Yet another blot: Sri Lankan govt., hospital facilities for adolescents

Mar 26, 2024

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By Dr B.J.C.Perera MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

Adolescents and young people are in the news for a variety of reasons; some good, some bad, and some even ugly. However, there is no question about their importance to the nation as our Motherland’s future belongs to them. They are indeed the jewels of Sri Lanka.

Yet for all that, when one looks around at the present time, one sees the grim spectacle of adolescents suffering a great deal through disruption of their education, undeniable problems with transportation, poverty, food insecurity and to cap it all, unsatisfactory provision of facilities in our much-bandied and government-run free health service.

The Convention on the Rights of the Child defines a “child” as a person below the age of 18 unless the relevant laws of a country recognize an earlier age of majority. Sri Lanka is a signatory to this convention. However, currently, all Paediatric Wards of the National Health Service of Sri Lanka, in all hospitals, including the specialized children’s hospitals, admit patients below the age of 14 years. Those over this age are admitted to the adult wards. We need to analyse and mull over this situation in some detail.

There is an abundance of research publications regarding different perspectives of older children and adolescents being admitted to Children’s Wards and Adult Wards. In a nutshell, these youngsters are quite uncomfortable and unhappy in either place. They do not wish to be treated like children and they are quite bothered by what goes on in the Adult Wards. They would dearly love to have Adolescent and Young People’s Wards in which specific facilities are provided for their needs and steps are taken to provide age-appropriate facilities and care for their age group.

The prestigious British Medical Journal Paediatrics Open, in the Special Supplement of Volume 6 published on the 15th of December 2022, has printed not one, or, not two or not even two, or even three; but a total of 70, YES…, seventy, research articles from several countries, related to a myriad of different aspects of providing healthcare for adolescents. These include physical, mental and socio-economic problems faced by adolescents and young people. The central theme of most of those publications is the axiom that the requirements of adolescents differ very significantly from those of children and adults. When one looks carefully at the content of these erudite works, it is evident that these differences are of the utmost importance and are of paramount implications in the ultimate quest towards providing optimal healthcare to adolescents.

At least now, the political and administrative powers in our Motherland should be pushed or even cajoled and even coerced to take useful steps to even to start thinking of providing wards, clinics and necessary healthcare services to adolescents, at least in the island’s major hospitals for a start. These services would need specifically designated wards for adolescent boys and adolescent girls separately, adolescent healthcare clinics and most importantly, specifically trained and qualified grades of all healthcare personnel to cater to the needs of these youngsters. These adolescents need privacy, empathy, and kindness, and they need to develop confidence in and continue to trust those designated to care for their health needs. To foster such an assurance, special training for these workers is absolutely mandatory. As paediatricians who provide healthcare for little children, we are all too familiar with the little ones growing up to be adolescents who still insist on us continuing to provide healthcare for them because they have faith in us. This is particularly true of those who need long-term care.

At the present time, the required facilities for adolescents in our National Health Service are woefully and totally inadequate and for that matter, virtually non-existent. In such a scenario, it will need at the outset, a paradigm shift and a complete revamping of the mindset of the legislators, to get it into their feeble brains that the provision of such facilities is absolutely essential and is one of the ways forward towards the future advancement of our country. If we do not look after the health needs of young people, we will not get anywhere. An endeavour of such an attempt and one of such vast magnitude to look after adolescents would need to start with providing infrastructure facilities to cater to the special needs of adolescents. New wards and clinics will need to be built or commissioned and healthcare staff will need to be specially trained to look after the very distinct needs of youngsters. The infrastructure should be purpose-designed to ensure privacy for these young people.More than anything, these patients have to be provided unmitigated privacy.

It is particularly important to have trained staff to look after adolescents. People working in children’s wards are specially trained for the job at hand to attend to the needs of children. However, those handling adolescents and young people need very special extra training. That includes Specialist Physicians/Paediatricians, Psychologists, Sisters and Nursing Officers and all grades of minor staff.

