by Carlo Fonseka Courtesy Island

When word came from Singapore on the 8th of November that Venerable Sobitha was dead my emotions overwhelmed my reason. To admit this is not necessarily to embrace unreason. Some critics jibed that my reason must have “fled to brutish beasts”. A Shakespearian insight came to mind: “He jests at scars that never felt a wound”. Remember, it was the judgment of the great 18th century rationalist philosopher David Hume that “reason is and ought only to be the slave of the passions”. In actual fact, passions, emotions, desires and feelings are what compel human beings to act; reason serves only to choose the effective means (fair or foul) to achieve what emotions dictate.

On 9 September Venerable Sobitha and I participated in what proved to be, alas, his last public event. We took part in a musical program promoting temperance held at the Sumangala Hall of the Sri Jayawardenepura University, organized by some students under the guidance of Venerable Sobitha. The next morning he had walked into a ward of the National Hospital Sri Lanka to consult a neurologist (Dr. Padma Gunaratne) about his backache which had become unbearable. Perceptive doctor that she is, Dr. Gunaratne having thoroughly examined Venerable Sobitha neurologically, had also recognized the existence of a heart problem andhad therefore referred him to the Institute of Cardiology. Less than two months after that event, Venerable Sobitha died of pneumonia in a hospital in Singapore. That was the final outcome of the dedicated medical care Venerable Sobitha received from an ad hoc galaxy of over a dozen of our best doctors who did their best for him. During the period between the 10th of September and the 8th of November the venue in which Venerable Sobitha received treatment was changed six times, with his consent, of course, and in his best interest. But to what purpose? For my part, although I was constantly on the scene, there was nothing definitive I could do except to watch too many cooks spoiling the broth and finally lamenting the death of my very dear friend.

To Blame or not to Blame

Far be it from me to blame the dedicated doctors who undoubtedly did their best to save Venerable Sobitha’s life. In mycareer as a doctor, I erred fatally five times and reported my errors to the world in the last issue of the British Medical Journal of 1996. (If you care to, you can read about my errors by googling my article titled “To err was fatal”). So who am I to blame others for erring? What cries for explanation in Venerable Sobitha’s case, however, is why after being treated by a high-powered team of dedicated doctors, my 73 year old friend who walked into hospital and had straightforward elective heart surgery had to die a couple of weeks later of pneumonia in a Singapore hospital. Having been an ubiquitous presence on the medical scene of our country for 55 years, I know that according to WHO estimates even in developed countries as many as 10 out of every 100 patients are gravely harmed while receiving hospital care. For example, according to the Institute of Medicine Report, in the USA it is estimated that upto 98,000 medical error deaths occur annually. Again, in developed countries, Health Care Associated Infections (HAI) complicates anything upto 10% of admissions in acute care hospitals. The scope of patient safety problems in developing countries such as ours is not well documented but itcertainly cannot be less than in developed countries where “patient safety” is at a premium. In fact, “Patient Safety” is a fundamental element of health care extensively and intensively addressed by the WHO. To repeat, worldwide, adverse events occur in about 10% of hospital patients. Apart from errors committed by doctors, there are other causes of hospital deaths. According to the WHO publication titled Regional strategy for patient safety in the WHO South-East Asia Region (2016 – 2025) deaths may result from unsafe processes such as communication failures, ineffective teamwork, overwork by health care personnel and even poor patient handovers! In the case of my obliging Venerable friend,he was “handed over” at least six times during his terminal illness.

Patient Safety

Patient Safety is not a high priority discipline in our country. To tell the truth, in a recent postgraduate examination in surgery (MD, Surgery February/March 2013) a question was set by one public spirited examiner on Patient Safety. Almost all the candidates fared so badly in this question that the authorities concerned arbitrarily decided to expunge the question from the examination paper. Otherwise the pass rate would have become unacceptably low! So much for the importance of patient safety in our country. The sad truth is that in our country when it comes to patient safety, anything goes!. I believe that Venerable Sobitha was only one victim of the rotten state of medical care in our country. Significantly enough, Venerable Sobitha who saved democracy for our country during his life has compelled us to focus on patient safety for the rest of us, by his death.

Minor Inquisition

The Island prominently published my lament on Venerable Sobitha on the day of the spectacular funeral the nation gave him (12thNovember). Predictably, some members of my profession had grave misgivings about the wisdom of my public lament. On the 16th of November the Sri Lanka Medical Association (SLMA, not to be confused with Sri Lanka Medical Council, SLMC) summoned me for a meeting to clarify certain matters arising from my lament. The meeting turned out to be a minor inquisition. The committee members of the SLMA are distinguished professors, specialists and consultants who have all excelled me their old physiology teacher in the field of medical practice. Some of them told me in no uncertain terms that I should not have indulged in a public lament particularly because I happen to be the current President of the SLMC. I riposted that the public knows me not so much as the President of the SLMC as a Scientific Firewalker and that our noble profession had nothing to fear from the lamentation of a firewalker about the death of a friend. One of my interlocutors Dr. Sarath Gamini de Silva, a loquacious, witty, inveterate rhymester and general physician, in the October issue of the Official Newsletter of the SLMA raised a question with poignant relevance to Venerable Sobitha’s case: “… How competent is a person trained in one area mainly, say an endocrinologist … to be called a specialist in treating … heart disease or neurological disease …?” Venerable Sobitha’s main problem was a heart problem and he died of neurological complications which resulted in pneumonia. Dr. de Silva concludes his piece titled Thoughts on Current Specialist Practice with a set of rhyming verses one of which goes like this:

“Let not the patient be used as bait

Left helplessly, resigned to his fate

Rectifying matters can’t be left to the state

Let the profession act before it is too late”

That is precisely the burden of my lament about Venerable Sobitha’s death.

Conclusion

Believe it or not, by the fortuitous concourse of circumstances, the next morning (17/11) I had to go to the Kingdom of Bhutan to discuss the very subject of Patient Safety. It was on the invitation of the WHO. I was accompanied by Consultant Surgeon Dr. Lalantha Ranasinghe, Vice-President of the SLMC and Dr. Chandana Atapattu, a dedicated Member of the SLMC. On behalf of the SLMC, we participated in the Sixth Technical Meeting of the Medical Councils Network of the WHO South-East Asia Region. The theme of the meeting was the “Roles of the medical doctor for Patient Safety”. The subject that had been allocated to me long before my beloved friend Venerable Maduluwawe Sobitha passed away. The pity of it is that this was the equivalent of bolting the stable door after the horse had fled to another world.