A Call for Accountability: Death of a Young Woman in Kilinochchi

On November 28, 2013 a pregnant mother from Malaiyalapuram North[1] (Malaiyalapuram) in Kilinochchi District died at Jaffna Teaching Hospital. She was 17 and 2/7 weeks pregnant at the time of her death.

She had been injected with Jadelle,[2] a Progestogen-only subdermal implant (PODSI), [3] on September 07, 2013.[4]

The deceased – Ms. Manjula Satheeshkumar – was twenty-six-years-old.[5] She was married and had one child, a boy.

Jadelle1

Jadelle2

At the time the implant was inserted, Ms. Satheeshkumar was two months pregnant. However, she was not aware of her pregnancy. Additionally, Ministry of Health (MoH) officials failed to administer a pregnancy test which should have been part of pre-implant screening especially for women who are not sure of if they are pregnant.[6]

After receiving the implant, Ms. Satheeshkumar was suffering from severe abdominal pain. Her husband, Mr. R. Satheeshkumar, decided to take her to a private hospital in Kilinochchi.  Hospital staff ran some tests and informed her that she was pregnant (Report attached).[7]

Thereafter, Ms. Satheeshkumar visited the Primary Health Centre in Malaiyalapuram and informed a Public Health Midwife (PHM) that she was pregnant. At that time, the PHM advised her to visit the MOH office in Kilinochchi and remove the Jadelle implant. By the time this conversation took place, the implant had been actively releasing progesterone for three and a half weeks.

During the first week of October, she visited MOH office in Kilinochchi to have the implant removed. Her implant was surgically removed at Kilinochchi hospital by a doctor.[8]

After the removal of the implant, she was continuously ill. She developed a rash, which was an allergic reaction on her skin and was feeling very itchy. Her neck was swollen and she regularly complained of having a lot of headaches and was consistently running a high fever.

On November 22, 2013 she was taken to Kilinochchi District Hospital by her husband due to her high fever.[9] After having been admitted to Kilinochchi District Hospital, she was transferred to Jaffna Teaching Hospital the following day – on November 23. She was running a fever and was subsequently placed in the Intensive Care Unit (ICU) at Jaffna Teaching Hospital.

She passed away on November 28 at approximately 4am.

On the 28th of Novemenber,Mr. R. Satheeshkumar told TSA that “this was the worst my wife had felt in six years. Before she was injected with that implant, which the midwife coerced her into doing, she was totally fine. She had only been admitted to the hospital twice before…for the births of our two children.”

The day she was transferred to Jaffna Teaching Hospital, she told her husband, “I am afraid. My neck is swollen and I can barely speak.”[10] Her pregnancy record indicates she did not have any prenatal or postnatal complications in the past.( report attached)

TSA, in its previous report stated: “Failure to adequately conduct all pre-insertion tests jeopardized the health of these women. Moreover, failure to provide the women with after-surgery instructions – including directions for severe adverse reactions – represents a violation of the Jadelle protocol and endangers women’s well-being.”

The pregnancy record (shown below) failed to mention that the implant was the last form of contraceptive used, instead it says she was using pills; we do not know if this is an intentional entry or a mistake. Accurately recording medical history is very important in patient care and diagnosis. Considering the fact that, a patient’s medical records contain false information, the appropriateness of the care given to them can be questionable. A patient’s history is not only a medical record, but in cases of death, also a legal document.

TSA notes here that there has been a clear breach in duty of care owed by the doctors and MoH due to the substandard pre-medical screening. This report is not conclusive that the cause of death was the implant itself, but it is very important to rule out the possibility that the implant could have materially increased or aggravated any pre-existing medical conditions. The obvious negligence in pre-screening and failure to obtain proper medical history from a patient prior to a minor surgical procedure is a legitimate cause for investigation.

Record 1
Record 2


[1] Malaiyalapuram North is located in Karaichchi Divisional Secretariat Division.

[2] She gave consent and the procedure was administered at the Primary Health Centre in Malaiyalapuram.

[3] TSA’s initial article about this incident can be read here: http://groundviews.org/2013/09/13/coercive-population-control-in-kilinochchi/

[5] She was born on August 26, 1987.

[6] During a telephone interview with TSA, Ms. Satheeshkumar’s husband mentioned that his wife frequently had irregular periods.

[7] This happened approximately two weeks after Ms. Satheeshkumar was administered with the Jadelle implant.

[8] TSA was unable to confirm the name of this doctor.

