by Dr Upul Wijayawardhana Courtesy Island

My friend and senior colleague, Carlo Fonseka, has no doubt that ‘too many medical cooks spoiled the broth’ and resulted in the unfortunate death of a national treasure, Ven. Madulawe Sobitha Thera. His heartfelt lament published in ‘The Island’ on 12 November concludes thus:

“Sadly our profession could not save him for the nation. I do not weep for Ven. Sobitha who died in the fullness of honours. Instead I weep for myself and the rest of us. On behalf of my profession, I beg for forgiveness from the nation for failing so dismally to save Venerable Sobitha and I hang down my head in sorrow for shame.”

It has evoked a multitude of responses of differing shades of opinion. When the current President of the Sri Lanka Medical Council, the regulatory body of Doctors, makes such a sweeping statement, naturally, the profession has to take note and, as a member of that noble profession for over half-a-century, I feel I will be failing in my duty, if I do not express my views. Some may say we are ‘killing’ Ven. Sobitha, again and again, by protracting this correspondence but,as someone who braved to criticize my colleagues in the past, I feel I am obliged to state a few facts to diminish their responsibility for this unfortunate incident.

Minor Inquisition

In a follow-up piece published in ‘The Island’ of Saturday November 28th, re-printed in ‘Sunday Island’, the next day, with an enlarged headline ‘Carlo blames “too many cooks” –Controversy over VenSobitha’s death’, Carlo, in his typical tongue-in-cheek manner, refers to a ‘minor inquisition’ held by some council members of the Sri Lanka Medical Association, the all-encompassing professional body of Sri Lankan doctors. This surprised me as I am not aware of such an occurrence in the history of the SLMA. I speak with some authority as I was very actively involved in the SLMA from 1973 to 1988, holding all the key positions, except that of the Treasurer (I was never good with accounts) and the President, but was President-elect in 1988, when I left for UK on an impulsive but, in retrospect, a lucrative decision.

The minor inquisition is confirmed in a letter titled ‘Unfair criticism of Sri Lankan doctors- a rejoinder’ by my friend, Professor Sanath P Lamabadusuriya (Sunday Island, 6 December) but the perception of what transpired is at variance with Carlo’s interpretation. Perhaps, as the Buddha said over 2500 years ago, ‘the world is your (own) perception’. However,Sanath’s letter was very helpful as it gives essential facts regarding Ven. Soratha’s terminal illness. I was under the impression that he had an aortic valve replacement but it was a mitral valve replacement, which carries a much higher risk. He was referred for Cardiac intervention by the Neurologist as she found him to be in heart failure. Further, Ven. Sobitha had renal impairment and was diabetic; long standing and poorly controlled, I am made to understand. Considering all this, there is no doubt that Ven. Sobitha belonged to a very high-risk category. It is not unusual, not only in Sri Lanka, to rush to definitive treatment when it is a VVIP and it is purely conjectural whether the outcome would have been different had surgery been delayed till complicating factors were corrected as much as feasible.

His mental state, of huge disappointment and despair would, certainly, have compounded the risks. It is rumoured that though Mahinda Rajapaksa, much maligned by him, visited Ven. Sobitha in hospital, President Sirisena, who owes his present position largely to the valiant efforts of the prelate, did not visit him.Though used to ungratefulness, with wits dulled by severe illness, how Ven. Soratha reacted to this we will never know but can be sure, as we can be, that it would not have helped his mental state. It is well known that those who face severe illness with optimism fare a lot better than those who face with pessimism but, interestingly, trials showed that by being prayed for did not improve outcome.

Being the ever-questioning sceptic I am, may be because I have over-interpreted the words of wisdom of the Buddha about questioning, each and every, in ‘The Kalama Sutta’, I was not in agreement with everything Ven. Sobitha did or said but had the greatest respect for him as a conviction fighter for good causes. As much as Carlo was angry with his fellow doctors, I was so angry with the politicians, who made use of him to gain power and let him downso badly in no time, I wrote a piece titled ‘Did Yahapalanaya kill Ven. Sobitha?’ Interestingly, it appeared in the same issue of ‘The Island’as Carlo’s ‘controversial lament’ but the editor, with valued judgement, changed the title to ‘Venerable SobithaThero’. I shall not repeat the arguments I set there, except to say that at the time of writing I thought Ven. Sobitha belonged to a low-risk category, but repeat that it was politicians who were more responsible for his death than doctors.

Perhaps, later, the Editor agreed with my assessment when he stated in the editorial on Monday, November 30th:

“Ven. Sobitha campaigned hard to dislodge a seemingly monolithic government and lesser minions are enjoying the fruits of his labour. We believe his heart condition worsened because at the time of his death he must have been at least 15 years older than his chronological age thanks to his activism and the attendant stress. Regrettably, the venerable monk died a sad man; he could not achieve his goal of having the executive presidency abolished and electoral reforms introduced.”

Tay Bridge Disaster

Disappointment hastens mortality and there are many examples of it, the one that comes to mind being the ‘Tay Bridge disaster’

The Tay Bridge in Scotland, which was completed in February 1878, was nearly two miles long, consisting of 85 spans and, at that time, was the longest bridge in the world. The spans carried a single rail track and Sir Thomas Bouch was responsible for the design, construction and maintenance of the bridge. He was knighted for it as it was such an incredible achievement at the time.

The Tay Bridge disaster occurred during a violent storm on 28 December 1879 when the bridge collapsed while a train was passing over it on the way to Dundee, killing all 70 passengers aboard. It is said that Sir Thomas got on to a boat and went round looking at the wrecks and dead bodies floating and got ill very soon. An inquiry found that the cast iron used was not strong enough because of impurities of carbon embedded and blamed the entire disaster on Bouch. Under ‘shock and distress’ he died 30 October 1880, a few months after the public inquiry into the disaster finished.

Was ‘Yahapalanaya’ a bridge too far for Ven. Sobitha? Did he not realize that our breed of politicians are like impurities embedded in cast iron?

Politicians broke the heart of Ven. Sobitha and doctors were not able to fix it. Whoever at fault, the great prelate is no more and all that the medical profession can do, to honour him, is to make use of this opportunity, however unfortunate it may be, to better ourselves and improve the standards of health care.

While Professor Upali Illangasekara (The Island, November 24) gives explanations to some misdeeds (though it is no justification) what Dr Mahinda de Silva states in his opinion piece on Monday 7th is grossly unfair by most of the medical professionals in Sri Lanka. Some others have referred to a ‘rotten medical system’ simply because of a few bad eggs, which again is grossly unfair by the vast number of very competent doctors in the country. I was privileged to train ten post-graduates in Medicine from Sri Lanka, at Grantham Hospital, UK and found their knowledge and competence second to none. There was never a single valid complaint against any of them and all staff missed them, when they left at the end of their training.

What ails our medical profession is attitude, not competence. They need to be more responsible and compassionate to their patients. They should stop behaving like non-professionals who drop their tools at the drop of a hat. They should use strikes as a weapon of last resort,not what happens today, behaving like ‘harbour workers’ of yesteryear.

The person most capable and best placed, as President of SLMC, is none other than Carlo and may I earnestly request him to channel his sorrow to productivity: get the support of SLMA, GMOA and all other medical associations and colleges to draw guidelines regarding patient safety, private practice etc. May I also request him to persuade and convince the SLMC to introduce re-validation, which is done in most developed countries, and use his influence on PGIM to establish continuing medical education for all doctors, not only specialists, which is an essential part of the process of revalidation. If he does so, the premature death of Ven. Sobitha would not have been in vain and, though politicians would not, we would have learnt a lessonwhich could result in long lasing improvements of health care.