Of course, at the present time, in a country that is reeling from the unrelenting impact of an economic downturn, rampant corruption, and extremely poor governance, such an initiative as the healthcare of youngsters may come way down in the list of priorities of the people at the top of the legislature. Yet for all that, the emergent and nascent problems for the populace of our beautiful land that is envisaged for the immediate future, which includes wayward education, food insecurity, international indebtedness, poverty, unemployment, as well as a whole host of a conglomeration of catastrophes including repression of the youth, are more than likely to cause severe hardships for the youngsters of our beloved island. We, as adults, and this applies even more to the legislators, are duty-bound to look after our nation’s adolescents and young people. It is said that none are as blind as those who refuse to see and none are as deaf as those who refuse to hear. It is all there to see and also there to hear from the mouths of the horses as well. The best evidence for this notion is the number of young people clamouring to go abroad, seeking greener pastures.

Finally, I would like to echo the immortal words of that great statesman, Nelson Mandela, even at the risk of repeating them again for all to see and hear. He said, “There can be no keener revelation of a society’s soul than the way in which it treats its children. Let us reach out to the children”. I am sure he meant to include adolescents and young people as well. Nelson Mandela would be turning in his grave, over and over, again and again, if we refuse to do so.

It is now over to you, the powers-that-be.

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By Prof. Priyan Dias,

Emeritus Professor in Civil Engineering (University of Moratuwa); Consultant/Professor, Sri Lanka Institute of Information Technology; and Fellow, National Academy of Sciences of Sri Lanka

It is a year since the passing of Professor Lakshman Jayathilake, a Peradeniya University Emeritus Professor in Mechanical Engineering. Apart from his professorial role, he was also Vice-Chancellor of Peradeniya University, Chairman of the University Grants Commission and Chairman of the National Education Commission. He was an educationist to the hilt. Although in a different engineering faculty and from a different engineering discipline, and also junior to him by over a decade, the limited number of interactions I had with him were always thought provoking. Even before I met him, I was aware of his impeccable engineering pedigree, having worked for his PhD at Imperial College, London, under Professor Brian Spalding (FRS, FREng), known then as the Grand Old Man of Computational Fluid Dynamics. Later, he became interested in the Systems Thinking and Practice pioneered by Peter Checkland at Lancaster University. It is this interest in systems that first brought us together, after I heard one of his talks on the subject – I now happen to be an Associate Editor of Civil Engineering and Environmental Systems.

We once had to travel to Anuradhapura and back in a day, to inspect the Jethawaranamaya, which was exhibiting large cracks at the time, for Prof. Jayathilake to comment on the moisture movement within the structure, and myself to opine on its structural integrity. While passing Kurunegala on our return, he mentioned that there was a village school in the district where students were trained to speak very good English. He was quick to point out however, that English proficiency alone would not guarantee employment or upward mobility, since that depended on social connections as well. It is not that he did not see the great value of learning to operate in English, but he was well aware of the various divisions that language brought within our country. When I once wondered aloud at a meeting in his presence whether the teaching of engineering solely in English stifled student creativity, he was quick to acknowledge the problem. At any rate, we need our collective wisdom to tackle our language problems in Sri Lanka – something that Prof. Jayathilake was keenly aware of and did his best to ameliorate.

