The universe today has been bombarded by medical expertise from every which way pontificating on “solutions” to a covid-pandemic of an extremely complex and varied character. Chandini Liyanagama, a senior Sri Lankan Australian medic, has essayed criticisms of the processes in Sri Lanka on the basis of a webinar broadcast from the island.[1] It is, of course, best to respond to this appraisal on the foundations of the webinar sessions that provoked this assessment.[2] So, I sent it to a few Sri Lankan medicoes within the island for their appraisals.
Dr Sarath Gamani de Silva kindly forwarded the ‘report’ to another medico who was directly involved in the webinar discussion and we now have Dr BC Perera’s devastating evisceration of Liyanagamage’s readings. However, I preface that step by presenting a critique from Gerald Peiris, one of Sri Lanka’s leading economic geographers, on the basis of general principles leavened no doubt by access to the views of his daughter Indumathie and son Manju, both senior medical personnel in the town of Kandy where Peiris lives.[3]
I = Email Memo from Dr. Chandini Liyanagama, 7 May 2020
I am Dr Chandini Liyanagama,
Senior specialist Anaesthetist, Brisbane, Australia
To Whom It May Concern
I would like to give some feedback about the webinar which I joined from Brisbane yesterday.
1). The main focus of the expert panel from SL was to impress the world saying SL is doing very well compared to rest of the world. “They are the only country doing things which rest of the world is not doing very well” If you are in that stand and not willing to learn ,you are in very big trouble .
They were not able to show any evidence for that message they wanted to give to the world .
2) We attend a Webinar to learn from others experiences to learn about this unknown threat affecting the whole world. But the SL panel did not show any interest to learn from other experts from around the world or give evidence of their practices . This attitude does not help to try and share information and also to learn and fine tune the approach against this threat.
This is a continuously evolving situation.
Australia as well as SL is in a good position because we faced it much later than lot of other countries. We learn and look for all these experiences and change our plans every minute to improve the outcome .
3) There was no transparency and they were trying to hide lot of things without going into details
No answers to lot of questions from the audience about improving immunity, use of Vit C and D , steps taken to avoid malnutrition with prolonged shut down, use of anti-viral drugs , safety of health care workers, testing criteria, data, audits about contact tracing and quarantine, any loopholes and corrections done about these which is what is happenings now in SL, details about the qualifications and training of personnel involved in contact tracing , how many are employed to do the contact tracing which is a very vital element to limit the spread ,who is in charge of that process ?
What is the process after contact tracing, criteria for testing and quarantine ?
4)About training of health care staff ,the front runners which is a very important aspect of this pandemic management
No one mentioned anything or answered any questions about these.
How they train the staff about donning and duffing of PPE, airway management, capacity building and modelling , etc to prevent spread among them.
Any simulator training which need to be done every day to train the staff which is not happening in SL. There should be a professional team in charge to supervise these daily to see all staff are competent by doing practical training
One anaesthetist from audience said they have 100 ICUs ventilator beds which is adequate, probably he does not have any idea about the modelling and the association with preventative measures
How much capacity they have on testing kits PPE etc
DGH is clueless and has no idea about these ?
What measures taken to increase the capacity of the health system to face the pandemic?
No mention about any by him only talked about the PHI and some legislation.?
4) no mention about communication at all among the health care staff and the public to avoid spread of misinformation by the media, fear mongering , confusion, stigmata and conflicts amongst them in front of the public.
No unity about the management plan which needs to be finalised by the key players with representations from all grades
There should Be proper daily updates communication system between the health administration ,task force and the rest of the
Health care staff all over the country
I will attach some information to be shared if you are interested here with.
Kind regards
Dr Chandini Liyanagama
Senior Specialist Anaesthetist
QEII Jubilee Hospital
Brisbane Australia
II = Note from Gerald PEIRIS, 5 May 2020
Michael, ………..At long last, what is really wrong with Sri Lanka has been discovered by an expert! What a comedian! The plain fact it that there is no overarching ‘Pandemic control’ strategy elsewhere in the world which can serve as a model for Sri Lanka. We could, of course, learn from their experiences — achievement and failures. That is being done here.
There is no evidence whatever to this expert’s charge that those who have directed the war against Covid-19 in SL since early March prioritised the objective of showing the world their unique competence. It is quite easy for these self-appointed pundits to make this type of indictment without an iota of concrete evidence. There is no need to take them seriously. Sri Lanka doesn’t need accolades, what it does need is concrete material assistance (not advice), not so much in Covid-control, but for our post-pandemic (if and when such a state occurs in the foreseeable future) economic recovery.
To digress, it is sad to see that the Aussie government has become an acolyte of Washington and is trying hard to replace Trump’s fig- leaf with an amude (loin cloth).
Best regards, Gerry
III = A Response from DR BJC Perera, Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
Dear all,
Thank you, SG, for forwarding this.
It is quite obvious that this lady anaesthetist is a disgruntled Sri Lankan (originally perhaps), with a chip on her shoulder and a ‘holier than thou’ attitude.
