|
|
Men & Matters
Opposition demands for fresh polls
By KautilyaWhen I spotted the news item, a report of a speech made by the Opposition Leader, Ranil Wickremasinghe in some remote N.W.P. small town, I ragged the greenest of greenhorns in the club. Starting quite early, isn’t he, your skipper? "So what’s wrong?" he shot back. Come on, its a sitter for the SLFP/PA isn’t it? That’s what everybody says.... what’s the buzz word? Consensus...consensus that’s it... picked it up from a Colombo campus don at the Oriental Club. Come on, how about a small bet.... round of drinks, okay?
"Well, you and your paper pundits know everything..." he snorted and left our group... Rude chappie, really, PHD or no PHD.
But I was wrong from the start, evidently. Certainly the Bishop of Chilaw was on the ball. Wayamba people demand as a right, fresh polls, went the headline and just below another item headlined NWP violence should be unequivocally condemned...MEP, no supporter of the Vatican, not from the start, I mean Don Philipo. Phillip Gunawardena, the father of Dinesh and Indika, and founding father of the local Marxist movement.
Finally, a front page "lead" Ranil wants future polls on same day.
Quite a reasonable request, surely Professor G.L.... an eminently fair-minded scholar fallen among politicos.
Fair and foul, keep the main Opposition party... in the opposition. Is that the game-plan. Mind you Junius the Genius did just that with a referendum, remember? It is the fairest way to test public opinion, the Romans taught us, he told me in his study at Braemar, his Ward Place home. I really didn’t know... I wasn’t around to work with Junius Caesar, I said. "Julius... Julius Caesar..... I thought you went to Royal College... a strong hint that the interview was over and it was time for me to get back to the pub.
So what’s the JVP up to these days? Playing it straight — at least one wing!
Ethnic Warfare
Here’s a piece of news for everybody who plays "war games" seriously.... the brass, and politicians of the calibre of Deputy Defence Minister, Anuruddha Ratwatte. Advances in genetic engineering could make it possible for weapons targeted at specific ethnic groups to be developed within ten years. Who says this? Which crackpot claims this? 1st accused, I am afraid is the BMA. If at all, the boffins in the British Medical Association. So says a study published a few weeks ago, the British government has of course expressed its concern, the diplomats most of all.The UK and the European Union have decided to raise the matter at the ongoing disarmament talks in Geneva. They hope to argue strongly for a "verification protocol". If accepted the protocol will be added to the 1972 convention. The latter, says David Buchan, reporting from Geneva is the only disarmament treaty to have no monitoring or enforcement provisions. Already genetic information is being used to ‘improve’ biological weapons by increasing their antibiotic resistance.
Allah be praised. I am a chronic amoebiosis case — from the Royal College boarding house in "Glendale" Bandarawela. Motto? Disce Aut Discede.... Learn or Depart.... Or, in the language that some of Shakespeare’s characters did not use.... CRAM OR SCRAM.
Setting Standards in Medical Practice
The Role of the Consultant Physician
Presidential Address of Dr. Jagath Wijesekera to the College of PhysiciansAll those who are responsible for providing a satisfactory health service in this country, have one common objective and that is, to provide a better service to our patients. Many individuals are involved in achieving this objective. The authorities i.e the officials of the Ministry of Health are mainly involved in laying down the rules and objectives.
Then there are those who are actually responsible for providing this service.
They are the
- Consultants
- Junior doctors
- Nursing staff
- Paramedical personnel
Today in this induction address, which I have titled ‘Setting Standards In Medical Practice - The Role Of The Consultant Physician’ I will be, as the President of the Ceylon College of Physicians, looking at the role the Consultant Physician has to play to achieve this ultimate goal - providing a better service to our patients.
During this address I would like to highlight some of the problems that physicians face and suggest recommendations to improve existing services.
Consultant Physicians working for the Ministry of Health face many problems and stresses. As a result many feel that their ability to provide good standards for their patients is being compromised.
In the past few years, consultant physicians have come under considerable stress as a result of changes in their workload, coupled with lack of resources and rising public expectations. A large increase in hospital admissions without a parallel increase in the available beds and back-up service accompanied by an increasing awareness and expectations by the public who now demand constant consultant involvement in their care, have led to this situation. The relatively small increase in the number of consultant appointments has certainly been insufficient to enable them to cope with these increasing pressures. This factor is compounded by the additional demands for consultants to participate in undergraduate and postgraduate teaching programs, continuing medical education and training of junior doctors.
The ability of the health services of this country to provide good standards of medical care for its patients has always depended upon the dedicated hard work of the professional working in it. Consultant physicians for their part have not stinted in the time and effort they have given to provide the highest possible standards for their patients. However, the ever increasing multiple pressures on Consultant Physicians pose a threat to these high standards achieved so far and could well reduce the quality of care.
Sri Lanka is seriously under doctored, a fact further aggravating the major difficulties in providing a safe medical service. In this address I would like to warn that if working conditions are unsatisfactory for physicians then the standards of care is likely to fall. There is a perception among many Consultant Physicians that standards are already falling.
I sent out a questionnaire to consultant physicians working in general hospitals (Teaching & Teaching) and base hospitals to gather their views on the subject of medical care and workload. The Questionnaire consisted of 7 questions. They were:
l. What is the average number of patients seen on a ward round?
2. Is it possible to see all patients in the ward everyday?
3. Average number of patients per clinic?
4. Is there enough time for teaching and training?
5. Is there enough time for reading journals and books?
6. Do you think the standard of care is rising or falling?
7. Do you still like the work you do but feel there is too much of it?
RESULTS
A summary of the results to questions 4 - 7 is given belowQ. Is there enough time for teaching and training? Responses:
No - 68%
Yes - 32%
Q. Is there enough time to read journals and books? Responses:
No - 88%
Yes- 12%
Q. Is the standard of care rising or falling?
Responses:
Falling - 48%
Rising - 32%
Static - 16%
Don’t know - 4%
Q. Do you like the work but think there is too much of it?
Responses:
Too much - 80%
Not too much - 16%
Don’t know - 4%
The results of this survey thus showed that the consensus among the Consultant Physicians in this country was that Physicians in general were burdened with a work load which was well in excess of the optimal. In their response it was also evident that a majority of Physicians felt that more emphasis should be laid on team effort and that methods of distributing this work load should be found.
