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Thursday, March 24, 2016

Why Sri Lanka beats India in maternal mortality ratios - Al Jazeera English

Sent by Rohini Ana
I had no hesitation in posting this.

Rohini Anandaraja

23 Mar (1 day ago)
to me
Dear Lucky,

What follows is a link to an article sent to me by my daughter from NY.

Those in SL probably know all about this already.
To me it was wonderful news- I could appreciate the great way things have been organized.
If you think this might be of interest  in the blog  you may use it.



  1. Rohini, thank you (and your daughter) for sending this in. It was heartwarming to read, and made me feel very proud of the preventive health care programs in Sri Lanka. I remember working with the mid-wives in the ante-natal clinics as a medical student at DMH. I also remember the first time that I assisted a midwife with a normal delivery. It was one of those "milestone" memories that become etched in one's brain. I was very impressed with their dedication even then, and I am happy to read that the programs are being maintained. I know that the infant mortality rate is also very low in Sri Lanka as a result of the ante-natal clinics run by the midwives. Some of the inner-cities in USA have higher infant mortality rates because of lack of access to clinics such as these.

  2. A really heart warming account and thanks so much for the link Rohini (and your daughter). I too remember the midwives in Sri Lanka. One such memory is at Matale were as SHO, I did 1 year of O&G. There was a rule that the midwife had to call the doctor for a breech delivery and I still distinctly remember this. I arrived there with a great deal of panic as I had no clue what to do (apart from some vague recollections from Dr Attapattu and Prof Ranasinghe's teaching), and I was sensible enough to tell the midwife that they knew far more than I did and would they mind going ahead with assisting the delivery while I watch and learn, and learn I did!

    i can't help but get on my hobby horse again about how practitioners who do their job because they like it and value their skills for the benefit of others with no thought of monetary rewards, are what is needed. When Ari the wonderful midwife, is at large as a midwife, the only thing she cared for was doing a good job and helping a person who needed her help. Monetray reward would not have even crossed her mind fleetingly. I am afraid privatisation of Health Care and uncontrolled Private Practice has had a detrimental effect on what Health Care practitioners, including doctors, do. Everybody deserves some financial compensation in their jobs but the ability to earn more money by doing more, possibly unsafely and unsoundly, and sometimes unethically, should never be an incentive for doctors. This is why in the UK, I am a passionate supporter of the NHS and view the creeping privatisation of the NHS with the emphasis on financial rewards with a great deal of sadness. Some say that spending on health care is a bottomless pit and I disagree. The State should give predominance to preventive medicine and also stop pampering the Public to demand unrealistic expectations such as "the right to choose the hospital" etc. When you couple this with promotion of defensive medicine by encouraging litigation, of course care costs go up. The British Public are willing to pay more tax if it is targeted to Health care and if you also think of the millions of £ profit made by Private Health Organisations, the myth that there is no money can be destroyed. There is absolutely no evidence that Private Providers do any better. They sometimes show better statistics because they "cherry pick" services and treat staff harshly. The fact is that Health Care is a golden opportunity for Private Organisations to make money. It is the proverbial Golden Egg.

    I am so proud of my Land of birth for success stories like this one. It is a pleasant change from crooked politicians and massive care costs in some Private Hospitals where poor patients have had to sell all their property and borrow money from relatives to pay huge bills.

    1. Mahen,
      How you managed your first breech delivery was interesting! One important lesson I was taught very early in my internship by my consultant was that the "ward sister" would know much more than I would as a freshly qualified doctor. This was music to my ears-as I started learning medicine in earnest only after I qualified and had to care for patients! Many were the times I sought an opinion from the helpful "ward sisters" I was fortunate to work with in Galle where I did my internship.
      Money and ethics is another vast subject!
      I totally agree with you - compassion and dedication has to be at the heart of medicine,and there can be no excuse for unethical practice.

  3. One aspect of this article which I failed to mention in my brief note to Lucky was the dedication of these workers which is to be greatly admired.I guess in whatever field one works,little progress will be made without genuine interest and dedication.
    It is also plain to see,this standard of preventive healthcare did not happen in a flash-
    Hence credit is also due to those healthcare professionals who have gone before and paved the way for this wonderful outcome.
    Dr. Lakshman Abeyagunawardene-Lucky! in his memoirs has written a chapter (No 10)giving a detailed history of how the Health education system in SL has developed over the years,and as I have learnt only in recent months-has himself been instrumental in taking health education in SL onward.
    In my ignorance I only know of just two other batchmates- Sriani Basnayake and Lalini Seebert who have been active players in this.
    My thanks to these dedicated preofessionals who have served
    their country of birth so well.

