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Tuesday, February 26, 2019

Rajarata Medical Faculty produces excellent results in Paediatrics

The following e-mail was sent by Sanath. Let us all congratulate him for an excellent job done.

Professor Sanath P. Lamabadusuriya                                                    21 February 2019

21 Feb 2019, 21:58 (5 days ago)
to bcc: me

Dear Friends,
I am very pleased to inform you that the Final MBBS results of the Rajarata Medical Faculty were released yesterday. Fifteen students obtained distinctions in Paediatrics. (It is probably the highest number of distinctions in one subject in the short history of Rajarata.) The average mark of the common MCQ examination in Paediatrics (conducted by the UGC) was 40 before I started teaching at Rajarata in April 2015. This year it has increased to 62.

Kind regards,

Thursday, February 21, 2019

The Placebo by Zita Subasinghe Perera

Today, I found I had lost my voice and was confined to a corner unable to verbalise anything and feeling rather left out, when on the radio, I heard a talk on ‘Placebos’. It worked like a tonic on me!
We heard the word in our training in connection with clinical trials to establish the truth about the efficacy of a ‘real’ drug against a ‘placebo,’ the latter being a sugar pill or some inactive inert material made to look like the real thing. The Wikipedia defines placebo as a substance or treatment of no intended therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham-surgery, and various other procedures.

In the talk I listened to, a woman spoke about her episodes of irritable bowel syndrome (IBS) which made life impossible. She heard about a practitioner who would treat her. He gave her a placebo to start with and extolled its virtues as the ideal treatment for her condition, she took it and was completely healed. She never suffered from IBS again. She was unaware it was a ‘placebo’ that healed her. So, what happened here? She believed it was a drug which was magical as much as the reputation of this practitioner. She had faith; she ‘knew’ it would work. So, it was a reaction in the whole body associated with this faith.

Later in these trials, patients were told they were receiving a placebo but that it has been known to work. And it did! Why? Because the patient’s ‘faith’ made certain changes in the working of her body, which enabled getting rid of the unwanted condition.

So, it now appears that a placebo effect and the placebo itself are quite powerful and patients while being completely aware that they are receiving a placebo yet get benefit. It finally appears that what works is the faith in the doctor, his personality, his well-wishing toward the patient, his touch, his kindness, all of which militates against the very basics of our medical training which were based on basic sciences, pharmacology, pathology and therapeutics to name a few.

So why is this ‘placebo’ and the ‘p-effect’ gaining currency now?Should trained medical practitioners ‘pooh pooh’ these ideas and stick to what they were taught? Or should doctors be aware of and appreciate and even use other treatment modalities such as placebo effects, acupuncture, faith healing, religious healing, and such methods which were not part of our curriculum except to mention such subjects in an almost derogatory way?

I for one, have the policy of ‘live and let live’. I don’t claim to know everything. I respect and accept my training and it has been my life. But there are things in the art of healing which I do not understand. And this is because, I think, that our minds are powerful complex structures and anatomy, physiology and pathology cannot truly claim to know all that is going on.

Published online 2009 Mar 18. doi: 10.1371/journal.pone.0004824
PMCID: PMC2653635
PMID: 19293925
Placebo Response of Non-Pharmacological and Pharmacological Trials in Major Depression: A Systematic Review and Meta-Analysis

Sunday, February 17, 2019

Speedy Dialogues - Episode 4 with Kumar Gunawardene

Speedy Dialogues Series;
Episode 4. Kumar Gunawardane.

“My favourite writers and poets” 

Speedy: Good morning Kumar. Thank you for being the 4th guest on my Dialogues series. I am so pleased that the series has had a very favourable response. May I start by saying that I always enjoy reading your thoughtful comments on the Blog. I count you as one of our regulars. I must congratulate you again for being awarded the position of Consultant Emeritus from the Townsville Hospital where you worked as Director of Medicine/Cardiology. I know that you were largely instrumental in setting up a tertiary level cardiac service.

Kumar: That is very kind of you Speedy. It was a great honour and furthermore, it gives one a good feel when your work is recognised. I was really happy as I was only the third person to receive this prestigious award.

Speedy: Well-deserved I am sure. OK, down to business, what topic shall we discuss?