THE PRINCIPLE REASONS FOR INCREASED STRESS AND PRESSURES ON CONSULTANT PHYSICIANS
There are many reasons for the increased stress and pressures on the work of the consultant physicians at the present time. Principle among these is the expanding workload, but other factors are also salient.PUBLIC EXPECTATIONS
The public expects standards in medicine to be high and understandably complain when they are judged not to be so.On the one hand, patients and their families demand higher standards at existing costs, which is inadequate to meet these demands. On the other hand, there is pressure from the government to reduce costs as far as possible.
There is also a perception that every misadventure must be ‘someone’s fault’ and this has led to an increase not only in complaints but also in the pursuit of medico-legal actions, thus adding still further to the pressures on the consultant.
BED NUMBERS
There has been no increase in bed strength to keep pace with increase in admissions especially in the number of beds available for acute medicine.In most medical wards of General and Base Hospitals there are at times an equal number of ‘floor patients’ as there are patients occupying beds. The physician in charge has a difficult job of trying to decide
(a) which patient is well enough to give up his bed to a more critically ill patients
(b) is this patient well enough to be actually treated on the floor
One has to have total disregard as to the comforts of a sick individual and the physician has to compromise on adequate and proper investigations, as, his priority becomes, ‘clearing’ the ward to make room for new admissions.
JUNIOR DOCTORS
Most physicians working in General and Base hospitals have only two post intern housemen manning their wards with no Senior House Officers or Registrars, the situation being marginally better in the Teaching Hospitals. On the other hand, when one considers the Intern House Officers, disruption of the undergraduate medical programme in the universities over the past years has resulted in an increase in the number of intern medical officers being crowded into a single unit. Before this disruption of university education, interns were regularly posted into units and there were not more than two to three interns per unit at any given time. This ensured a good training to these interns whereas now there are six to seven of them in most units, even in base hospitals, resulting in these doctors not obtaining an adequate training.NURSING STAFF
There is also a severe shortage of nursing staff in the state sector due to an inadequate number of nurses passing out each year from the training schools. This is compounded by the fact that a significant number of trained nurses are leaving the country to work abroad for higher salaries.AVAILABILITY OF LABORATORY AND RADIOLOGICAL SERVICES
In the majority of hospitals where consultant physicians work even the basic biochemical and homological investigations are at times difficult to obtain or is being rationed. Radiological facilities are limited and even a chest X-ray is sometimes not available.Even at the National Hospital, which is the final referral centre for medical care in Sri Lanka investigations are not freely available to the physician. For example at the Institute of Neurology the limited number of CT scan facilities have made it necessary for the Consultant Neurologists to actually decide which patient need CT scan investigation most and sometimes patients who actually, require CT scans cannot be scanned due to the limited quota available.
DECIDING PRIORITIES
There are ethical considerations relating to performing sophisticated and expensive investigations for some very ill and extremely elderly patients in situations where there is little hope of successful therapeutic outcome. Decision making in these circumstances is very stressful for the physician concerned and can take much time in discussion with patient’s relatives and other staff.As Consultant Neurophysician in charge of the intensive care at the Institute of Neurology I often have to face such situations especially since our is a six bedded unit and patients are referred to this unit from all parts of the country.
One has to decide on issues such as
- Which patient needs intensive care?
- How long can he stay in intensive care?
- At what point of his critical illness could he safely leave intensive care to make room for another patient who needs such facility?
- At what point does one withhold life support therapy for irreversible neurological disease? (such as severe encephalitis, cerebral haemorrhage, advanced motor neurone disease and muscular dystrophy in the terminal stages)
OTHER ETHICAL CONSIDERATIONS
The consultant physician has to decide on various other ethical issues. Among these are 1) The role of the patient and his relatives in decision makingThe autonomy of the patient in the central ethical principle in medical practice. Thus the wish of the patient is the main determinant of the physicians actions.
2) Ethical aspects of cost- benefit relationship
The general consensus is the prevention of futile treatment. Thus appropriate use of life sustaining therapies and ‘Do - Not - Resuscitate’ (DNR) decisions nave become important ethical issues. The discussions on foregoing therapy and DNR decisions are usually led primarily by the opinion of the patient or his relatives. However at times, these decisions have to be taken unilaterally by the consultant in the best interest of the patient.
3) Ethics in the Transportation of the critically ill
Studies indicate that necessary intensive care intervention should not be denied due to the fear of transport related complications. Therefore patients requiring intensive care should be sent to hospitals with the available facilities provided they are transported under optimal conditions.
The physician is also involved in important issues such as ethics in research, issues pertaining to brain death and ethics in organ procurement, which I believe, will become a major issue in this country in the near future with the introduction of the cadaveric organ transplant programme.
RECOMMENDATIONS
Having briefly outlined some of the problems and stresses Consultant Physicians have to face, now, I would like to discuss recommendations for the betterment of effective hospital practice, looking primarily from a Physicians perspective. These are:TEAM WORK
The Consultant can no longer work in isolation and now need to work in teams, often as the team leader. In many specialities teamwork has become the central feature for the provision of care to patients and it is incumbent on all physicians to adapt to this style of work. Any lingering prejudice regarding teamwork must be rejected.In this context I am pleased that we were able to start the first stroke unit in Sri Lanka at the Institute of Neurology in July this year. The success of this stroke unit depends on the team involved. This team includes the Consultant Neurologist (team leader), Consultant in Rheumatology & Rehabilitation, junior medical staff, nurses, Speech Pathologist, Physiotherapists and occupational therapists.