Also, on our return from Anuradhapura, Professor Jayathilake pointed out a police station from which he had to effect the release of some JVP affiliated student activists – ‘so called heroes’ he called them. Many Vice-Chancellors have had to spend time in police stations to rescue JVP oriented student activists. Very few, if any, have done that for LTTE oriented ones. And there lies a difference that still haunts our land. Both the JVP and LTTE were branded as terrorist organisations during their ‘active’ days. However, largely as a result of ‘Colombo Society’ becoming aware of the impoverishment of southern JVP youth (recall the phrase Kolombata kiri, Gamata kekiri ‘Milk for Colombo, (lowly) melons for the village’), they have largely become integrated into mainstream society – causing the JVP revolution to be seen not as an aberration of, but a corrective to, the body politic, with many of today’s JVP MPs commanding widespread respect. This change of perspective was due in no small measure to the Report on the Presidential Commission Youth (1990), in fact chaired by none other than Professor Lakshman Jayathilake. Together with him, Professors G.L. Peiris and Arjuna Aluwihare were also involved in discussions with these southern youth who had been ‘left behind’ by society. As a young academic at that time, I looked up to them as genuine heroes – academics who left their ivory towers to solve the messy problems of our nation. In my opinion, however, we missed the opportunity to have another Youth Commission to hear the grievances of the northern youth after the crushing of the LTTE uprising. I said as much when I made representations to the Lessons Learnt and Reconciliation Commission (LLRC). As a result, there is no corresponding sympathy for the plight of impoverished northerners, the ‘national question’ remains unanswered, the LTTE maintains its ‘terrorist’ brand (while the JVP has shed its), and talented Tamil citizens, who two generations ago contributed to the development of Malaysia and Singapore, today give their hearts, minds and energies to Canada and Australia.

Days after the Boxing day tsunami of 2004, when I was wondering how an engineering academic like myself could be relevant at that time of national calamity, I had a phone call from Professor Jayathilake, urging me as a structural engineering academic to study the performance of tsunami affected structures, so that we could ‘build back better’. That led to me and other colleagues documenting and analysing such tsunami induced structural failures. The Society of Structural Engineers, Sri Lanka was able to issue its Guidelines for Buildings at Risk from Natural Disasters as a result of this work, later adopted by the Disaster Management Centre and the National Building Research Organization. One of the resulting technical papers won a prize from the Institution of Civil Engineers, U.K. – Professor Ranjith Dissanayake, the current President-elect of the Institution of Engineers, Sri Lanka, was a co-author. Two other young graduates who helped me with this work are now engineering professors at Peradeniya (Hiran Yapa) and Moratuwa (Chinthaka Mallikarachchi). Tsunami resilience work in Sri Lanka continues to this day, with significant Sri Lankan contributions to the global knowledge base, among which is a University College London initiative led by Professor Tiziana Rossetto and involving Dr Ajith Thamboo (South Eastern University of Sri Lanka) and Prof. Kushan Wijesundara (Peradeniya University), with logistical support from the National Academy of Sciences of Sri Lanka. I should also mention my Moratuwa University colleague and good friend from school days, the late Professor Samantha Hettiarachchi, who spearheaded the Indian Ocean Tsunami Warning System. Professor Dilanthi Amaratunga, based in the U.K., has given leadership in the socio-economic resilience aspects. I note that the National Science Foundation intends to have a 20th anniversary symposium on the subject in December 2024, probably involving oceanographer Prof. Charitha Pattiaratchi from the University of Western Australia.

Towards the end of his career, Professor Jayathilake identified himself with two emerging universities, serving as the Dean of the Engineering Faculty at the University of Ruhuna, and as the Chancellor of the Wayamba University. That was typical of the man – using his not inconsiderable stature to help emerging institutions. Lakshman Jayathilake has gone the way of all the earth, but those whose lives were touched by his have doubtless benefitted through their engagement with a multi-dimensional human being. I am blessed to have interacted with him, even in a small way.