The webinar was designed for the involved countries to share their experience and was not formulated as a portal to minutely dissect with hair-splitting precision the logistics, qualifications etc of the people who are in the frontline. The panel dealt with the absolute essentials of the Sri Lankan experience. All the therapeutic measures that the writer has mentioned are not all that well proven scientifically.
I wonder whether even the Aussie Government has the answers to any of her vitriolic accusations if they were applied to that country. It was painful to see the attempts made to portray some of the panelists as a set of almighty fools.
Interestingly, the original sender M. Roberts has deleted her e-mail address. If the contact details were available, we could have invited her to the next webinar and proceed to take her apart to see what makes her tick!!!!!!! With a bit of effort, her credentials are given as follows:-
Location Brisbane, Queensland, Australia.
Education Bachelor of Medicine @ visaka vidyalaya mahamaya college medical school
I wonder what this Medical School is?
Anyhow, we need not bother about such nincompoops. The document does not even deserve any action on our part. The very many complimentary communications that we have received are evidence enough of the quality of the webinar.
We just need to completely and disdainfully disregard these misguided brickbat slingers and just carry on.
Best regards.
Dr. BJC 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.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
Founder Chairman, Sri Lanka Forum of Medical Editors 2016
Past President, Colombo Medical School Alumni Association (CoMSAA) – 2015
Past President, Sri Lanka Medical Association (2013).
Founder President, Sri Lanka College of Paediatricians (1996-97)
IV = An Email Note from Pauline Gunewardene, President, Ceylon Society of Sydney, 7 May 2020
Strange article Michael, considering SL actually is a success story by any count on controlling the spread of the virus and fatalities from it – 9 [deaths] so far. I think only Israel has done better – and they too have used their tri forces in the drive to beat Covid19.
The doubling of infected cases, now at just 771, was only because of a spike in numbers as a result of 340 Navy personnel getting infected In the process of an operation to get an infected cluster in the Suduwella area under control with the added complication of keeping drug users in the area from trying to escape.
Perhaps the SL participants in the Webinar did not explain details adequately?
The attached link to an article by the reputed Indian reporter Nittin Gokhale gives an excellent analysis of the SL successful approach.
https://stratnewsglobal.com/combatting-covid-19-the-sri-lankan-approach/
Best regards, Pauline
************
ALSO SEE =
“Sri Lanka’s military is playing many roles in the COVID-19 battle from contact-tracing to running quarantine centres” = https://www.thehindu.com/news/international/covid-19-sri-lankan-military-is-helping-the-country-fight-the-pandemic/article31350778.ece
END NOTES
[1] I received a copy of this viewpoint via Email. I have sent emails out seeking bio-data on Chandini Liyanagamage.
[2] I have not had access to this webinar discussion myself.
[3] Highlighted emphasis in the Memoranda that follow are the insertions/impositions of The Editor, Thuppahi.
Excellent responses by both Gerald Peiris and Dr, B.J.C. Perera
thanks, Mike, for working on this commentary by Chandini Liyanagama of Australia. Liyanagama’s commentary certainly deserves disambiguation. Being familiar with the work of both Peiris and Perera, I have confidence in their remarks – especailly that of Dr. Perera as a very senior medical specialist, health administrator and someone in professional leadership.
Nevertheless, I must remark that Liyanagama’s core critique does ring a familiar bell to me, a veteran journalist who has reported both locally as well as for foreign media outlets since 1978. The ‘bell’ that rings familiar is Liyanagama’s claim that the Sri Lankan panel in the Webinar did their best “…to impress the world saying SL is doing very well compared to rest of the world. “They are the only country doing things which rest of the world is not doing very well” …”. As someone who has time and again listened to various Sri Lankans both professionals of various kinds and also politicians and activists doing exactly that, or similar, I have to say that I would not be surprised to hear the same at that Webinar. I have no idea as to who was in the Sri Lankan panel so I cannot judge. Sadly there ARE professionals who, for a variety of reasons, would try such a thing: it could be because they are stooges of somebody, or they are inspired by a narrow (bizarre) patriotism/nationalism.
As regards the accuracy of how “well” sri Lanka is doing vis-s-vis COVID-19, I am happy to give a general accolade to all the medical professionals concerned as well as to the Health administrators and the police and armed forces. I believe that our medical professionals cohort is among the best in the world, given the context they must operate in. I served four years on the Ethics Committee of the SLMA and saw their calibre. Any failures on the pandemic front that I see are related purely to the huge lack of resources and the seeming inefficiency of the political leadership in ensuring that those resources are quickly and adequately procured and also deployed in the correct way. One serious failure is in the proactive (as opposed to just reactive) testing of the population. The other is the accuracy of the fatality count – the current figure is suspiciously low.
Pauline Gunawardena’s mediatory query may help explain the Webinar outcome:- “Perhaps the SL participants in the Webinar did not explain details adequately?”
mike