Rohana R. Wasala

Sri Lanka becoming a macbethian sick state?

The traditional ritual of anointing medicinal oil (or ‘hisa thel gaema’ in Sinhalese, literally, applying oil to the head) is unique to the Sinhala Aluth Avurudda observances. This year, the ritual was performed at the auspicious moment of 9:04 a.m. (Sri Lanka time) on Wednesday April 16. It was observed at appointed venues across the island at the same time. The anointing was done, as usual, mostly by Buddhist monks in their monasteries. Where they were not available for the purpose, a senior citizen would do the needful. The oil anointing ceremony was held to invoke blessings of good health on all the individuals who subjected themselves to the ritual. Prime Minister  Amarasuriya was shown participating in the oil anointing ceremony at the historic Kolonnawa Raja Maha Viharaya. There were many social media videos showing similar oil anointing scenes that included even elephants and hippos in a zoo receiving the compassionate treatment; this is not seen as going too far with traditions, for extending loving-kindness even to animals is taken for granted in the majority Buddhist Sri Lanka. Watching this ritual (that used to be so familiar for me in my childhood and youth) from abroad I couldn’t help my eyes  filling with tears, feeling kind of homesick, in spite of me having spent more than forty-three years of my adult life living and working away from my Mother Country Sri Lanka. 

Though usually Buddhist monks do the anointing, it is not considered a religious practice by the ordinary Buddhists. It is only a part of the completely secular Sinhala Aluth Avurudda festival. The most important annual religious festival for the Sinhalese (especially Sinhalese Buddhists)  is Vesak, which will be held next month. However, the oil anointing ceremony impresses on the Avurudu celebrants the great importance of maintaining their physical and mental health throughout the coming year, reflecting the high level of attention that our traditional culture pays to that objective. However, the actual discrepancy that is noticed between the ideal and the reality in the mundane world, as in other countries, is a different matter. Shining beacons like ideals of a long evolved culture are important for what they are; their importance doesn’t go away because those ideals are only imperfectly realised by the people of that culture. But the values endure.

The news of this happy occasion and my awareness of a deepening political and cultural malaise in my beloved Motherland backhome reminded me of a book I read during the Covid-19 lockdown period of 2020-2022: OUR MALADY by American historian and public intellectual, the Yale University professor Timothy D. Snyder published in 2020. The book, whose subtitle is ‘Liberty and Solidarity’, is about the weakness of the American healthcare system that he himself got a taste of, privately. Professor Snyder came to know first hand how America failed its citizens in the public healthcare sphere as an inmate of a hospital ward, where he was admitted to the emergency room at midnight on December 29, 2019. He was complaining of a condition of severe bodily ‘malaise’. Malaise is ‘a general feeling of discomfort, illness or unease whose exact cause is difficult to identify’ (Google Dictionary). Doctors later told him that he had an abscess the size of a baseball in his liver. The emergency operation to remove the abscess was done after seventeen hours of his having had to wait confined to a hospital bed!

‘Rage’ is the word he repeatedly uses to describe how he felt during his hospitalisation. He was not raging against God or any particular person or a group or the bacteria that caused his illness. ‘I raged against a world where I was not’, Snyder writes in the Prologue to the book (implying how much he was angry about there not being a healthy enough healthcare system to look after Americans who fell ill like himself. The book grew out of entries he made in a diary that he maintained while recuperating in hospital. Proficient in a number of European languages including English, French and Polish, he adopts a sort of poetic idiom to deal with his naturally dull subject.

 He imagined he was not suffering in solitude, though. He thought about other Americans in his situation, and empathised with them. The absence of a sound healthcare system is America’s malady according to Snyder. Probably, the current situation in America is different, having changed for the better. We must remember that the time he is talking about was the last year of  the first term (January 20, 2017-January 20, 2021) of the 45th US president Donald Trump of the Republican Party. Currently, Trump is serving as the 47th US president. The ideas that professor Snyder develops in the book have global topical relevance, I think. They are organised into four Chapters or ‘Lessons’ as he dubs them, which in my opinion, have implications that could be utilised even by the citizens of the Macbethian ‘sick state’ that Sri Lanka has become today, complete with a Macbeth (though a muppet) and a shadowy but more determined Lady Macbeth.

