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Is Sri Lanka Medical Council fit for purpose?

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By Dr Upul Wijayawardhana

Quite a number of my distinguished colleagues have written about the Sri Lanka Medical Council (SLMC) or held press conferences lately, but all of them addressed only one issue; the removal, by the Minister of Health, of the president and four members of the council appointed by her predecessor. Whilst my colleagues are questioning the legality of this action, the Minister contends that she has the authority to do so and justifies her action on the basis of the findings of the five-member committee she appointed. As we, doctors, as well as politicians, being equally unaware of the finer points of law, perhaps, it is best left for the judiciary to decide on the legality or otherwise of this decision. However, if the courts decide that the Minister of Health acted illegally, surely, she should resign, not only because of this but also because of her erratic behaviour during the grave health emergency we are going through. We do not seem to be very lucky with our Ministers of Health; one with the infamy of a bogus ‘crocodile’ press conference being replaced by another who pollutes rivers with pots of a concoction devised by a faith healer and then, adding insult to injury, by promoting an untested remedy invented by a Kali Amma inspired kapuwa to get rid Covid-19!

After going through the website of the SLMC and making comparisons with the only other regulatory body I am familiar with, the General Medical Council of UK (GMC), I have a greater concern; whether the SLMC, as constituted at present and the way it seems to be functioning, is fit for purpose. Not being sufficiently distinguished, I have not had the pleasure of serving on either of these august bodies but have had dealings with both, after being reported by my colleagues.

I still remember the day my good friend Dr S. J. Stephen came rushing to my humble abode in the Summit Flats the moment he learned that I had been reported to the SLMC by a close colleague of mine. He was so concerned he offered to retain a top lawyer for me. I was reported for advertising myself by doing programmes on radio and television! Nowadays many doctors seem to be doing these but at that time I happened to be the pioneer in TV health education programmes. I remember Sanath Liyanage, who produced the very popular educational programme “Neth Sera” for Rupavahini, telling me that the medical programmes were widely watched even in Jaffna though my discussions with a panel of experts was in Sinhala.

When SLMC requested my comments regarding the complaint all I did was to point out that I did these programmes on behalf of the Sri Lanka Medical Association (SLMA), in keeping with its policy of public education and with the approval of the SLMA council. The matter did not progress further, but many infuriated colleagues of mine urged me to report the person concerned for his unethical action, malicious reporting, etc., but I did not want to descend to his level.

In addition to being the Consultant Cardiologist, for a time I was the Clinical Director of Medicine at Grantham Hospital in the UK. A doctor of Indian origin, whose name incidentally was Vaidya (Physician in Sanskrit), whom I appointed as a Staff Grade Physician (a position just below a Consultant) was behaving erratically and in spite of numerous representations by me, no action was taken by the hospital administration. He was once caught trying to put a nail under one of the tyres of my car! His ire got worse when post-graduate trainees from Sri Lanka who worked with me started winning the hearts and minds of the staff and patients with their ability as well as attitude. I must say I am very proud of the 10 trainees I had who have excelled themselves in Sri Lanka. Dr Vaidya reported me to the GMC on many counts including ‘import of illegal Sri Lankan labour’! After detailed written submissions the GMC decided that there was no case against me for further investigation. I must admit that I had few sleepless nights fearing a GMC investigation, which is a harrowing experience.

After it was proved that Dr Vaidya forged a letter from the Post-graduate Dean the hospital was forced to suspend him though they did not find him guilty of racism in spite of his circulating a letter condemning Sri Lankan doctors and the medical education system in Sri Lanka! Fortunately, the GMC took a different view when he was reported. I was the key witness at the GMC inquiry against him and one of the trainees who had returned to Sri Lanka was also present as a witness at the GMC expense. Dr Vaidya was found guilty of racism and forgery, as well as a number of other offences and his name was erased from the medical register.

In the UK, it is very easy for anyone, even a patient, to find out whether a doctor is registered and is in the specialist register as the GMC maintains an excellent website. Also, there are clear instructions in the website how to make a complaint against a doctor. All complaints are investigated by the Medical Practitioners Tribunal Service (MPTS) and all decisions of the MPTS are available on their website for public perusal. A quick glance shows at least three doctors receiving warnings each month and a few more getting undertakings/suspensions. Thus, there is an active process for patient protection.