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By Dr. Justice Chandradasa Nanayakkara

The decline in moral and ethical values is a global phenomenon. The erosion of moral values has become a very disturbing feature in our society. We live in a hedonistic materialistic world in which the acquisition of material possessions and otherworldly things takes pride of place over pursuing ethical and spiritual values. Society today is wreaked by violence and other heinous crimes. Crimes such as murder, sexual harassment, drug addiction, theft, and corruption have become the order of the day. Great moral and ethical values that existed in traditional Buddhist societies seem to have been replaced by selfish motives and egoistic drives of human beings. People’s insatiable avarice and greed have eroded time-honoured ethics and moral values. They have little concern for spiritual and ethical values. The world has become so competitive that people have the audacity to lie, cheat, and bribe to get what they want. Even people in leadership positions lack integrity and lie and distort the truth for the purpose of achieving their objectives. Moreover, indiscipline on the road is worsening by the day. As a result. driving on our roads has become a stressful experience.

It goes without saying, that the decline of moral and ethical values is bound to impact negatively modern society and impede its progress destroying everything in a nation. Today, a lack of moral and ethical values can be seen in every sphere of life in our society. It is an objective reality that no one can deny. Most of the problems that society experiences today can be attributed to the non-observance of good moral and ethical principles. It is by the standards of morality that people maintain that the fabric of any society can be held together.

Moral values are standards by which we distinguish between right and wrong, good and evil. Many people use the words morality and ethics interchangeably. Like morality, ethics is basically concerned with what is right or wrong in human conduct. Ethics and morality play a crucial role in guiding people to live a harmonious life and how to interact with each other. Ethical and moral principles guide people’s behaviour, decisions, and actions. Throughout human history, moral and ethical values have always been important for interfaith harmony, peace, and progress. Both ethics and morality help you to abandon the distorted projections that our thoughts and emotions create and also to promote collaboration and community existence. But ethics should not be identified only with religion, as ethics can apply even to an atheist. Religion is the basis for morality and it is the religion that can set high standards and provide intense motivation for ethical behaviour. Most of the ethical and moral values that people observe today are those preached by the founders of dominant religions in the world. In essence, morality is a practice that maintains your status as a decent human being.

Buddhism upholds lofty and demanding moral and ethical values in many of its scriptures and codes of precepts. Buddha declared in many of his discourses that true happiness could only be realised by leading a life of moral rectitude or virtue.

The five precepts in Buddhism, which are known as Pancasila in Pali and Sanskrit constitute the minimal standard of morality that Buddhists are expected to observe in their day-to-day lives. They represent Buddhism’s core values, which can be followed not only by Buddhists but also by people belonging to other religious persuasions. The precepts are of normative character They are analogous to the spirit of the Ten Commandments of Christianity and the codes of conduct of many other religions. Unlike the Ten Commandments precepts are accepted voluntarily by the person himself, as undertakings rather than commandments enforced by divine authority. Precepts are forms of restraint on our conduct formulated in negative terms. They are guides to help follow the path to enlightenment., and accumulate good kamma. Morality in Buddhism is essentially practical in that it is only a means leading to the final goal of ultimate happiness. The five precepts as a disciplinary code enable laymen to live a virtuous and noble life without renouncing worldly life.

In Buddhism, the quality of any act depends on the intention of the person who commits it. If a person performs an action out of greed, hatred, and delusion his action is considered to be unwholesome. Therefore, in the practice of the five precepts underlying intention with which one practices it would be important. Consciousness is considered the forerunner of our actions.

Dhammapada states, “Mind is the forerunner of all things, mind is their leader; they are made by the mind. When someone speaks or acts with impure thoughts, suffering follows, like the wheel follows the hoof of the ox.”

The morality of buddhism that Buddha propounded thousands of years ago offers timeless wisdom that resonates just as much today. By following the basic principles of morality, we can prevent destructive unwholesome, and negative emotions from taking hold and maintain inner peace regardless of the problems we face today.

The objective of Buddhist morality (sila) is to eliminate crude passions that are expressed through thought, word, and deed. It is by these three means a person’s morality is measured. Therefore, as Buddhists, we are expected to examine regularly whether or not what we think, do, and say causes harm to ourselves and others. This is known as training in virtue (sila sikka).