Consultants must collaborate with and understand the skills of the other professionals involved in the team. I am happy to say that we are already seeing some positive results where stroke care is concerned at our stroke unit, in the six months since it’s inception.
ADEQUATE CONSULTANT COVER
It is impossible for consultant to single handedly provide a 24 hour cover while working in acute medicine. This is also true for the finer medical specialties such as Cardiology, Neurology, etc where it is no longer acceptable for a consultant to work alone.I would like to emphasis that whenever new units are opened outside Colombo, especially in the finer specialties, at least two Consultants or one Consultant and a Resident in that speciality should be appointed, if one were to provide a satisfactory uninterrupted service.
MAN POWER
In Sri Lanka the figures for each speciality are as followsNB: The numbers in brackets indicate the number undergoing training at the moment.
These figures speak for themselves and need to be improved urgently. It is interesting to note that e.g: the recommended European guidelines is one Consultant per 80,000 population with at least two Consultant per speciality in a hospital.
Therefore our Consultant cadre requirements have to be reviewed and the relevant authorities namely the Ministry of Health and the Post Graduate Institute of Medicine will have to evaluate the ground situation and calculate a reasonable number of new posts that will be necessary to achieve the optimum ratio Consultant per population for both Acute medicine and the finer specialties for a developing country like ours. It is indeed encouraging to note that both the Health Ministry and Postgraduate Institute of Medicine have recognised the need for new specialties such as Nephrology, Endocrinology, Neuro Physiology and Cardiac Electro Physiology and that postgraduates are already being trained in some of these fields.
BASIC REQUIREMENTS WHEN OPENING NEW UNITS
When new units are opened both in acute medicine and the finer specialties, the Health Ministry should ensure that a reasonable number of beds, adequate staff and investigatory facilities are provided before Consultants are posted to these new units. It is regrettable to note, for instance in the past, Neurologists have been appointed to new units set up at General Hospitals at Kurunegala and Ratnapura without even an Electroencephalogram been provided to these units. Non availability of these basic facilities lead to frustration and disappointment in those young physicians who are posted to these newly opened units.ADEQUATE JUNIOR MEDICAL & NURSING STAFF
A Consultant Physician will need and optimum minimum number of junior medical officers and nursing staff in his unit, to provide a satisfactory service for his patients.AVAILABILITY AND ACCESS TO A FULL RANGE OF INVESTIGATIVE FACILITIES:
Basic investigatory facilities such as Haematology, Biochemistry and Radiology should be available and accessible in all institutions where Consultant Physicians work.
More specialized investigations such as Ultra sound, CT and MRI scanning and other imaging techniques should be available when appropriate.
The benefits of modern imaging technology are becoming apparent but it is clear that only hospitals of a certain size will be able to provide such equipment.
REFERRAL FOR A SECOND OPINION
There must be immediate access to other medical opinions particularly acute surgical opinion.SECRETARIAL SUPPORT
The Ministry of Health should address this as an urgent priority. The lack of secretarial support results in the poor coordination of the work of the Consultant Physicians. I would consider this as one of the major problems facing all Consultants, especially for those in the State sector.TIME FOR COMMUNICATION
Consultants must have adequate time to assess patients and to explain the diagnosis and treatment to them and their families. This has become increasingly difficult in the face of a heavy workload and often leads to a perception of lack of communication or ‘off handedness’ with a greater likelihood of complaint.AUDIT
Physicians should be encouraged to do regular audits of their own units. Audit involves the systematic critical analysis of the quality of medical care including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome.I would like to briefly mention an audit we did at the Institute of Neurology last year, the findings of which were presented at the last SLMA annual sessions. Stroke care in Sri Lanka has not been previously evaluated. We used an audit package designed by the Royal College of Physicians and the UK stroke audit group.
The study highlighted deficiencies in certain aspects of stroke care at our institute. Relative strengths and weaknesses have been identified, and based on these, intervention to improve care has been designed and implemented already.
In Sri Lanka at the moment, efficient audit is often severely impaired, if not impossible because of the non-availability of records and when available, the very poor quality of these. More adequate provision of record keeping and Information Technology is an urgent need in our hospitals.
CONTINUING MEDICAL EDUCATION
The requirements for Continuing Medical Education (CME) should be considered mandatory to allow the provision of an up-to-date clinically safe service. The Consultant is an employee of the ministry of health. Encouraging and finding the funds when possible for CME are a duty of the employer. The Post Graduate Institute of Medicine also, obviously, has a major role to play here.RESEARCH
Research is not a mandatory part of every Consultant’s life, but it is essential if medicine is to advance and it can enhance job satisfaction. Onerous work loads make research impracticable in busy non - Teaching Hospitals and, even in Teaching Hospitals, they are increasingly a hindrance. Whenever possible reasonable opportunity should be provided for research and adequate time and facilities should be made available.In Teaching Hospitals, good relations with the affiliated university is important to encourage collaboration with other scientists and help each party understand the working arrangements of the other. For example changes in the undergraduate curriculum and it’s consequences should be discussed by the University staff with Consultants of the Ministry of Health and a consensus arrived at, all stages of it’s implementation.
ROLE OF THE CEYLON COLLEGE OF PHYSICIANS IN ASSISTING CONSULTANTS
The prime role of the Ceylon College of Physicians which is an umbrella association of the Sri Lanka Medical Association, has always been to ensure high standards of care for patients. Judging the conduct of doctors, of course, is the responsibility of the Sri Lanka Medical Council.Physicians are encouraged to approach the College whenever they face difficulties at work. Such help has been sought in the past and will probably be sought increasingly in the future. A visit to a hospital by a team of physicians selected by the College, (Peer Reviewing) may be a helpful way to identify problems and suggest possible solutions. The implementation of these, would then be the responsibility of the local doctors. Such an approach, will typify the desire of the College to be supportive to Physicians in maintaining standards. It is my belief that the College should strive to implement such a programme in the near future.