I was aghast when I went through the SLMC website, not only for its primitive nature but for the paucity of information. The only detailed part in the website is the history of the CMC/SLMC, perhaps, reflecting our national weakness of harking on past grandiosity! Though it claims that the SLMC “is a statutory body established for the purpose of protecting health care seekers” there is not a word on the website how disappointed ‘seekers’ could raise concerns! There is no way of finding out whether any strictures were passed on any doctor or whether they are registered. As a test, I entered the names of some my trainees to find out the registration status but only a recurring message ‘no matches found’ appeared. As it is rumoured that there are many fraudulent practitioners, surely, this facility should be available.

According to the SLMC website, its President still is Prof. Carlo Fonseka! Carlo must be conducting affairs from heaven! But that is not possible because Carlo did not believe in an afterlife, a topic we discussed when I met him last, a few months prior to his death. In spite of the claim “it is a body corporate having perpetual succession and a common seal”, the last available annual report is for 2010!

I can go on pointing out many deficiencies on the website. I am surprised that many distinguished members of the profession who sat on the council did not realise the importance of an up-to-date website which, in this era of electronic communication, is the face of any organisation.

The most damning aspect, of course, is the constitution of the SLMC where there is a total disregard for the principle of ‘conflict of interest’. No office-bearer of a trade union should sit on the council of a regulator as it may compromise decisions. Justice becomes a mockery if the same counsel appears for both the prosecution and the defence! Any office-bearer of a trade union, even if not barred from contesting, should be mandated to give up such positions if they decide to sit on the council of the SLMC, as they cannot have it both ways. I am surprised that ex-officio members like the Deans of the faculties of Medicine and the Director General of Health Services did not take a principled stand on this issue. Had they declined to sit with those on whose part there was a conflict of interest, the government would have had no choice but to amend legislation. Or, is it that no government can defeat the rice-mafia or doctors’ mafia?

Not only the website but also the SLMC itself needs an overhaul but it should not go the way the GMC did. Many doctors in the UK are taking early retirement or exploring other avenues as they perceive that the GMC has become a body that harasses doctors, after it was revamped following public pressure. I am sure with the vast potential of talent available in Sri Lanka a middle way could be found and the SLMC can become a regulatory body fit for purpose.

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Islamophobia and the threat to democratic development

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There’s an ill more dangerous and pervasive than the Coronavirus that’s currently sweeping Sri Lanka. That is the fear to express one’s convictions. Across the public sector of the country in particular many persons holding high office are stringently regulating and controlling the voices of their consciences and this bodes ill for all and the country.

The corrupting impact of fear was discussed in this column a couple of weeks ago when dealing with the military coup in Myanmar. It stands to the enduring credit of ousted Myanmarese Head of Government Aung San Suu Kyi that she, perhaps for the first time in the history of modern political thought, singled out fear, and not power, as the principal cause of corruption within the individual; powerful or otherwise.

To be sure, power corrupts but the corrupting impact of fear is graver and more devastating. For instance, the fear in a person holding ministerial office or in a senior public sector official, that he would lose position and power as a result of speaking out his convictions and sincere beliefs on matters of the first importance, would lead to a country’s ills going unaddressed and uncorrected.

Besides, the individual concerned would be devaluing himself in the eyes of all irrevocably and revealing himself to be a person who would be willing to compromise his moral integrity for petty worldly gain or a ‘mess of pottage’. This happens all the while in Lankan public life. Some of those who have wielded and are wielding immense power in Sri Lanka leave very much to be desired from these standards.

It could be said that fear has prevented Sri Lanka from growing in every vital respect over the decades and has earned for itself the notoriety of being a directionless country.