The three factors of the noble eightfold path form the Buddhist code of conduct.(sila). They are right speech, right action, and right livelihood. Observance of the five precepts is considered the stepping stone for the cultivation of higher virtues and mental development.

The Five Precepts also embody the spirit of fundamental human rights that are of universal nature. The extent to which people observe the Five Precepts differs from person to person, from society to society, and from country to country. According to Buddhism, living a life in violation of the precepts is believed to lead to rebirth in an unhappy destination. The five precepts form the part of eight precepts that Buddhists observe particularly on poya days.

Morality ( Sila ) as the most important step on the spiritual path contributes to harmonious and peaceful co-existence among diverse communities. In a society where morality prevails members are conscious of their respective roles and duties essential for mutual trust and security, leading to the prosperity and progress of society. Non-adherence to principles of morality can often bring about unrest and turmoil in a country.

Morality (Sila) is closely related to the practice of mindfulness (sati) High morality requires a high degree of mindfulness to continuously monitor the mind, speech, and actions.

Therefore, the whole teaching of Buddhist morality can be summed by one stanza. ” Sabbapapassa akaranam, kusalassa upasampada, sacittapriyodapaanam, etam Buddhana sasanam.” Abandoning what is evil, cultivating what is good, purifying one’s mind, that is the teaching of the Buddhas.”.

Core principles of buddhism focus on how to live a virtuous life by practicing self-control and letting off destructive emotions like anger and other three unwholesome roots. This enables adherents to gain an objective perspective and tranquility in the face of many problems in life.

A life grounded in morality is always free from mental restlessness, turmoil, and anxiety. Observing the Five precepts has been shown to buffer the effects of perceived stress on depression. It is believed that people with high levels of observing the five precepts in their day-to-day lives would be less likely to develop depressive symptoms (Wongpakran). Moreover, the five precepts along with the triple gem are the required conditions for the practice of buddhism and the formal initiation to become a Buddhist. The Buddhists normally remind themselves of their commitment to keeping these precepts by observing them at least once a day.

By the first precept, we undertake to refrain from taking the life of a living being. it is based on the belief that all life is precious and sacred. Aiding and abetting someone to kill a living being is no different from killing yourself. It is a commitment to non-violence and compassion for living beings and is not limited to human beings but extends to all sentient beings. It presupposes that all life is interconnected and any harm done to a living being can have an impact on the ecosystem. It encompasses a wide range of acts such as violence, murder capital punishment, and disapproval of abortion, euthanasia, and suicide.

By the second precept, we undertake to refrain from taking what is not given. It underscores the respect for the rights of others. It signifies an individual right to possession as well as the protection of wealth rightly acquired. It encompasses acts such as deception, coercion, misappropriation, and exploiting another’s vulnerability. The precept promotes fairness integrity and respect for others’ property.

By the third precept, we undertake to refrain from sexual misconduct that causes harm and distress to others. It includes actions like adultery and sexual exploitation. Sexual misconduct stems from sensory desire. Rape, prostitution, incest, bigamy, and seduction are all violations of this precept.

By the fourth Precept, we undertake to abstain from falsehood and to speak the truth. The Precept covers such acts as tale-bearing, harsh and abusive speech, idle chatter, vain talk, and gossip which brings about discord and disharmony between families, friends even nations. Observance of this precept is conducive to concord harmony.

By the fifth precept, we undertake not to consume alcoholic drinks and other stimuli that cause loss of conscience. Substances like marijuana, opium, and morphine heroin come under this precept. People tend to think taking a drink once in a way is not harmful, but the real problem is what they do when they are under the influence of alcohol. When a person is under the influence of liquor he is no longer in full control of his mental faculties. Because of that, he would do things that he would never otherwise do. The breach of this precept leads to the degradation of the individual, disruption of the family life, and the degeneration of society.