Kumar: Thank you for accepting me for your series.  I have enjoyed immensely your virtual interviews and the current “Speedy Dialogues”. I’m flattered and privileged to have been invited to participate in this. I thought of discussing ‘my favourite writers and poets’.

Speedy: That is a great topic and I am sure our colleagues will chip in with their views too. How shall we progress in this?  How about if I ask you first to name some of your favourites and then go on to why you reached that conclusion and maybe give some quotes and references. If you are able to connect some of these with your own life events, in other words, give us "connections" that would greatly add to the interest.

Kumar: I shall do my best. My story has to start with my great aunt Ellen. I was initiated into the love for books and literature by her. She lived next door. She was a gracious, silver haired lady to whom both my brother and I were intimately attached. She was full of fun, generous and had an endless fund of stories. Cuddled close to her on a ‘hansiputuwa’ (armchair) in the stillness of a tropical night, broken only by the incessant hum of the cicadas, I would listen enthralled to the stories of kings and queens and gods and demons. The only distraction was the fascinating flickering of the myriad of fireflies.

Speedy: How lovely Kumar! I can picture this beautiful scene you painted so well, as you talk. What sort of books did she refer to? Just being curious, how did she get the name Ellen?

Kumar: As you are aware, everyone in the colonial era had western names. My father was Martinus and my mother was Beatrice. Ellen is a variant of Helen and both names are derived from the same Greek root ele meaning light or bright.

Speedy: Thanks for that. In fact, on my mother’s side, they are all Sinhala names such as Anula, Soma, Upasena, Upatissa but on my father’s side, there are names like Abraham, Elizabeth, Coraline (I suspect it is a corruption of Caroline), and Alice. Thaththa himself was Edwin. In many instances in those days, our people took these names after converting to Christianity for certain advantages that accrued, not necessarily a ticket to Heaven in your afterlife, but for tangible benefits in this!

Kumar:  There you have it. Well, she introduced us to her late husband’s library, initially to Sinhala books on Buddhism and history. My favourite was the Thupawamsa, the story of the illustrious king Dutugemunu and the building of the magnificent stupa the Ruwanveliseya. One of my greatest pleasures visiting Anuradhapura these days is circumambulation of this great stupa in the cool of an evening transporting myself back into that era, imagining sometimes being a noble parading loftily, sometimes a humble peasant toiling away at the construction.

Speedy: I would concur with you without any hesitation. Ruwanveliseya on a full moon day with the serene silence only being broken by the gentle chanting of devotees pervaded by the smell of burning incense and fragrant flowers is hard to beat.

Kumar: How poetic Speedy!

Speedy: And you must also be reminded of the song Danno Budunge which was sung as the three princes saw the beautiful spectacle of the city of Anuradhapura after crossing a wooden bridge.

Kumar: One of my all-time favourites, especially the Amaradeva version. I read your blog post on Danno Budunge and enjoyed it very much.

Speedy: Glad you did Kumar. And there is the King Dutugemunu story of course. And what sort of books followed?

Kumar: Next she gave me the novels of Piyadasa Sirisena and W.A Silva. PS was the first Sinhala novelist. WAS’s novel Kelahanda became a blockbuster film starring the beautiful Rukmani Devi, the Queen of the Sinhala cinema. I once saw her at a wedding when she was around the age of fifty. She was still strikingly beautiful and when she sang there was a hushed and even reverential silence followed by thunderous applause at the end.

Speedy: Oh I remember Rukmani Devi with such fondness. She was beautiful and there was that special “X” factor about her. We used to call her the Elizabeth Taylor of Ceylon!

Kumar: She was also called the “Nightingale” of Sri Lanka” and acted in close to 100 films. She was the first and perhaps the only SL actor or actress to grace the cover of the FILMFARE magazine which was a favourite of the girls of our generation. She was the heartthrob of many and was married to Eddie Jayamanne and as far as I can recall, it wasn’t all that happy.

Speedy: That is the general view. She had an admirer, Neville Fernando who supposedly wrote the song Menike Obe Sinawe, with RD in mind, but I am not sure.

Kumar: Is that so? How interesting. I must tell you Speedy, Ellen achchi certainly knew how to keep her protégés interested in books. She would from time to time bring delicacies while we were poring over the dusty volumes. Her special treat was a slab of Kit Kat chocolate which she gave us each on her monthly pension day. This was the basis of a story which she would repeat with much glee. Apparently, I had said acchchi I’m going to kill you. ”Why puthe don’t you love me anymore”. “No, no I love you very much, but when you die you will go to heaven and send me chocolates every day!!”