All these ills and more are contained in the current controversy in Sri Lanka over the disposal of the bodies of Covid victims, for example. The Sri Lankan polity has no choice but to abide by scientific advice on this question. Since authorities of the standing of even the WHO have declared that the burial of the bodies of those dying of Covid could not prove to be injurious to the wider public, the Sri Lankan health authorities could go ahead and sanction the burying of the bodies concerned. What’s preventing the local authorities from taking this course since they claim to be on the side of science? Who or what are they fearing? This is the issue that’s crying out to be probed and answered.

Considering the need for absolute truthfulness and honesty on the part of all relevant persons and quarters in matters such as these, the latter have no choice but to resign from their positions if they are prevented from following the dictates of their consciences. If they are firmly convinced that burials could bring no harm, they are obliged to take up the position that burials should be allowed.

If any ‘higher authority’ is preventing them from allowing burials, our ministers and officials are conscience-bound to renounce their positions in protest, rather than behave compromisingly and engage in ‘double think’ and ‘double talk’. By adopting the latter course they are helping none but keeping the country in a state of chronic uncertainty, which is a handy recipe for social instabiliy and division.

In the Sri Lankan context, the failure on the part of the quarters that matter to follow scientific advice on the burials question could result in the aggravation of Islamophobia, or hatred of the practitioners of Islam, in the country. Sri Lanka could do without this latter phobia and hatred on account of its implications for national stability and development. The 30 year war against separatist forces was all about the prevention by military means of ‘nation-breaking’. The disastrous results for Sri Lanka from this war are continuing to weigh it down and are part of the international offensive against Sri Lanka in the UNHCR.

However, Islamophobia is an almost world wide phenomenon. It was greatly strengthened during Donald Trump’s presidential tenure in the US. While in office Trump resorted to the divisive ruling strategy of quite a few populist authoritarian rulers of the South. Essentially, the manoeuvre is to divide and rule by pandering to the racial prejudices of majority communities.

It has happened continually in Sri Lanka. In the initial post-independence years and for several decades after, it was a case of some populist politicians of the South whipping-up anti-Tamil sentiments. Some Tamil politicians did likewise in respect of the majority community. No doubt, both such quarters have done Sri Lanka immeasurable harm. By failing to follow scientific advice on the burial question and by not doing what is right, Sri Lanka’s current authorities are opening themselves to the charge that they are pandering to religious extremists among the majority community.

The murderous, destructive course of action adopted by some extremist sections among Muslim communities world wide, including of course Sri Lanka, has not earned the condemnation it deserves from moderate Muslims who make-up the preponderant majority in the Muslim community. It is up to moderate opinion in the latter collectivity to come out more strongly and persuasively against religious extremists in their midst. It will prove to have a cementing and unifying impact among communities.

It is not sufficiently appreciated by governments in the global South in particular that by voicing for religious and racial unity and by working consistently towards it, they would be strengthening democratic development, which is an essential condition for a country’s growth in all senses.

A ‘divided house’ is doomed to fall; this is the lesson of history. ‘National security’ cannot be had without human security and peaceful living among communities is central to the latter. There cannot be any ‘double talk’ or ‘politically correct’ opinions on this question. Truth and falsehood are the only valid categories of thought and speech.

Those in authority everywhere claiming to be democratic need to adopt a scientific outlook on this issue as well. Studies conducted on plural societies in South Asia, for example, reveal that the promotion of friendly, cordial ties among communities invariably brings about healing among estranged groups and produces social peace. This is the truth that is waiting to be acted upon.

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Pakistan’s love of Sri Lanka

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By Sanjeewa Jayaweera

It was on 3rd January 1972 that our family arrived in Karachi from Moscow. Our departure from Moscow had been delayed for a few weeks due to the military confrontation between Pakistan and India. It ended on 16th December 1971. After that, international flights were not permitted for some time.

The contrast between Moscow and Karachi was unbelievable. First and foremost, Moscow’s temperature was near minus 40 degrees centigrade, while in Karachi, it was sunny and a warm 28 degrees centigrade. However, what struck us most was the extreme warmth with which the airport authorities greeted our family. As my father was a diplomat, we were quickly ushered to the airport’s VIP Lounge. We were in transit on our way to Rawalpindi, the airport serving the capital of Islamabad.