  4. Thank you Rohini, for the kind words in your comment. It is something that I would never have dared to mention myself! But as every right thinking professional knows, this type of success can come only if leadership is provided at a higher level.

    I am proud to say that I was the first in my batch to have opted to do public health as a career. As you know, all Medical Officers had to do two years of public health compulsorily and everyone had to take their turn. In my case, I didn't even wait until I was called for the two year stint. When I was serving as MO/OPD Colombo South Hospital, I took the decision to exercise this irrevocable option with more than two years of my OPD term yet to be completed. Thus it was in October 1970 that I went on transfer to Matara voluntarily.

    When I applied for the WHO Fellowships that were advertised in 1972, I didn't have the stipulated minimum period of two years of public health. But my experience in the Anti VD Campaign was also considered as public health. Thus, I was in the group that was selected when all other successful candidates were much more senior to me.

    Of course, many others in our batch who had stayed back in Sri Lanka did opt for public health later. Among them were Gnanissara, Wimal (Jayakuru), Ranjith Kuruppu and the late Bernard (Randeniya) and Punsiri Fernando. Pramilla (Kannangara) and Lalini (Seebert) were two others who did public health, but they were both in the academic field.

    I am open to correction here. But if I am not mistaken, Sriani (Dissanayake) was specifically involved in sex education and not in the broader field of public health.

    1. This comment has been removed by the author.

    2. Well done Lucky, and thanks for filling me in on our batchmates.

  5. In addition to all of our batch-mates mentioned above, we should not forget the pioneers in Public Health who taught us, such as our beloved Dean at the time, Prof. O.E.R. Abhayaratne and others who established these programs.

  6. Srianee,in Lucky Abey's memoirs-"From Hikkaduwa to the Carolinas" Prof.Abhayaratne is the first mentioned in the list of "gurus" whose dedication in one way or another fashioned our careers.
    For those who may not have read his memoirs-Chapter 5 gives info on just about everyone in our batch.
    Apart from his sustained interest in and loyalty to our batch-the book makes clear his genuine interest in people he has encountered throughout his life.
    His narrative of his experiences in the health sector in SL was interesting, some of which I could identify with even though my stint in SL was very brief.
    What amazed me most about this book is the fact it has all been written entirely from "notes" in a 60+ year old computer sitting on his shoulders!
    A very good review of this book is available on google-much more than I can say. No - he hasn't paid me to say any of this either!!

    1. Rohini, Thanks for this recommendation of Lucky's book. I know I have a copy, but didn't get down to reading it properly when he first gave it to me. I skimmed it and put it on my "back burner." I will read it when I get back to CT. As for his 60+ year old computer sitting on his shoulders (now 70+) I am always amazed at his recall of details. Go Lucky!

    2. Rohini, Thanks for this recommendation of Lucky's book. I know I have a copy, but didn't get down to reading it properly when he first gave it to me. I skimmed it and put it on my "back burner." I will read it when I get back to CT. As for his 60+ year old computer sitting on his shoulders (now 70+) I am always amazed at his recall of details. Go Lucky!

  7. Rohini
    After so much negative publicity about healthcare in the developing world it is great to read something positive and uplifting. Please thank Natasha for the link. Reading it made my day and made so many of us happy.
    Our thanks to those in Public Health in SL and our teachers who showed us the way.

    1. Nihal-I'm sorry I had missed this-I shall pass on your message to Natasha-thank you

  8. Thanks Rohini, for providing the link to this excellent account which makes us proud of Sri Lanka's maternity service record. It also leads us to other very important subjects like Female Genital Mutilation which never gets enough light of day. I hope as many as possible will read these accounts you have taken the trouble to bring our way.

  9. Zita,Seeing you have referred to FGM, I might send you an article I was very impressed with regarding security for women into your private email if I may.
    I seem to miss a lot of dialogue that goes on in the blog as I haven't been scrolling back for comments/replies that come in later-but shall look out for your reply.cheers Rohini

  10. That would be most welcome,Rohini. I am ashamed to say I hardly knew anything about FGM during my training. Later on I could think back on some difficult and painful deliveries I had been present at. These were cases of transferred from other countries where the practice was rampant. Now with the readership of our Blog is increasing, useful links like you have provided will be invaluable. Nita

  11. Rohini, Where is your daughter in NY?