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Dr D. Chandraratna

It was sixty years ago that Martin Luther King (MLK) stood on the steps of the Lincoln memorial in front a sea of people estimated to be around 250,000, who had gathered for a march on Washington under the slogan, ‘Jobs and Freedom,’ gave voice to his dream.

‘Let us not wallow in the valley of despair. And, I say to you today, my friends, that despite the difficulties and frustrations of the moment, I still have a dream…, that one day this nation will rise up and live out the meaning of its creed. I have a dream ,that my four little children will one day live in a nation where they will not be judged by the colour of their skin but by the content of their character…, I have a dream that one day, little black boys and black girls will be able to join hands with little white boys and white girls and walk together as sisters and brothers…, and sing in the words of the old Negro spiritual, ‘Free at last, free at last! Thank God almighty, we are free at last’.

Andrew Young, US Congressman (1973-77), US Ambassador to UN 1977-79), and Mayor of Atlanta for 8 years, now aged 91, a confidante of MLK recalls that “I do not know how it happened, but it was meant to be. It set forth a movement that changed not only America, but it changed the world. It lifted the crowd to such a crescendo that it really lifted the nation. And it went worldwide’. Penguin Books, records that no public figure of his generation could match the skill with which he made a mastery of the spoken word the servant of his cause. Andrew Young says, ‘if there was any disciple that lived out the faith that Gandhi and Jesus expressed in humanity it was Martin Luther King Jr’. Andrew Young, one of the few surviving members of the inner circle worked with King through the 50’s and 60’s until the day King was killed by an assassin on the 4 th April 1968.

King took to the podium on that day, despite one of his advisors, Wyatt Walker, remonstrating with him not to deploy his ‘I have a dream’, speech which he had made mention three times before. He was told that it had to be limited to 10 minutes and being the 16 th in the line; if he spoke any longer Walker threatened to cut the microphone off. The sound system had been sabotaged the previous night which Robert Kennedy, the Attorney General, ordered the Army corps to fix.

The crusades like the March on Washington after Selma, Montgomery Alabama and Birmingham had made many political enemies and King was targeted by the FBI, labelled Communist, ‘to be dealt with.’ The possibility of violence and crackdown was expected.

History records that when King started Wyatt Walker would say, ‘Oh shit! he is coming out with the dream’.

His crowd was made up of activists, students, celebrities, in the looming presence of Abraham Lincoln seated in the grand memorial behind. King was the last speaker in a line of sixteen and Andrew Young recalls, ‘They did not expect his remarks to get such media coverage. Neither could they ever conceive those parts of it still reverberate among so many after 60 years later. ‘It lifted the crowd to such a crescendo, it really lifted the nation, and it went worldwide’.

Andrew Young in a recent interview given from his hometown in Louisiana says that King and his inner circle, inspired by Mahatma Gandhi in his nonviolent Satyagraha demonstrations used the same method against poverty, racism, and segregation. Just as Gandhi, King was driven by a spiritual fervour to redeem the soul of America from the evils of racism and discrimination. Gandhi’s success was attributed to the nonviolent campaigns, marches and sit-ins and non-cooperation with evil. King as with Gandhi was of the view that ‘an eye for an eye and a tooth for a tooth will leave everybody blind and toothless.

In the final years of his life the protest movement which initially was one in pursuit of dignity expanded to a broader struggle for equality of opportunity in employment, housing employment and poverty. He campaigned against the Vietnam war. The FBI pursued to destroy King by tarnishing his image but to King his struggle was not about personal piety but a project of broader social justice. The protest marches had the desired effect and John F Kennedy, initially reluctant to spend political time on civil rights made political the moral case which compelled Lyndon Johnson to enact the Civil Rights Act of 1964 and the Voting Rights Act of 1965. King was never confrontationist but being a pastor was very persuasive. Lyndon Johnson stated, ‘there is no cause for self-satisfaction in the long denial of equal rights for millions of (coloured) Americans, but there is cause for hope and for faith in our democracy in passing these two Acts’.

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