We quickly realized that the word “we are from Sri Lanka” opened all doors just as saying “open sesame” gained entry to Aladdin’s cave! The broad smile, extreme courtesy, and genuine warmth we received from the Pakistani people were unbelievable.

This was all to do with Mrs Sirima Bandaranaike’s decision to allow Pakistani aircraft to land in Colombo to refuel on the way to Dhaka in East Pakistan during the military confrontation between Pakistan and India. It was a brave decision by Mrs Bandaranaike (Mrs B), and the successive governments and Sri Lanka people are still enjoying the fruits of it. Pakistan has been a steadfast and loyal supporter of our country. They have come to our assistance time and again in times of great need when many have turned their back on us. They have indeed been an “all-weather” friend of our country.

Getting back to 1972, I was an early beneficiary of Pakistani people’s love for Sri Lankans. I failed the entrance exam to gain entry to the only English medium school in Islamabad! However, when I met the Principal, along with my father, he said, “Sanjeewa, although you failed the entrance exam, I will this time make an exception as Sri Lankans are our dear friends.” After that, the joke around the family dinner table was that I owed my education in Pakistan to Mrs B!

At school, my brother and I were extended a warm welcome and always greeted “our good friends from Sri Lanka.” I felt when playing cricket for our college; our runs were cheered more loudly than of others.

One particular incident that I remember well was when the Embassy received a telex from the Foreign inistry. It requested that our High Commissioner seek an immediate meeting with the Prime Minister of Pakistan, Mr Zulifikar Ali Bhutto (ZB), and convey a message from Mrs B. The message requested that an urgent shipment of rice be dispatched to Sri Lanka as there would be an imminent rice shortage. As the Ambassador was not in the station, the responsibility devolved on my father.

It usually takes about a week or more to get an audience with the Prime Minister (PM) of a foreign country due to their busy schedule. However, given the urgency, my father spoke to the Foreign Ministry’s Permanent Sectary, who fortunately was our neighbour and sought an urgent appointment. My father received a call from the PM’s secretary around 10 P.M asking him to come over to the PM’s residence. My father met ZB around midnight. ZB was about to retire to bed and, as such, was in his pyjamas and gown enjoying a cigar! He had greeted my father and had asked, “Mr Jayaweera, what can we do for great friend Madam Bandaranaike?. My father conveyed the message from Colombo and quietly mentioned that there would be riots in the country if there is no rice!

ZB had immediately got the Food Commissioner of Pakistan on the line and said, “I want a shipload of rice to be in Colombo within the next 72 hours!” The Food Commissioner reverted within a few minutes, saying that nothing was available and the last export shipment had left the port only a few hours ago to another country. ZB had instructed to turn the ship around and send it to Colombo. This despite protests from the Food Commissioner about terms and conditions of the Letter of Credit prohibiting non-delivery. Sri Lanka got its delivery of rice!

The next was the visit of Mrs B to Pakistan. On arrival in Rawalpindi airport, she was given a hero’s welcome, which Pakistan had previously only offered to President Gaddafi of Libya, who financially backed Pakistan with his oil money. That day, I missed school and accompanied my parents to the airport. On our way, we witnessed thousands of people had gathered by the roadside to welcome Mrs B.

When we walked to the airport’s tarmac, thousands of people were standing in temporary stands waving Sri Lanka and Pakistan flags and chanting “Sri Lanka Pakistan Zindabad.” The noise emanating from the crowd was as loud and passionate as the cheering that the Pakistani cricket team received during a test match. It was electric!

I believe she was only the second head of state given the privilege of addressing both assemblies of Parliament. The other being Gaddafi. There was genuine affection from Mrs B amongst the people of Pakistan.

I always remember the indefatigable efforts of Mr Abdul Haffez Kardar, a cabinet minister and the President of the Pakistan Cricket Board. From around 1973 onwards, he passionately championed Sri Lanka’s cause to be admitted as a full member of the International Cricket Council (ICC) and granted test status. Every year, he would propose at the ICC’s annual meeting, but England and Australia’s veto kept us out until 1981.