Speedy: You must have loved her to bits! Isn’t it lovely to have achis and seeyas and aunts and uncles like that who are such great characters? They love you so much, unconditionally. Without them, our childhood would have been so much poorer.

Kumar: I agree entirely. I think it is so important for those of us who have grandchildren, to give them time and affection.

Speedy: I am sure our colleagues and readers would heartily endorse that. These events you recalled were just before you went to Primary School?

Kumar: Yes. By the time I joined STC my love of books was firmly entrenched. We were very fortunate to have outstanding teachers in both Sinhala and English. The doyen of Sinhala teachers in the Lower School was Arisen Ahubudu.  Apart from being a supreme storyteller he was a noted poet and a lyricist. You all would be familiar with his songs in the films Rekawa and Sandesaya. Puruthugeesikaraya was a chart topper.

Speedy: Couple of interesting things there. You mentioned Arisen and this clearly is a sinhalafication of Harrison. I also came across Rapiel (For Raphael), Coraline for Caroline and many others I cannot recall at the moment. What are your thoughts on this Kumar?

Kumar: I’m sure you are correct regarding the derivation of Arisen. We kids were told it was the “Hela” version of Aryasena

Speedy: Sorry for that digression but this is what makes these dialogues interesting!

Kumar: I agree

Speedy: Tell us some more about this intriguing character. More coffee?

Kumar: No thanks Speedy. About AA, we had double periods for our Sinhala classes. He would get us to complete our assignments in one period and then relate a story rest of the time. My favourite was his story based on Ryder Haggard’s novel “She”. This was given a magical twist by AA which I couldn’t recapture on reading the original book. His other stories which held us spell bound were Kumaratunga Munidasa’s vintage children’s fiction Heensaraya and Hathpana.

Speedy: What sort of character was he really?

Kumar: He had a magical technique to quieten the little monsters that we were. At his intonation “Eyes”- we would close our eyes; “Ears and Tongues”- would silence us; “Body”- would make us stock-still. In one minute all the rowdiness would cease and the master and pupils were ready to get on with the day’s lesson.

Speedy: Sounds a bit of a tyrant!

Kumar: Not really! Just a strict disciplinarian.

Speedy: And you had a whole new set of characters when you moved to Upper School?

Kumar: In the Upper School another Sinhala teacher Mr. C.S.Weerasinghe aka “Pol Weera” read to us “Gamperaliya” (Uprooted) the first of Martin Wickremasinghe’s quintessential trilogy; the others being Kaliyugaya (the age of destruction) and Yuganthaya (the end of an era). They were in the epic tradition of the Russian novelists. We had good reasons to be attentive in that class. Firstly it was an absorbing tale, but more than that PW, a sturdy man built like a prize-fighter packed a good punch. I myself was a recipient once for no good reason and the injustice of it still rankles.

Speedy: So you were a bit “naughty” then Kumar?

Kumar: I wouldn’t put it quite that way Speedy, although CSW might agree with you!
But seriously, I am grateful to him for introducing me to these Sri Lankan literary giants.
MW was perhaps the most prestigious of the Sinhala novelists but Gunadasa Amerasekera, a dentist by profession, Karunasena Jayalath, Ediriweera Sarathchandra and many others whose works were equally good are well worth a read. Many of these have now been translated to English very competently. Gamperaliya and Karunasena Jayalath’s Golu Hadawatha (The silence of the heart) were turned into film masterpieces by Lester James Peries

Speedy: Now there is a great man. I mean Lester James Peries. I remember him well and the first thing that comes to my mind when his name is mentioned is “Rekawa” which you did mention before. The other recollection is the impact Rekawa had on the Sinhala cinema. What are your thoughts on this Kumar?

Kumar: Indeed he was a pioneer, a visionary if you like. Rekawa was produced in 1956 and was a watershed in the Sinhala cinema; the first film free of Indian influences, the first to be shot fully in Ceylon and the first to be shot entirely outdoors. The musical director was a mutual favourite of ours Sunil Shanta. And the lyricist was Fr. Marcelline Jayakody.