CONCLUDING COMMENTS
Some of the thoughts I have shared with you this evening have been discussed at the council meetings of the Ceylon College of Physicians and some are in function already. It will be my endeavour to ensure that these ideals are further strengthened during my tenure of office. The provision of high quality medicine by Consultants is a dual responsibility. The Health Authorities must employ sufficient staff and provide appropriate facilities for the work of the Consultant and his team. The Consultants either individual or as a body in the hospital, must make firm and if necessary, vociferous requests for the staff and other facilities they need, adopt satisfactory working patterns and practices and educate themselves to monitor their own performance, and possibly, even partake to monitor the performance of colleagues.Considerable pressure from all of us will be necessary to bring working conditions into line, as discussed in this induction address. Success will help to safeguard the quality of care given to our patients. This in turn, will help set higher standards in medical practice. The Consultant Physicians and the College of Physicians, which is the official body of the Physicians in this country, have an important role to play to achieve this goal.
Lightning, Black-outs and accountability
By J. VarnakulasingheIsland wide black-outs are the least acceptable of the shortcomings of our electricity supply. One of the worst occurred on 1st May 1995. It started around 7 pm and lasted well into the next day in some areas.
Almost all such black-outs have been attributed to lightning. Commenting on the black-out of 11th December 1998 Dr Siyambalapitiya regrets that no inquiry, to ascertain details; is carried out after such events. He adds that the Universities do not carry out studies that will lead to fine tuned solutions of the shortcomings he sees in the supply industry, and then he raises the broad question of who is accountable.
This article examines certain aspects of the black-outs and of accountability, and suggests how matters might be improved.
Transmission lines are generally protected against lightning which is transitory, by the automatic interruption of supply. The circuit breakers that cut off supply are set to "open" fast, with a view to avoiding permanent damage to the line, and to "reclose" shortly thereafter to verify whether supply can be restored. If a breaker does stay closed all is well, but if it automatically reopens, it is set to reclose as before, and only if it opens yet again is supply permanently cut off. This process of opening and closing ensures that supply is not, and cannot be, restored to lines permanently damaged whilst lines not so damaged have their supply restored,.
The repair of permanent damage means time for location and identification of the fault, and time for repairs. As supply was restored in 2 hours on 11th December it is unlikely that any repair was called for or done.
As in the majority of black-outs supply is restored within hours, it does appear that black-outs are largely due to the mal-functioning of the single phase tripping arrangement adopted in the name of economy. It is imperative therefore to replace the single phase arrangement with a 3 phase one as black-outs entail heavy losses to the nation,. There is little doubt that such replacement can be done by local engineers at minimum cost.
Coping with Lightning
There is permanent damage being done to the insulators on lines here by lightning, and this can and needs to be minimized, if not eliminated. This country has a very high isokeraunic level - measured by the number of days in the year in which there is lightning. More importantly, on each such day there may be several electrical storms in each of which there may be several strikes, some of very high intensity - these important facets are not indicated by the isokeraunic level. Only Florida, Ecuador and one or two other places are said to have more frequent and intense lighting than we have - the frequency and intensity of lightning here is only now being measured.Transmission lines are designed (in theory) to cope with "direct strikes". But, in fact the higher the voltage of a line the better it does cope. Thus, lines need to be designed with great care, and when there is a choice, it is necessary to opt for the higher voltage.
Towards the end of the 1960s Dr Ikeda conducted a survey to ascertain the effects of lightning on the power system in this country. His Report indicated what Basic Insulation Levels the lines and substation equipment here should conform to.
How best Dr Ikeda’s recommendations may be used to redesign our lines and substations and ensure their safety, and better performance under the severe conditions of lightning was dealt with in two papers (1971 and 1974) presented by the writer at the Institution of Electrical Engineers (Local Centre) - the latter paper urged that early steps be taken to feed the 132 kV network through 400 kV lines which would be immune from lightning.
When the Mahaweli Hydro Complex was being designed around 1980 the CEB proposed to build 400 kV lines to transmit the energy from the Mahaweli power stations, but they were persuaded that 220 kV was adequate for Sri Lanka for 15 years - the person proffering advise was unconcerned that transmission lines needs must serve us for 50 years, and unaware of the reasons for the short lived use of the 275 kV in the UK. If we had built a 400 kV network to feed into our 132 kV system, black-outs would have been a very rare occurrence, indeed.
Today there is a wealth of information of how to ensure that transmission lines and substation equipment operate satisfactorily without getting damaged. We are yet to make meaningful use of this information, and until we do the quality of service provided by our transmission system will remain poor.
Accountability
As to who is accountable for the sorry state of the supply industry, there are many answers. Dr Siyambalapitiya’s position seems to be that the talented electrical engineers in the CEB have all been taught the essentials of transmission lines and have state of the art mathematical tools to provide us with a good transmission system, so why have they not? My own view is that all those who become engineers have more than an adequate knowledge of mathematics and that the vast majority of them have talent, but what they have been taught about transmission lines is nowhere near adequate for the task, and that state of the art mathematical tools are no substitute for years of meaningful experience in the fields of design and construction of transmission lines. If the talented engineers of the CEB had been provided the opportunity to acquire adequate knowledge and meaningful experience, they could and would, I am sure, have long since given us a good transmission system. For fifty years this country has been importing consultants to do transmission lines, obviously with little effect in advancing the capability of local engineers.The CEB Act places the responsibility, for providing a proper supply to the nation, collectively on the Members of the CEB Board. The fact though is that over the last two decades and more, that responsibility has, by administrative fiat been taken over by the ministry, by special committees and in certain matters by the Cabinet itself. So now it would seem many are responsible for the sorry state of the industry, but no single body of persons can be held accountable.
If a specific body of persons is to be made accountable for the electricity supply industry - there is no doubt that needs to be done in the interests of economic development - all the responsibilities of, and the powers exercised by the Board and the various committees need to be transferred to that body. If that body is not to end up in the same way as the Board, that body needs to be a Commission appointed by and responsible to Parliament.