I always felt that our Cricket Board made a mistake by not inviting Pakistan to play our inaugural test match. We should have appreciated Mr Kardar and Pakistan’s efforts. In 1974 the Pakistan board invited our team for a tour involving three test matches and a few first-class games. Most of those who played in our first test match was part of that tour, and no doubt gained significant exposure playing against a highly talented Pakistani team.

Several Pakistani greats were part of the Pakistan and India team that played a match soon after the Central Bank bomb in Colombo to prove that it was safe to play cricket in Colombo. It was a magnificent gesture by both Pakistan and India. Our greatest cricket triumph was in Pakistan when we won the World Cup in 1996. I am sure the players and those who watched the match on TV will remember the passionate support our team received that night from the Pakistani crowd. It was like playing at home!

I also recall reading about how the Pakistani government air freighted several Multi Barrell artillery guns and ammunition to Sri Lanka when the A rmy camp in Jaffna was under severe threat from the LTTE. This was even more important than the shipload of rice that ZB sent. This was crucial as most other countries refused to sell arms to our country during the war.

Time and again, Pakistan has steadfastly supported our country’s cause at the UNHCR. No doubt this year, too, their diplomats will work tirelessly to assist our country.

We extend a warm welcome to Mr Imran Khan, the Prime Minister of Pakistan. He is a truly inspirational individual who was undoubtedly an excellent cricketer. Since retirement from cricket, he has decided to get involved in politics, and after several years of patiently building up his support base, he won the last parliamentary elections. I hope that just as much as he galvanized Sri Lankan cricketers, his political journey would act as a catalyst for people like Kumar Sangakkara and Mahela Jayawardene to get involved in politics. Cricket has been called a “gentleman’s game.” Whilst politics is far from it!.

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Covid-19 health rules disregarded at entertainment venues?

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Believe me, seeing certain videos, on social media, depicting action, on the dance floor, at some of these entertainment venues, got me wondering whether this Coronavirus pandemic is REAL!

To those having a good time, at these particular venues, and, I guess, the management, as well, what the world is experiencing now doesn’t seem to be their concerned.

Obviously, such irresponsible behaviour could create more problems for those who are battling to halt the spread of Covid-19, and the new viriant of Covid, in our part of the world.

The videos, on display, on social media, show certain venues, packed to capacity – with hardly anyone wearing a mask, and social distancing…only a dream..

How can one think of social distancing while gyrating, on a dance floor, that is over crowded!

If this trend continues, it wouldn’t be a surprise if Coronavirus makes its presence felt…at such venues.

And, then, what happens to the entertainment scene, and those involved in this field, especially the musicians? No work, whatsoever!

Lots of countries have closed nightclubs, and venues, where people gather, in order to curtail the spread of this deadly virus that has already claimed the lives of thousands.

Thailand did it and the country is still having lots of restrictions, where entertainment is concerned, and that is probably the reason why Thailand has been able to control the spread of the Coronavirus.

With a population of over 69 million, they have had (so far), a little over 25,000 cases, and 83 deaths, while we, with a population of around 21 million, have over 80,000 cases, and more than 450 deaths.

I’m not saying we should do away with entertainment – totally – but we need to follow a format, connected with the ‘new normal,’ where masks and social distancing are mandatory requirements at these venues. And, dancing, I believe, should be banned, at least temporarily, as one can’t maintain the required social distance, while on the dance floor, especially after drinks.

Police spokesman DIG Ajith Rohana keeps emphasising, on TV, radio, and in the newspapers, the need to adhere to the health regulations, now in force, and that those who fail to do so would be penalised.

He has also stated that plainclothes officers would move around to apprehend such offenders.

Perhaps, he should instruct his officers to pay surprise visits to some of these entertainment venues.

He would certainly have more than a bus load of offenders to be whisked off for PCR/Rapid Antigen tests!

I need to quote what Dr. H.T. Wickremasinghe said in his article, published in The Island of Tuesday, February 16th, 2021:

“…let me conclude, while emphasising the need to continue our general public health measures, such as wearing masks, social distancing, and avoiding crowded gatherings, to reduce the risk of contact with an infected person.

“There is no science to beat common sense.”

But…do some of our folks have this thing called COMMON SENSE!

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