[9] Ms. Satheeshkumar was admitted to Kilinochchi District Hospital at around 10am.

[10] Ms. Satheeshkumar was actually at Kilinochchi District Hospital when she said this.

  • Dhammika Perera

    This is very irresponsible journalism guys. First of all, the autopsy report has not been released yet (One will definitely be done as this is a maternal death and an autopsy is mandatory). Second, you have no reason to suggest that the death was caused by a condition caused by the implant. The only negligent act here is not conducting a pregnancy test prior to the insertion of the implant (they are not injected as you state, they are subdermaly inserted). And finally, it is largely due to Sri Lanka’s high modern contraceptive use and low fertility rate that the country has managed to bring its maternal mortality below 30/100,000 when neighboring countries rates have stayed above 200. Painting a single incident into a disaster in this manner with no proof is simply the worst kind of irresponsible journalism one could fathom and you should be ashamed of yourselves.

  • Rathika Innasimuttu

    Dhammika,
    please read “Above the Law: Violations of Women’s Reproductive Rights in Northern Sri
    Lanka” authored by TSA on October 11, 2013. The report clearly asked for an investigation
    into what went wrong and to inform and educate women who were assembled
    together in the pretext of a nutrition camp, so that they could be injected
    with Jedelle, of the pros and cons of this Implant and why it was administered
    in this particular way to avoid situations of
    this nature.

    TSA’s reasons to call for an investigation is stated clearly on the above
    report, “TSA notes here that there has been a clear breach in duty of care owed
    by the doctors and MoH due to the substandard pre-medical screening. This
    report is not conclusive that the cause
    of death was the implant itself, but it is very
    important to rule out the possibility that the implant could have
    materially increased or aggravated any pre-existing medical conditions. The
    obvious negligence in pre-screening and failure to obtain proper medical
    history from a patient prior to a minor surgical procedure is a legitimate
    cause for investigation.”

    A two year old child is crying for a mother and a husband wants answers.
    The husband is asking for an investigation as to why his perfectly healthy 26-year-old
    young wife died. The only difference between her previous pregnancies and the
    present one is that the Implant had been actively releasing progesterone for
    three and a half weeks in her system this time.

    Are
    you claiming that this is a sensationalized piece of journalism because this call
    for justice is by a Tamil man from an economically marginalized subaltern Tamil
    community of Malayalapuram, Killinochchi who are not entitled to checks and
    balance or accountability for all the crimes that are continue to be perpetrated
    on them?

    The burden of proof is with the Ministry of Health and all that the
    family is asking for is an impartial inquiry into what happened.

    • Santhiyapillai

      Dhammika,

      Before we commit, we should study the case and write as comment. I think Rathikka has cleared you clearly about this. Feel for a poor mothers life.

      Santhiyapillai

    • Dhammika Perera

      Dear Rathika,

      I am a doctor myself and I feel for any life lost, especially a mother’s. I am not trying to cover up the fact that the service providers who inserted the contraceptive implant should have conducted a pregnancy test prior to the procedure. That act of neglect should be accounted for. Do you have grounds to believe that an investigation has not been undertaken? Have you asked the Ministry of Health to comment on the piece before publishing it?

      Furthermore, if the women were subjected to implant insertion without proper counselling about the method and it’s pros and cons, that too is a professional breach and should be investigated. However, combining nutrition and contraceptive services is a universally advocated practice in both nutrition and reproductive health and you can find technical papers on the benefits of that approach in websites such as K4H (Knowledge for Health) and the Family planning sections of USAID.

      We need to be sure that the women were ‘coerced’ into nutrition camps and subjected to contraceptive procedures before making such claims and we should be sure before making allegations of an implant being the possible cause of a maternal death. Such irresponsible allegations can drive populations away from attempts at combining nutrition and contraceptive services according to universally accepted guidelines and from modern highly effective contraceptive methods such as implants.

      I work in many countries and I am not driven by ethnic lines and it is another cheap media stunt to bring that into this conversation. A human life is a human life and that discussion should end there. This is not and should never be a political discussion.

      Best

      Dhammika

      • nusra

        Hear ,hear Dhammika. This issue is and should only be about the negligence demonstrated in not doing a pregnancy screen before inserting Jadelle.
        I can’t believe so-called educated people resort to cheap tricks like accusing people of racism when all Dhammika is doing is clarifying the situation.
        I’M all for social accountability , but you just gave your cause a massive drop in credibility.

