head the papacy.
Pope Francis, as did his predecessor, Pope John Paul II, reduced the usual formal trappings and rituals of office, and exuded an aura of benign, avuncular simplicity. All three of most recent papacy, chose to exchange the comforts and grandeur of the Papal Palace, for the simpler basic quarters within the Vatican, normally reserved for dignitaries of the Catholic Church, when visiting Rome, for church duties as necessary.
His Holiness the Pope is the nominal Leader of the 1.3 billion Roman Catholics in the World and the titular custodian of the Vatican City and its treasures, (including the priceless St. Peter’s Cathedral). He may thus be regarded as the wealthiest man on earth. The “Vatican City” is the smallest country in the world, being a mere 44 hectares and with a population of less than one million. It is for all practical purposes independent of Italy, although located within Rome.
The millions who would have watched the Pope’s funeral on TV, would have (as did I), been impressed by the fact that the casket was in effect, a simple box, devoid of metal trimmings, handles and satin linings, etc. Usually, papal coffins are said to be nests of three units. The innermost is of Cypress wood (symbolizing simplicity), a lead lining, (for preservation of documents), and the outermost of Oak (to signify resolve and strength).
In contrast, we go well beyond, perhaps in the belief that we could be regarded as being “cheap and stingy” rather than of being “simple and affordable”. Even the poorest, will exceed the limits of affordability. The further consideration would be that of environmental damage, in terms of timber consumption, tree depletion, and carbon dioxide emissions, particularly where cremation is preferred. Are the metal trimmings which may need considerable quantities of timber.
Hard and fibre-board may provide opportunities for the design of less expensive models, able to satisfy both aesthetic and practicality at affordable cost.
The Buddha has pointed out that after death, the body is akin to a mere fathom long bundle of wood.
These may well be regarded as worthy lessons to be learnt.
Dr. Upatissa Pethiyagoda
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