Speedy: Now there you taught me something. I had no idea that it was the first to be shot in Ceylon. There is a contrary view about the outdoor shooting though, and I am told that it was really the film "Gambada Sundari", starring Kingsley Jayasekera and Sheela Peiris in 1950, which was the first film shot entirely outside studios. I knew that almost all Ceylonese films were really remakes of South Indian films and they were poor remakes too, but they were popular among the masses.

Kumar: Yes, the South Indian influence was big and what the people seemed to like.

Speedy: It is sad that this ground breaking breath of fresh air which had such international success was a box office failure in Ceylon.

Kumar: Yes, it was ahead of time and as you know, it is not the first highly acclaimed film to suffer such a box office failure.

Speedy: True. I can think of one, Shawshank Redemption (1994),the American drama film.

Kumar: Coming back to Gamperaliya, the lead actress of Gamperaliya, Punya Heendeniya married Dr Milroy Nanayakkara one of our seniors. He was a fellow hosteller at Bloemfontein. I did a locum for three months for his brother Dr A.S.H. de Silva while he was away studying for his MD. This was shortly after we finished internship and were not employed immediately.

Speedy: Talk about connections, both known and unknown!
We covered a lot on your exposure to Sinhala literature. What about English? Shall we recall some of your favourite English poems and poets?

Kumar: Yes, I shall be happy to do that Speedy.
In the Lower School, we were inducted into the delights of great English poets and poems.
The one that is indelibly implanted in my memory is Cassabianca, Felicia Dorothea Heman’s deathless verse.

The boy stood on the burning deck
Whence all but he had fled
The flame that lit the battle’s wreck
Shone round him o’er the dead.

Only years later did I learn that this was a true story and the boy was waiting for his father who lay dead in the ship’s bowels.

Speedy: I couldn’t recall Cassabianca word to word but of course knew about it.
Have you heard one of the parodies on this great poem? It goes like this-

The boy stood on the burning deck.
His feet were covered in blisters.
He'd burnt the socks right off his feet.
And had to wear his sister's

I suppose it is not really funny at all. As you say, it was based on a historical event. Whether or not the young Giocante Cassabianca (only 12 years old), actually sacrificed himself as the poem claims, it's certain that both the boy and his father, Commodore Cassabianca, were killed on the French flagship, L'Orient. It had caught fire, and, when the flames reached the powder kegs, it exploded.

Kumar: You get much more from the arts and literature when you research the origins, as you did Speedy with Danno Budunge.

Speedy: Indeed Kumar. I learnt such a lot when I did my research on DB.

Kumar: The other poem I recall with fondness is The Highwayman. Even the most recalcitrant rascals of our class could not help being seduced by this Alfred Noyes poem. The brilliant opening lines are unforgettable.

The wind was a torrent of darkness among the gusty trees
The moon was a ghostly galleon tossed upon cloudy seas
The road was a ribbon of moonlight over the purple moor
And the highwayman came riding -
The highwayman came riding, up to the old inn door.

Reading these lines even after all these decades makes one’s spine tingle.

Speedy: I read a summary of this (does not capture the spirit of the poem like the original which of course is a masterpiece). It goes like this.

The highwayman is visiting his girlfriend Bess at her father's inn. He's on the move as he is always robbing and moving on.  He only has time for one kiss and leaves promising that he'll be back by the next night at the latest. But the next evening, it’s not the highwayman, who shows up but some British soldiers. They drink a lot of beer, tie up Bess, and then they wait at the windows to shoot the highwayman on his return. Bess is tied up with a gun at her chest, and she wriggles around until she gets her finger on the trigger. Then, when she hears the highwayman's horse, she fires the gun, and gives her life to warn him about the ambush. The highwayman tries to get away, but he gets mowed down by the soldiers in the middle of the road, and dies in a pool of blood. On certain winter nights, his ghost still rides down the highway to meet Bess.

Kumar: Sad isn’t it, and brave.

Speedy: True love with no strings attached!

Kumar: The next one I like to share is The Tyger by William Blake.

Speedy: I must confess that I am not familiar with The Tyger at all. I recognise William Blake for one of the most moving hymns I have heard, “Jerusalem”.

Kumar: Jerusalem is probably better known by many and you are not alone in that Speedy, but The Tyger was relished by the boys more for its parody on our headmaster than the beauty of its words.