  • Soundra Mahalakshmi

    The product Information on Bayer’s website repeatedly stresses that pregnant women should not use Jadelle and that women should immediately discontinue use if they become pregnant. Failure to adhere to the Jadelle guidelines also represents a violation of Ms. Satheeshkumar’s rights to bodily integrity, health, and reproductive health. Please refer the Jadelle leaflet meant for users: http://f.cl.ly/items/0p442j202M3v3H241F08/Annex%20II_Jadelle%20Patient%20Leaflet.pdf

  • Off the Cuff

    To The Social Architects,

    “To provide efficient, effective and qualitative health services to the people of the Northern Province by implementing policies and strategies formulated by national and provincial health ministries to enable to face issues and challenges emerging in the provision of services within the province”.

    That is the Mission Statement of the Northern Provincial Council’s Department of Health Services. The Chief Minister of the NPC is Mr Wigneswaran a former Supreme Court Judge. The NPC is a Tamil Administered Province.

    The Head of this dept is the Provincial Director of Health Services Dr(Mrs) S.R.Jude (according to the latest information available from the NPC web site). Family Planning is one of the functions of her dept. and her latest annual report gives the following details for the whole province. Tubectomy 2798, injection 4197, loops 3591, pills 6837, condoms 7177 and implants as 2615. Out of 276 medical institutions 34 are primary medical care units. Only the Jaffna Teaching Hospital is listed as administered by the Line Ministry. The overwhelming majority (close to 100%) of Health Care personnel in these institutions are Tamil.

    Strangely the investigative powers of the TSA could not uncover the names of medical personnel!

    The TSA does write provocative articles though they do not respond to questions.
    The death of this young Tamil mother is irreplaceable to her child and the husband.
    Has the TSA taken this up with the authorities?
    Especially the PDHS Dr Mrs S.R.Jude and the CM Mr Wigneswaran.
    Hopefully the TSA will respond this time!

    • Rathika Innasimuttu

      Off the Cuff,

      It is not that TSA can’t uncover the names of the doctors, we already know who they are. The doctors are employees of the Ministry of Health and it is the Ministry’s responsibility to undertake an investigation. All we can do is raise the issue and support the family to get redress, which people are doing.

      You may call it provocative and we call it- timely information to act. Agree to disagree.

      • Off the Cuff

        Dear Ms Rathika Innasimuttu,

        Glad to see a response from the TSA at last.

        You state “It is not that TSA can’t uncover the names of the doctors, we already know who they are.”

        That is very strange because your article claimed that you did not know.
        Deception seems to be second nature to the TSA.

        TSA wrote “Her implant was surgically removed at Kilinochchi hospital by a doctor.[8]”
        Reference 8 states as follows ” [8] TSA was unable to confirm the name of this doctor.”

        You have shot yourself in the leg and blasted your credibility sky high.

        Your intention is to create dissension and that would have been compromised by disclosing the names of the Doctors and the support staff including the mid wife. They would have all been Tamil.

        You say “The doctors are employees of the Ministry of Health and it is the Ministry’s responsibility to undertake an investigation.”

        That is laughable given that except for the Teaching Hospital of Jaffna ALL other 275 Health Care institutions of the Northern Province (Hospitals, Clinics, MOH offices, Family Health Clinics and Dispensaries etc) are Administered by the Northern Provincial Council of the TNA and CM Vigneswaran!

        This lady was examined by TAMIL doctors in Malaiyalapuram, Killinochchi. According to you “She gave consent and the procedure was administered at the Primary Health Centre in Malaiyalapuram”. Thus if anybody neglected this lady it was the staff of the Primary Health Care Centre of Malaiyalapuram. Hiding the FACT that ALL of them were Tamil working at NPC run medical facilities exposes your intent. Which is stirring the Ethnic pot!

        You say “All we can do is raise the issue and support the family to get redress, which people are doing”

        That’s very magnanimous. But is that all you could do?
        How about asking the Provincial Director of Health Services of the NPC (who is the Head of Medical services in the North) what went wrong? If that does not give satisfactory results how about asking the CM of the NPC Mr Vigneswaran what he is doing while his people are implanted with Jadelle Contraceptives by Tamil Doctors (who according to you are incompetent)?

        You see madam Rathika Innasimuttu, there is a govt of your own in the North now. They run the Medical services in the North. Unlike in the past you cannot blame the Central govt now. When the NPC medical services make a mess of the people under their care the only fall back is the Central govt run Jaffna Teaching Hospital.