The shortcomings of the supply industry that consumers complain of such as black-outs, burn-outs, low voltage, high voltage, interruptions, etc are the result of technological shortcomings and they add to the cost of supply. Thus the Commission must be so composed as to have a technological bias, yet be able to look carefully into the economic consequences of its activities.
Both major political parties in this country have been responsible for ferreting away the statutory powers of the CEB Board and making it ineffective. Moreover, they and all the other parties are committed to providing electricity to everyone, so electricity is no longer a significant political issue.
May one hope therefore, that collectively they will find within themselves the courage to give this nation a body of competent persons, vested with the necessary powers and solely accountable for providing us a proper supply of electricity at a minimum cost.
The writer is a Chartered Engineer. His wide experience includes a decade in the design and construction of transmission lines at 400 kV, 275 kV and 132 kV in the UK, on contracts for the Central Electricity Generating Board.
Tamil separatism and the "Thimpu Principles"
Kamalika PierisAt the Thimpu talks held in Bhutan in 1985, the Tamil delegation consisting of TULF, LTTE, PLOTE, EROS, and EPRLF issued the following statement:
"It is our considered view that any meaningful solution to the Tamil national question must be based on the following four cardinal principles:
1. Recognition of the Tamils of Sri Lanka as a nation.
2. Recognition of the existence of an identified homeland for Tamils in Sri Lanka.
3. Recognition of the right of self-determination of the Tamil nations.
4. Recognition of the right to citizenship and the fundamental rights of the Tamils who look upon the island as their country."
Let us examine each of these four assertions.
"Tamils of Sri Lanka are a Nation"
The concept of ‘nation’ used by the Tamil separatist movement is borrowed from the west. In the west the word ‘nation’ initially was used to form the sovereign states of Europe as we know them today. But the word is also used today by ethnic groups within these sovereign states, in their demands for autonomy, self rule, and secession. Anthony D. Smith dates this eruption of ethnic conflicts, and assertions of ‘Nationhood’ to the 1950s. (Smith P 20.) Smith declares "Nowhere has the ethnic revival occasioned more surprise than in its European heartlands, and nowhere has there been such a proliferation of ethnic movements in the last two decades." He gives the following incomplete list of European communities who seek autonomy: Scots, Welsh, Breton, Corsican, Basque, Catalan, Flemish, Ulster, Tyrolese, Croat, Slovak, Greek, Cypriot, Maltese, Quebecois, Jurassien, Galicians, Andalusian, Cornish, Manx, Faroese, Shetlanders, Channel Islanders, Frisians, Gelderlanders, Walloons, Sardinians, Sicilians, Slovenes, Alsations, Occitanians, Bavarians, Lithuanians, Czechs, Poles, Bulgarians, Armenians. (Anthony. D. Smith. "The Ethnic Revival" 1981, p 13,69, 163) I have given this long list to indicate the extent of the phenomenon in Europe.
The vast contemporary literature on ethnic movement in Europe is due essentially to the importance of such movements in Europe. Think of the Arab-Israeli conflict, the mess in Bosnia-Serbia-Yugoslavia-Kosovo. Certain academics have selected the ethnic movements as their field of specialisation, and have provided various theories about them. Writers such as Kedourie, Gellner, Connor and A. D. Smith belong to this category. Their explanation as to ethnic movements in Europe are based on the weaknesses of the industrial society, and the centralised political state. These analyses are not relevant to Sri Lanka.
However, their analysis of the various strategies used by these ethnic movements, is extremely relevant. I will indicate why later. These writers have attempted to outline the various strategies used by the European ethnic groups to obtain power. They point out that modern ethnic nationalisms have had to ground their aspirations in arguments appealing to general principles like popular sovereignty, inalienable rights and cultural diversity. (Smith p xiii) They refer to the utilisation of ‘culture markers’ particularly language. Smith says "One of nationalisms abiding myths is the identification of nationality with language." He traces this myth to the 18 century notions of the emotional power of language developed in France and Germany. (Smith p 45) Smith further points out that in most cases, the notion of ethnic identity was created by the intellectuals of that ethnic group. The masses generally did not generate ethnic movements. The intellectuals did. (Smith p 68) Smith further observes that ethnic communities usually ‘possess’ a recognised territory, with which they are habitually associated. Ethnic groups also often display a jealous and deep rooted attachment to particular areas or regions within one or more plural states. "A nation without its homeland is almost unthinkable’. (Smith p 63)
All this will sound very familiar to Sri Lanka public, who have listened to these arguments by the Tamil separatist movement, over and over again. It will be apparent now that the Tamil separatist movement has borrowed all of its assertions from the European cases. The ideology of the Tamil separatist movement is totally devoid of any original ideas. They simply use the European arguments, and their terminology. Virtually all the words and phrases used come from the west. This includes statements as to the ‘right to be different’, the need to express" identity." These European movements, are defined by Anthony, D. Smith as ‘social groups whose members share a sense of common origin, claim a common and distinctive history and destiny, possess one or more distinctive characteristics, and feel a sense of collective uniqueness and solidarity" (Smith p 66) The Tamil separatist assertions are built around these variables.
This concept of ‘nation’ is relatively new in Europe. Not more than 200 years old. On the other hand, a different concept of ‘nation’ in terms of an independent, sovereign state, has been in existence for centuries in Asia. Asia developed centralised, monarchical states very early on, approximately around 4. B.C. Sri Lanka was recognised as one such sovereign, independent state from very early on. It sent an embassy to Rome. Other Asian countries, such as China, Burma, India recognised the monarch in Sri Lanka.
