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Yes indeed, Hippocrates is turning in his grave

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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



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Opinion

A paradox of history

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Shakespeare

There seems to be a striking similarity between ancient Greece and modern Britain. Both countries remain paradoxes of history. Greece was a small city state constantly at war with neighbouring countries. It did not have a big army, but it had considerable sea power. However, Greece was a leading state over the whole of the Mediterranean. In fact, Greece was once a super power in the Western world.

Britain was very powerful in the 19th century. British justice was administered in Africa, India and Ceylon. British factories flourished in many countries and schoolchildren started reading R.L. Stevenson’s ‘Treasure Island’ and the works of Rudyard Kipling. What Ralph Waldo Emerson said in the 1850s is still valid today. He said, “If there’s one test of national genius universally accepted, it is success; and if there be one successful country in the universe for the last millennium, that country is England. It is the best of actual nations.”

In World War I, Britain faced a crushing defeat. Eventually, the British Empire was reduced to a Commonwealth. World War II shattered the image of Britain further. Although Britain lost much of its power, it continued to be an influential country. Even after achieving independence, India retained English as an official language. The British parliament system is well established in many Commonwealth countries. Some people still wonder how England still exercises its influence over the minds of men and women.

Staying power

There are many powerful countries in the world today such as the United States, Russia and China. Although England is not a super power, she has staying power. According to Oliver Wendell Holmes, a good part of greatness is simply being there. For that matter, England has been there for many centuries. So far no other country has been able to defeat her. As a result, sometimes we wonder whether we can have a world without England.

England has had an unwritten Constitution for a very long time. Other countries have emulated her political institutions. The British people have an established church with complete religious freedom. Although there are social classes in Britain, there has been no major clash among them. Unlike in many other countries, there are only two leading political parties in England. When the Labour Party is in power, the government is not subservient to labour. Similarly, when the Conservative Party is in power, the government is not conservative.

Most British colonies in the East including India and Ceylon did not sever the cultural and emotional links with Britain and retain them even after achieving independence. India became independent in 1947, but she decided to retain English as an official language. By doing so, India produced a number of English writers such as R.K Narayan. However, Ceylon did not give English any official status and treated it as a link language. As a result, students paid less attention to learning English. They were made to understand that everything can be done by learning Sinhala and Tamil. We have failed to produce English writers in the calibre of J. Vijayatunga who wrote ‘Grass for my feet.’

Politically shrinking

The United Kingdom is politically shrinking. However, its influence vibrates throughout the world. English has brought many nations together. There is a common understanding among countries that share the English language and literature. William Shakespeare’s dramas are staged in countries such as China where English is not an official language. People have come to the conclusion that English has become a broker of ideas and institutions.

England is not an aggressive country. However, if provoked, it can deliver a mortal blow to its enemy. British Prime Minister Margaret Thatcher showed her mettle as the iron lady. Britain held the fort against the might of Napoleon Bonaparte who ruled France. The country can still boast of a heavy moral credit. The British stick to their international agreements. The power of England draws mainly from its language. British people say ‘It’s right’ when it is right’. When it is not right, they say, ‘It’s not right.’ Meanwhile English occupies a pre-eminent place in world languages. All the research work in many parts of the world is available in English. You can learn any subject easily through English.

Apart from the language, people respect British standards which are technical specifications and quality benchmarks developed by the British Standards Institution. The United Kingdom’s independent national standards body was established in 1901. It maintains over 37,000 standards covering industries such as construction, manufacturing and technology ensuring safety and reliability.

British English

Standard British English is the variety of English that has undergone codification to the point of being socially perceived as the standard language associated with formal schooling, language assessment and official print publications. For historical reasons dating back to the rise of London in the ninth century, the form of language spoken in London and the East Midlands became the Standard English used in schools, universities, literature and law.

British English functions as one of the two major foundational and standard varieties of the English language alongside American English. It serves as a primary reference point for spelling and grammar. It acts as a global standard, and international institutions are often defined by specific pronunciation.

Most Sri Lankan doctors primarily move to England for postgraduate training, higher specialisation and better career prospects. They are driven by superior training infrastructure, world-class facilities and globally recognised qualifications.

To sum up, when you think of learning an international language, there is no alternative to English. If you wish to read literature, you cannot ignore eminent English dramatists and poets such as William Shakespeare and John Milton. Many leading Sri Lankans like S.W.R.D. Bandaranaike were Oxford University products. Therefore, English deserves to be made an official language in Sri Lanka.

karunaratners@gmail.com

By R.S. Karunaratne

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Opinion

State Literary Awards only for the rich?

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The Department of Cultural Affairs has once again called authors, and publishers to lodge their entries for selection of the prestigious State Literary Awards 2026.The criteria and conditions required and notified in the public domain, makes it mandatory for the literary work to be printed and published prior to submission for consideration of the awards. There is absolutely no provision for writers to submit their work in Manuscript form.

Where does that leave the financially impoverished writers who are talented, creative and wish to submit a well edited typescript of their work as manuscript for consideration of the State Literary Awards? In a literary environment that encourages a proliferation of self-published books of all forms and features presented by vanity publishers who have their eye on the purse of the author than on literary merit and artistic excellence, it is easy to show that you are an ” established writer” by spending your cash abundantly towards glossy covered books which the printing industry and fawning publishers will lap up with greed.