Tyger Tyger, burning bright,
In the forests of the night.

Tyger Tyger burning bright
Barneyge  p- - --  dynamite !!!

Speedy: Super! Boys will be boys as they say! Any more Kumar? This has been so interesting.

Kumar: Another perennial favourite was Leigh Hunt’s Abou Ben Adhem who awoke from a deep dream of peace (like some of my mates to whom poetry was anathema)! Its underlying message “Loving one’s fellowmen was more virtuous than loving the Almighty himself” was perhaps superfluous to us; we boys got along companionably with each other and also with most teachers with no thought of class, creed or race.

Speedy: Kumar, our dialogue has been so interesting! I just didn’t feel the time going. Thank you so much and I have no doubts whatsoever that our readers will savour this and recall their own literary experiences. In conclusion, let me quote my favourite author, Pelham Granville Wodehouse “There is no surer foundation for a beautiful friendship than a mutual taste in literature.”

Dr Kumar R.W Gunawardane, Cardiologist and much valued 1962 Colleague, thank you very much
Kumar: Thank you Speedy. I have a lot more anecdotes, but like Scheherazade, I will keep them for another occasion!

Friday, February 15, 2019

Mini Batch Reunion at Hyde Park Residencies

As she so frequently does, Pram entertained not only many friends from our batch, but also quite a few from our senior batch as well, last Saturday (9th February), at her Hyde Park Residencies where she now lives. It was a Mini Reunion of sorts where I met two old friends for the first time since our graduation in March 1967. They were LPJM (Pulasthi) Wickramasinghe and Asoka (Lubber) Wijeyekoon. Lubber has joined me and Anton Ambrose as members of the Baldies' Club!

I have inserted below, a few pictures from the event.

Standing L-R: Lubber, Lucky, Sanath, Harsha, JC, Senerat, LPJM. Kumar
Seated L-R: Suri, Swyrie, Pram, Chira, Bunter, Sura

Lucky at the mike singing with "Vendo" at the keyboards 

Thursday, February 14, 2019

"Recent Comments" boxes return

The much appreciated "Recent Comments" boxes have been restored.  It is virtually impossible to prevent pranksters from inserting comments. The most common reason for comments by pranksters is to try and attract viewers to a site they are marketing.  The only way is to introduce "comment moderation" which means that every comment will need to be seen and approved by the Blog Administrator. It is a thankless task unwanted by any BA and will also deter legitimate users from commenting.

Hope you use the two boxes for recognising new comments.  Speedy on behalf of BA

Wednesday, February 13, 2019

E-mail sent by Sanath Lamabadusuriya

This refers to some comments made by Rohini and Sumathi under an older post (See under New Medical Faculty at Sabaragamuwa) He has also sent some photographs. This is sure to get outdated soon if it is not published now.


Thank you very much Rohini and Sumathi for your well balanced comments. I am extremely sorry if I hurt your feelings by my outburst. My personal view is that Sri Lankans by nature, are less charitable compared to the British. Let me quote an example so as to justify my point of view.

"The morning after the tsunami, the first among many calls I received from abroad was from Michael Mars (co-Director of Sri Lankan Cleft Lip and Palate Project, in Galle), inquiring about my welfare. I told him that as I was based in Colombo I was OK, but Galle had been devastated. Next April I travelled to Galle with Michael and showed him the Sambodhi  medical students  hostel in Magalle (donated by BR Dissanaike) which was flattened. He was really moved after seeing the calamity and mentioned to me that he would try and raise funds so as to construct another hostel. Later the Sri Lankan Medical and Dental Association had their annual academic sessions in Warwick and I chaired a session in which Michael gave a guest lecture. While introducing Micheal, I mentioned about his ambitious project and invited donations from Sri Lankan doctors as he was short of 50,000 pounds. Later he told me that Padmini de Silva (wife of NRP de Silva) who was  a former registrar of mine and working as a Community Paediatrican in Eastbourne, had donated 2000 pounds in memory of her late husband and that there was another donation of 50 pounds. That was all ! Later that night Buddhika, Harshan and myself participated in the dinner dance after purchasing three tickets for 70 pounds each. (Michael did not attend the dinner as he was expected to buy a ticket although he was a guest lecturer!) There were hundreds of others at the dance. A band had been flown in from Sri Lanka to perform at the dance although Sri Lankan bands were available in London. When I inquired from Dr. Panagamuwa , the treasurer,what the profits were, he told me that although the ticket sales had raised thousands of pounds, they were breaking even. Later the hostel was constructed within the premises of the Karapitiya Medical Faculty and the British High Commissioner opened the building in the presence of Michael, few other fund raisers and myself. The Kuwaiti government also donated a hostel and thereby accommodation was provided for all the Ruhuna medical students"