After the South Indian invasions of the 10th to 13 century, Sri Lanka again emerged as a ‘nation’. The area under the actual control of the consecrated king got smaller and smaller, and half a dozen people were ruling at the same time, in different parts of the island, but the concept of a single consecrated king yet remained. Buvanekabahu I (1272-84) once sent a message to the Sultan of Egypt, offering to trade with pearls, elephants etc. He stated that the pearl fishery in Mannar was his, when in fact the Arya Chakravarti king of Jaffna had got hold of the fisheries at the time. (Gunasinghe. "The political history of YapahuwaÉ" p 76-77) The Portuguese got the Kotte king consecrated in Protugal, but did not do the same for the king in Jaffna. Portugal, Netherlands, and Britain were obliged to recognise the Sri Lanka king, though he was usually holed up in segment of the island.
The Tamils of Sri Lanka were not a ‘nation’ in the Asian sense of a political state. The Kingdom of Jaffna was too small, too shortlived, and too weak to sustain such an idea. Also the western concept of Tamils as a ‘nation’ clashes with the Asian concept of Sri Lanka as a ‘nation’. It is not possible to have a ‘nation’ within another ‘nation’.
Now let us return to the European concept of ‘nation’. E. J. Hobsbaum has taken a critical and mildly sarcastic look at the concept as it functioned in Europe, in his book "Nations and nationalism since 1780" (1990). He points out that the word ‘nation’ belongs to one period of European history. Its use in the modern political sense is quite new. (p 18) Initially it was held that self determination could only apply to viable units, and that a nation should be of a certain optimum size, so that it could enjoy the economic benefits of a large state. This was known as the ‘threshold principle’. (p 31) Nation building was seen as a process of expansion, not contraction into divisive small units. (P 33) Initially, the ‘nation states’ of Europe, such as Britain, France, and Spain were heterogeneous. They were multilingual, multiethnic because in Europe, the people were utterly mixed and it was impossible to unscramble them. This was due to various invasions of tribes from Scandinavia and West Asia in medieval times. Thus Mazzini remarked, after the Unification of Italy, "We have made Italy, now we must make Italians". Pilsudski, the Polish leader, said that it is the state which makes the nation, not the other way round. (p 44) And during this time, around 1870, many small communal groups sought assimilation into the ‘nation state’ (p 93)
Hobsbaum looks at the definition of a ‘nation’. He points out that the word is today used so widely and imprecisely that a definition is difficult. He says The objective definitions have failed, since they do not include all cases. The subjective definitions are worse. Therefore it is not clear as to how we distinguish a ‘nation’. Criteria given are usually common language, common territory, common history, common culture. Hobsbaum states that the best known of all the available definitions is perhaps that of Stalin, written in 1912. ‘A nation is a historically evolved, stable, community of language, territory, economic life, and psychological make up manifested in a community of culture’ (p 5) Hobsbaum points out that the criteria used, such as language, ethnicity etc. are themselves fuzzy, shifting and ambiguous, and useless for the purpose. (P 6)
In Europe, national movements were first of all simply cultural, literary, folkloristic. Then they turned into a political campaign, and thereafter into a mass movement. In the process the word ‘nation’ was used in all sorts of different ways, one of which was to equate it with the democratic ideals of the American and French nation specially after the French Revolution expounded its principles in 1789.
The words ‘National question’ came up with the break up of the Austro-Hungary Empire and the Ottoman Empire, prior to 1914. Further, a practice of having a National censes at state level National was begun after 1853. It was decided to include questions on an individual’s nationality, language, and race in this National Census, thus further emphasising these variables. (P 101)
Colonial movements picked up the language of European nationalism. "The leaders and ideologies of colonial and semi-colonial liberation movements sincerely spoke the language of European nationalism, which they had so often learned from the west, even when it did not suit their situation. And as the radicalism of the Russian Revolution took over from that of the French Revolution as the main ideology of global emancipation, the right to self-determination, now embodied in Stalin’s texts, reached those who had been beyond the range of Mazzini. Liberation in the Third World was now seen everywhere as ‘national liberation’ or among the Marxists, ‘national and social liberation’." (136)
The post colonial ‘nation state’ is a very central and powerful factor in its peoples lives. Hobsbaum says Ethnic and language communities, that is; cultural groups, are resentful of the homogenised, standardised tendencies of the centralised state, with its emphasis on macro-economic planning. Hobsbaum concludes his review of nations and nationalisms by pointing out that in the late 20th century, the concept of nations has been over taken by the idea of regions, and supra national groupings like the European Community. (p 182)
It will be clear now, that the Tamil separatist idea of a ‘nation’ is heavily based on the European one. It has borrowed arguments such as the centralised state, central economic planning in its current propaganda. In fact every phrase uttered by the Tamil separatist movement can be found in the western texts.
They have read them carefully, and borrowed heavily.
E. J. Hobsbaum’s book ‘Nations and Nationalism since 1780" has benefited from discussion with other scholars. Hobsbaum specially singles out Kumari Jayewardene and the other South Asian Scholars at the World Institute for Development Economy in Helsinki. (WIDER). (pvii) His reference for the
Sinhala-Tamil conflict in Sri Lanka are: Kumari Jayewardene’s "Ethnic and class conflicts in Sri Lanka", Uyangoda’s" Reinterpreting Tamil and Sinhala nationalism", R. N. Kearney’s ‘Ethnic conflict and Tamil separatist movement in Sri Lanka", Sunil Bastian’s "University admissions" and Charles Abeysekera’s "Ethnic representation in the state services’ both published in the book "Ethnicity and Social Change in Sri Lanka" issued by Social Scientists Association. (P 153, 158)
Despite this Hobsbaum is not taken in by the utterances of the Tamil separatist movement. Here is his assessment of the situation in Sri Lanka: (p6) he quotes from an ITAK document,
"The Tamil-speaking people in Ceylon constitute a nation district from that of the Singalese by every fundamental test of nationhood, firstly that of a separate historical past in the island at least as ancient and as glorious as that of the Singalese [sic], secondly by the fact of their being a linguistic entity entirely different from that of the Sinhalese, with an unsurpassed classical heritage and a modern development of language which makes Tamil fully adequate for all present-day needs and finally by reason of their territorial habitation of definite areas".