Timothy Snyder offers the four Lessons for his fellow Americans, and by extension, to fellow humans around the world including us, Sri Lankans. Perhaps these are uniquely American issues, with little direct relevance to a small country like Sri Lanka with no stake in the international pharmaceutical industry. But then no country can escape from the implications of the following facts (taken from Wikipedia): In 2023, the global pharmaceutical industry earned revenues of US $ 1.48 trillion, whereas the top 10 arms manufacturing companies earned only US $ 632 billion. In the same year, the global life and health insurance carriers industry, which is  the biggest industry in the world in terms of revenue, earned US $ 4.3 trillion. 

Our own late medical professor Senake Bibile (1920-1977), a pharmacology expert and a rare philanthropist and compassionate social activist of the Trotskyite Sama Samaja party persuasion who always had the welfare of the suffering poor at heart, met his death allegedly in mysterious circumstances in Guyana where he was attending a UN conference, promoting the domestic drug policy that he had developed for Sri Lanka, as a model for use in other countries and by the World Health Organization (WHO), United Nations Conference on Trade and Development (UNCTAD), and the Non-Aligned Movement (NAM) for developing policies for ‘rational pharmaceutical use’.

 It goes without saying that Sri Lankans are also highly vulnerable to the deleterious effects of the inhuman excesses of the purely profit oriented international Big Pharma; these harmful consequences get transferred to the innocent citizens magnified several times through  the unholy alliance between the local corporate drugs mafiosi and corrupt politicians. Be that as it may, Snyder adds another three equally important related points, covering all four, each in a Lesson that must receive the utmost attention of all adult Sri Lankans: health care for children and children’s education, truth in politics, and the supremacy of the doctors’ role in a malady situation. We will look at these briefly, intermittently taking our eyes off America  to reflect on our own country Sri Lanka.

Lesson 1 is ‘Health care is a human right’. 

Despite its wealth, professor Snyder complains, America is a sick nation; life expectancy is falling for Americans. Moody’s Analytics suggests that US millennials will die younger than their parents or grandparents, though there is no lack of money spent. What is causing this decline in life expectancy? Snyder’s unsettling answer is that the American healthcare system prioritises profit over people’s lives. America still lacks a universal healthcare system, in spite of being a supporter of the Universal Declaration of Human Rights and this leads to unequal access to health care, as Snyder asserts. 

Exorbitantly priced commercial medicine has a devastating effect on the protection of the health-care rights of the people. It has robbed the American citizens of their health, in Snyder’s view. The American health-care system’s profit-focussed approach and lack of investment in protective equipment for medical professionals jeopardised their safety during the Covid-19 pandemic. In America, 20 million people lost their jobs and over 150,000 died from pandemic. Health insurance became too expensive, and health care unaffordable. Without a diagnosis, many became dangerously ill or unknowingly infected others with the virus. 

Though poor, Sri Lanka beats America in respect of looking after public health. It has a better record in providing satisfactory health care for the citizens. The state runs an almost 100% free medicare service for all the citizens. There is a (kind of) parallel paid private hospital system as well, that caters to the better off segment of the population that can resort  to it if they prefer to do so. This potentially eases the burden on the free state medical services, which can then focus more on attending to the needs of the economically weaker section of the population. The maintenance by the state of such a public welfare based healthcare system is desired and supported by our dominant socio-cultural background that strongly resonates with the humanistic spirit of the Aluth Avurudda that prioritises health over all forms of wealth. This is embodied in the principle ‘Arogya parama labha’ ‘Good health is the greatest wealth’, the antithesis of the American attitude towards citizens’ health.  

Sri Lanka was among the handful of countries that contained the Covid-19 pandemic most efficiently, minimizing deaths, whereas in America, according to Snyder, flaws in the healthcare system were aggravated by the contagion. This led to more deaths in America than in other wealthy nations like Japan and Germany. But the not so well-to-do Sri Lanka escaped with a minimum number of Covid-caused fatalities amidst obstacles mounted by antinationalist  ill-wishers as I saw it at the time. That is Professor Snyder’s Lesson 1, which is about the human right of easily accessible health care. Sri Lanka is actually ahead of America in this respect in spite of relative poverty.

To be concluded