Even the Gratiaen Prize in Sri Lanka, sponsored by world-renowned Michael Ondaatje allows for Manuscript entries together with published books. Significantly, the manuscript entries that win the prize are assisted to publish their work which is part of the winnings. Many a young, aspiring writer with little funds who won the Gratiaen Prize on merit, but had submitted their entry in manuscript form have been thereby encouraged to submit their work on merit basis only.

It is a fact that the Commonwealth Short Story Prize, a massive state-supported initiative across 56 nations accepts only unpublished short fiction. Further, several countries in the world have established national or state level literary prizes that specifically accept unpublished manuscripts to provide equity in discovering new talent and supporting national literature without bias or favour. In Australia, Jamaica, Philippines, major national awards organised by the State for literature, specifically accept unpublished manuscripts for consideration.

Let’s face the truth. The printing costs are escalating. There is little demand in Sri Lanka for literary work in the English Language in particular. Traditional Publishing where the literary work is reviewed and assessed for talent and creativity and thereafter published is seldom found. The reviews and critical analysis of literary works are rare. But publishers make a pile by pandering to the vanity of aspiring writers who have the financial clout to pay their way through to being featured in prestigious award ceremonies and accolades. Thereafter, their substandard works get a further fillip by bearing the label of “Won the State Literary Award for Literature”! It is a cycle of literary charlatans and their pimps in the publishing industry for whom the price that is paid for publishing and not Meritocracy is the sine-qua-non.

Is this the level playing field promised by the NPP Government and their Marxist protagonists? A government that was voted into power on the platform of affording fair opportunity and equality seems to discriminate in favour of the Haves against the Have- nots in the cultural department to say the least! Anil Fernando

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Opinion

Delivering on English

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English literature offers a rich heritage of wonderful ideas and thoughts. The reader can be intellectually uplifted. It brings refreshing new vistas and stimulating new ideas. However, this English literature has to be first introduced to the student in order to fire up his or her interest and be made aware of this rich source of culture. Students of basic English as a second language work hard and learn all the hum-drum mechanics of the language, for which they get tested and graded. But importantly, nae crucially, this should be followed up with intellectual rewards for the students’ efforts – which, of course, is the enjoyment of the works of literature of the many great writers in the English language. This is the great payoff, the great dividend for all their efforts but this, apparently goes missing.

One of the obvious reasons for the lack of “follow through” may be lack of time allocated in the curriculum – or, perhaps, more darkly, the teachers’ own lack of knowledge of the great range of good reading materials produced by the countless generations of literary geniuses who have gone before. Such writers have laid down for us a heritage of glorious literary works in books and essays, all of which are to be found in any good library. It is thought that much of this good literature ought to be introduced to all students of English, “full stop,” as part of developing a knowledgeable and cultured society. (Isn’t that what we want?) Reading English literature should bring an intellectual enrichment to all those willing to drink from this Bacchanalian horn of plenty.

It must be said finally, that it can be fairly expected that most young people, especially those learning English as a second language, are totally unaware of the many outstanding pieces of writing that propel English to stand tall amongst the rest. That is, students need to be first introduced to great writings and have a spark of interest ignited in these great works of literature.

For example, by being introduced to “Daffodils,” a short descriptive poem by William Wordsworth, the student can get some very pleasant ideas to think on.

Do not overlook Conan Doyle’s “Sherlock Holmes” detective stories, each one captivating the reader’s attention right to the end. It is by these short stories that the novice reader can first consolidate his power of reading.

For light reading Jerome K. Jerome’s book “Three Men in a Boat” is suggested. On one occasion he goes to the library suffering from a slight hay-fever (allergy) seeking a cure. He consults a book, “Lexicon of Pharmacology”, and recoils in horror as his symptoms fit most of those diseases described in the book! He concludes he cannot live much longer and staggers home to rest and recuperate! This is a well related tale in the book – although seemingly quite implausible!

Similarly, by having the poem meanings explained, e.g. “What is Life if Full of Care?” by William Henry Davis – how he regrets that we humans are always in a hurry, too busy to notice or see the delights of nature, and scenes of natural beauty, e.g., a young woman’s smile as she passes by; we have no time to make friends and even kiss her. Regrets! Explaining this to students would bring a certain intellectual insight.

John Keats’s poem, “Ode to Autumn” is another great work describing the ripening fruits of the autumn season and how nature as a living being, brings to fruition all the good things of a rural landscape quietly humming with warmth after a hot summer.

Again, it is likely necessary to explain to a young, Sri Lankan mind the meaning of the descriptive poetry found in this magnificent poem.

This is the real English to be tasted and then swigged at lustily in pleasure and satisfaction, not some writing airing historical grievances for children to study!

1970 British Cohort Study

It should be observed here that the ‘1970 British Cohort Study’ followed 70,000 people to examine various aspects of their lives. One result discovered was that if a young person reads a lot, it develops his/ her general intelligence no-matter his parents; it makes him smarter.

It was also noted that reading brings life-long benefits; it improves mood, it helps with social skills, increases empathy, reduces anxiety, protects against depression and slows brain decay, the study found.

But these days many young people never gain a great competence in reading English; the fear is that standards are falling. This is bringing poorer critical thinking, less depth of personality and less empathy for others which has the result of a more turbulent society.

People are urged to switch off their headphones and read more of what they like – try reading the newspapers!

Priyantha Hettige

 

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