Dr. Sharmila Anandasabapathy: Ask Me About My Research

In case viewers don't know who Sharmila is, she is none other than Indra and Rani Anandasabapathy's daughter. As you all know, our batch colleague Indra and his wife Rani are frequent contributors to our batch blog. Besides being the wife of her anaesthesiologist husband Indra, Rani is also a talented artist and an avid photographer. Sharmila Anandasabapathy, M.D. is presently Director of Baylor Global Health and professor of medicine - gastroenterology at Baylor College of Medicine, Houston, Texas. Sharmila is joined by a special guest to demonstrate the importance of scientists and researchers talking with each other about their work. Please watch the entire video to see how "special" the special guest is!

Monday, February 11, 2019

Apologies from Speedy about New Comments


The latest comment boxes which were very popular had to be temporarily suspended as this could have caused a security breach. Once it is investigated fully, we shall inform you of any action to follow. Ove 50 comments from external source appeared including the Arabic script ones seen some time ago.

Speedy on behalf of BA

Saturday, February 9, 2019

Creative Spot - Sunsets by Indra Anandasabapathy

As you can see from this e-mail, there was a dire need for an easy way of looking back at older posts and comments. That is why we  had to intervene and break the line.  

Indra Ananda

Wed, 6 Feb, 23:03 (3 days ago)
to me
I sent you TWO SUNSET PICTURES FOR THE BLOG, and there are additional comments on ORCHID GROWING from me under my write up. Any way of drawing attention to newer comments?

The two sunsets:

Thursday, February 7, 2019

Keeping track of comments

 Before I proceed any further, I wish to acknowledge with thanks the part played by my friend and colleague Mahendra (Speedy) Gonsalkorale, who conceived the idea of posting the above lines as a new post under the heading - "Keeping track of comments".  The following few short paragraphs (in a different font) were actually drafted by Speedy almost in toto, to be posted as the Blog Administrator's own work, without divulging any other details. This is typical of the man whose main goal is to see that our batch blog lasts as long as possible. That is at least as long as one survivor in the batch remains in control of his or her faculties to read or write the last lines.

You will see two changes on the dashboard on your Right side.

There is a "Latest 5 comments" section and this is a "fill from above and the last one falls" type of column. As a new comment appears at the top, notification of the 5th one drops out. You will also see the name of the author and date posted and the first few words of the comment. If you click on it, you will be taken to the relevant post. Sadly, this method allows only 5 such comments at a time.

There is also a "Latest comments - first words" and this shows 10 posts, but it will reveal only the first words without the author or date. But nevertheless, if you click on it, you will be taken to that post but on a new tab on your browser.

I hope these changes make it easier for colleagues to identify a new comment as it appears. Please note that even if you go back to a post some months ago and post a new comment on it, that will be identified in the two panels. In this way, you are free to roam the blog and add comments which wouldn't be lost.

Wednesday, February 6, 2019

Further extension to "Time"

As the previous post wherein I have tried to accommodate Indra's request, this too is being published as a new post because there is no easy way in which viewers' attention could be drawn to older posts. As I have explained before, viewers have to simply click on "Older Posts" and keep looking at them!
(vide Speedy's first "Speedy Dialogue" (Episode 1) with Zita herself.

Thu, 31 Jan, 16:17 (7 days ago)
to mahengonsalme

We discussed 'TIME' in one of the Speedy Dialogues.
Today I found this link to an article which talks of Time as given by the Body Clock which gives man the Circadian Rhythm.
So it appears that TIME as applied to the human body is a very real thing and can determine the difference between Health and Disease.
I do not think this concept was known and therefore it was not taught to us during our days of medical training.
So it is important for us to be acquainted with this knowledge so we can help our families, friends and the general public whenever possible.