The purpose of this passage is clear: it is to demand autonomy or independence for an area described es ‘over one third of the island’ of Sri Lanka, on grounds of Tamil nationalism. Nothing else about it is as it seems. It obscures the fact that the territorial habitation consists of two geographically separate areas inhabited by Tamil speakers of different origins (indigenous and recent Indian immigrant labour respectively); that the area of continuous Tamil settlement is also, in certain zones, inhabited by anything up to a third of Sinhalese and anything up to 4I% of Tamil speakers who refused to consider themselves national Tamils and prefer identif cation as Muslims (the ‘Moors’). In fact, even leaving aside the central region of immigrants, it is not at all clear that the territory of major continuous Tamil settlement, comprising as it does areas of solid Tamil settlement (from 71 to 95% - Batticaloa, Mullaitivu, Jaffna) and areas where self-identified Tamils form 20 or 33% (Ampara, Trincomalee) should be described, except in purely cartographic terms, as a single space. In fact, in the negotiations which led to the end of the Sri Lankan civil war in 1987, the decision to do so was a straightforward political concession to the demands of the Tamil nationalists. As we have already seen the ‘linguistic entity’ conceals the unquestionable fact that indigenous Tamils, immigrant Indians and Moors are - so far - a homogeneous population in no other than the philological sense, and, as we shall see, probably not even in this sense. As for the ‘separate historical past’, the phrase is almost certainly anachronistic, question-begging or so vague as to be meaningless. It may, of course, be objected that patently propagandist manifestos should not be scrutinized as though they were contributions to the social sciences, but the point is that almost any classification of some community as a ‘nation’ on the grounds of such purportedly objective criteria would be open to similar objections; unless the fact that it was a ‘nation’ could be established on other grounds.
2. TAMIL HOMELAND. This brings us to the second of the Thimpu principles - recognition of the existence of an identified homeland. This ‘homeland’ concept is taken from the European ethnic movements. ‘Foxwatch’ points out that the Tamils who lobbied Britain during the independence discussions in the 1940s said nothing about a Tamil homeland. If indeed there had been a natural homeland, it would have emerged during the Soulbury Commission investigations in 1944. The homeland argument was not made, simply because the ‘homeland’ argument had not yet come into existence. (Island 4.10.98 p9) K. M. de Silva has conclusively demonstrated that the notion of a Tamil homeland is a myth, a deliberately concocted myth. Sri Lanka Tamils have no extensive territory over which they ruled. There are just three pockets of Tamil settlements, Jaffna, Batticaloa and Colombo, with about half of the Tamil population living scattered in the rest of the country. The Jaffna settlements only arose in the 13th century, those of Batticaloa have been dated 16th to 18 century, while the Colombo settlements is in the 20th century. Further, the Thimpu principle’s do not specifically state where this identified homeland is. There have been continuous migration of South Indians over the centuries. They came from present day Kerala, Tamilnadu and Andhra Pradesh, the three Indian states closest to Sri Lanka. They came as soldiers traders, invaders, plunderers, and as peaceful immigrants. None of these categories, except the invaders, could lead to a ‘homeland’. The rest integration and assimilation into the Sri Lankan community. Further, the Sri Lankan Tamil are just one of several minorities, together with the Burghers, Moors, Malays, ‘Colombo Chetty’, Barathas, Chinese., SELF DETERMINATION. The term ‘self determination’ was popularised by Woodrow Wilson, President of the USA from 1913-1921 and head of the League of Nations. The League of Nations was in existence from 1919 - 1946 and was the basis for the later United Nations Organisation. The idea of ‘self determination ‘was first expounded in the League of Nations, and was taken up by the UN. It is included in the UN Declaration of Human Rights, which says that all peoples are entitled to self determination. Therefore the key question was who are the ‘people’. The UN subsequently was obliged to provide a definition. It defined the ‘people entitled to ‘self determination’ were those living under colonial rule. People in sovereign states which were democratically ruled, were not entitled to further ‘self determination’. This decision was taken in two General Assembly rulings. These are: "UN General Assembly Declaration on the Granting of Independence to Colonial countries and People’s (1960) and the UN General Assembly Declaration of Principles of International Law concerning Friendly relations among States" (1970). These declarations affirmed the territorial unity of sovereign states. The ‘self determination’ principle should not be interpreted in such a manner as to dismember the territory or political unity of sovereign states, which were conducting themselves in compliance with the principle of equal rights, and had a government which represented the whole people with no distinction as to race, creed or colour.
Patrick Thornberry, examining the position for the London based Minority Rights Group, concluded that ‘self determination is not a right of minorities’. Minorities could share in self determination only with the rest of the population. Thornberry next argues that the term ‘peoples’ as defined by the UN can therefore apply only to the majority within the state. ‘There is little in this definition for minorities’. Thornberry’s last observation could be contested. The collective exercise of ‘self determination’ of a whole population cannot be interpreted as the exclusive right of a ‘majority’. He does not define ‘majority’. The majority here would be a simple numerical majority of votes, which could be composed of the votes of all ethnic groups. (P. Thornberry. "Minorities and Human Rights Law’ 1991. p9-10)
The United Nations has examined the position as regard the ‘self determination’ of minorities recently. The Sub-Commission on Prevention, Discrimination, and Protection of Minorities, requested a special report on the matter by Asbjorn Eide. This report titled "Protection of Minorities’, dated 10.8.93. Document No. E/CN.4 Sub.2/1993/34 Eide examines the position of minorities in sovereign states, with democratically elected governments.
Eide begins by announcing that ‘when a minority group lives compactly together in part of the territory of a sovereign state, its representatives sometimes claim that the group constitutes a people, or nation and on that basis is entitled to self-determination.’Eide examines their relevant UN discussions, and conclude that the word ‘people’ as used in the UN declaration means the ‘permanent, resident population of the territory, not the separate ethnic or religious groups, whether dominant or not in that territory’ (p17) Eide points out that over the years, interested parties gave exaggerated and misconceived interpretations to the right of self determination. He emphasises that this announcement of the right of self determination has led to acts of violence and aggression, based on vague and elusive interpretations of this right. Eide suggests that the statement issued last of all, by Vienna Declaration of 1993 could be considered conclusive.
Vienna Declaration and Programme of Action, 1993, stated as follows in section 1.2:
"In accordance with the 1970 Declaration on Principles of International Law Concerning Friendly Relations and Cooperation Among States in Accordance with the Charter of the United Nations, this shall not be construed as authorizing or encouraging any action which would dismember or impair, totally or in part, the territorial integrity or political unity of sovereign and independent States conducting themselves in compliance with the principle of equal rights and self-determination of peoples and thus possessed of a Government representing the whole people belonging to the territory without distinction of any kind"
Eide points out that the Vienna Declaration confirms the UN position given in 1966 and 1970. The UN is firm on its stand that it will not advocate the dismemberment of sovereign states which are member states of the UN. Eide makes the following observation regards the Vienna Declaration. The sovereign state should possess a government which represents the people in the territory without distinction of any kind.
If members of a group living either compactly together in an administrative unit of the State or dispersed within the territory of a sovereign State claim that the State is not possessed of a Government representing the whole people without distinction, this claim can be examined at the international level, either by the Committee on the Elimination of Racial Discrimination (CERD) in connection with its examination of the State’s report, since discrimination in political rights on ethnic grounds is covered by the Convention on the Elimination of Racial Discrimination, article 5, or by the Human Rights Committee. If the State is a member of the Council of Europe, it could also be addressed under article 14 of the European Convention on Human Rights in conjunction with Protocol 1. In such cases, the remedy will have to be that the discrimination is brought to an end and that the Government is made truly representative, by allowing for participation in the political process on a basis of equality of all members of the group.
"Only if the representatives of the group concerned can prove, beyond reasonable doubt, that there is no prospect within the foreseeable future that the Government will become representative of the whole people, can it be entitled to demand and to receive support for a quest for independence. If it can be shown that the majority is pursuing a policy of genocide against the group, this must be seen as very strong support for the claim of independence. The mere fact of there being ethnic violence between the majority and minority does not prove that there is an intent to destroy the group as such, in whole or in part. Even if there was, it would still have to be shown that the majority side was more responsible than the minority for the acts of violence taking place. Unfortunately, when violence has reached such levels, there is at present no machinery at the international level to which the aggrieved party can turn for an impartial finding.
" Special problems arise when a part of the settled residents of the country having an ethnic, linguistic or religious identity different from that of the majority is denied citizenship. This effectively blocks that group from participating in the political processes and could be a strong indicator that the Government is not representative of the whole people. In this situation also however, the primary effort should be to ensure that they obtain citizenship, rather than secession.
New States can of course still emerge through the peaceful and consensual subdivision of existing sovereign States. Borders can also be changed by agreement between the parties, obtained without duress. There is, however, no unilateral right under international law for groups to obtain such subdivision or border changes except under the conditions mentioned above. Changes arising from peaceful negotiations, free of acts of aggression or external intervention, are obviously in conformity with international law.
"The United Nations has not closed its door. Yet if every ethnic, religious or linguistic group claimed statehood, there would be no limit to fragmentation, and peace. Security and economic well-being for all would become ever more difficult to achieve ... . The sovereignty, territorial integrity and independence of States within the established international
system, and the principle of self-determination for peoples, both of great value and importance, must not be permitted to work against each other in the period ahead. Respect for democratic principles at all levels of social existence is crucial: in communities, within States and within the community of States. Our constant duty should be to maintain the integrity of each while finding a balanced design for all.’’
Eide also discusses the possibility of ‘internal self determination". It is possible that groups living within sovereign states do have a right self-determination short of secession. Eide argues that this is limited to the right to vote. Eide points out that there is no firm indication that groups have a right to local self government or autonomy within the state, on the basis of the right of self determination. He suggests that this may be possible in the case of groups with historical record of self rule, such as pre-existing autonomy within union republics of dissolved federal states. (p19)
(4. Citizenship rights of Tamils) The fourth principle in the Thimpu declaration contradicts the first three statements! If the Tamils are a separate nation, with a separate homeland, and are entitled to self-determination, then why ask to be treated also as citizens of the larger unit of Sri Lanka. In this last item we are told that the Tamil ‘nation’ also look upon the island as their country, according to the homeland clause they don’t. This is of course, the usual careless writing one associates with the Tamils separatist movements. What it means is that while some Tamil, have a homeland, others can however opt to be citizens of the larger unit of Sri Lanka. They probably mean the Estate Tamils.
It is now clear that the four principles of the Thimpu declaration can be easily dismissed. Therefore, in 1998, USA branch of the LTTE was considering a reworded and modified "Thimpu proposal". Prepared in 1996 by Rohan Edirisinghe and Kumar Ponnambalam. This was also discussed at a seminar held in Colombo at the Centre for Policy Alternatives. Edirisinghe pointed out that while the UN was not agreeable to supporting secession, the concept of ‘self-determination’ had been expanded to include devolution, autonomy and minority rights. The modified Thimpu proposals are these:
"1. The Tamil community constitutes a people with a distinct language, culture, tradition and identity. The constitution should recognise the above in order to ensure that the Tamil people live with dignity and self-respect.
2. The Tamil people have for centuries lived in certain areas and constitute a majority population in these areas.
3. There must be substantial devolution of powers in these areas, which is constitutionally guaranteed and secured. The people must have the right to determine their own affairs.
4. There must be complete equality particularly in the areas of race, religion and language. (Sunday Times, 18.1.98 p6)
This ‘revised Thimpu’ is much weaker than the original Thimpu, and is more a plea than a demand.
(Concluded)