        You say “TSA notes here that there has been a clear breach in duty of care owed by the doctors and MoH due to the substandard pre-medical screening”

        Yes quite right but that MOH office and ALL other MOH offices in the North are administered by Chief Minister Vigneswaran’s Tamil National Alliance. Hence though you try to Pass the Buck, it has stopped at the doorstep of Chief Minister Vigneswaran.

        You say “You may call it provocative and we call it- timely information to act. Agree to disagree.”

        Any unbiased person reading your article and discovering what you tried to hide from view, lying in the process, would realise “Provocative” too mild a word to describe what you are attempting to do.

  • Aia

    I have read news items on the same issue before and tend to smell a rat now. And some of our brothers seem
    very defensive in their comments for no reason. Family planning is a choice of the parents, not to be tricked into accepting something that the family hasn’t felt comfortable about it nor did they have the knowledge of. Who administered the drug is not the issue, neither whether be it a Tamil or a Sinhalese. Bringing
    in the newly elected CM’s into this shows none other than real desperation, it is kind of tactics being used to show off “every thing in north is hunky dory”, whereas he cannot even visit to places that are under his areas of
    jurisdiction, poor Supreme Court Judge. Those who administer the procedure are merely messengers, yes, there may be lapses on their part but, by and large, don’t shoot the messenger, they do their job as they asked to do. Intent of this implementation of the procedure and, to a particular location is the concern, and the public has the right to know. To make awareness of the danger this procedure presents is good thing, and writer deserves a commendation. If it meant a live saved by this article, what else would a journalist strives for. My heart
    goes to the family which paid a high price for someone’s conspiracy which is deplorable and akin to Hitler’s. Do not target poor peasants, for them being illiterate.

    • Off the Cuff

      Dear Aia,

      You say “Bringing in the newly elected CM’s into this shows none other than real desperation,”

      Desperation, When you or the TSA cannot even address the points I raised!
      Sorry Aia I am not desperate as I have not concocted anything or hidden anything or lied for political expediency. The fact is you and the TSA are trying to make political capital from a bereaved family’s grief.

      The information I presented in my comment to TSA was drawn from the LATEST Annual report of the Northern Provincial Council’s Head of medical Services, The Provincial Director of Health Services (PDHS), Dr(Mrs) S.R.Jude. She is not a Sinhalese either.

      The PDHS serves under the Northern Provincial Council. The Tamil National Alliance holds power in that Council and the Head of that Council is Mr. Canagasabapathy Visuvalingam Vigneswaran, the Chief Minister, who assumed office on 7 October 2013.

      If what the TSA has written in 3 articles in GV and what you insinuate is true, this matter should be dealt with an remedied with the utmost urgency by the NPC govt instead of focusing on the less important such as planting trees. Two months have already gone. Why is the NPC sleeping when the accusing finger is pointed at the NPC run MOH office?

      Why was this not taken up with the Province’s Political Head or the Province’s Medical Head?

      You stated “Do not target poor peasants, for them being illiterate.”

      “As a 12 year old I became conscious of how Tamils used the caste system to enslave least 75 percent of the Tamil population by obtaining their services virtually free based on their belonging to the servile class” wrote Ms Pearl Thevanayagam (a high cast Tamil Lady) in the Sri Lanka Guardian of June 2011.

      Parliament found it necessary to give more teeth to the Prevention of Social Disabilities act of 1957 by enacting the Prevention of Social Disabilities (Amendment) Act No.18 of 1971 as the first Law enacted failed for 14 years to stop the persecution Ms Thevanayagam had observed.

      Perhaps the 25% Tamil Ruling Class learnt how to enslave people and keep them ignorant by denying them an Education from Hitler! The Ruling class of Jaffna did not allow any child of the SERVILE 75% to attend any Hindu School in the Peninsular.

      Hence please keep your propaganda to yourself. The foreigners may lap up the drivel that you write but we in Lanka know who the the big bad wolf is.

      • Aia

        Off the cuff:
        Thank you for your reply. Did not expect a response for my comment. Will start back to front, funny you mentioned mine was propaganda and then asking to keep it to myself. Propaganda is there to be spread, although my intent was not to spread or politicise issues that needs to be looked at a compassionate angle. The timing of, the location chose for and the way the procedure has been implemented has got my attention, and it commenced well before the all- powerful NP council come into being. Implicating the fledgling council in this is an attempt tarnishing its image. But CW is very popular where it matters than your negativity would do to him. Don’t pretend that you don’t know of what has been happening since the Council has come to power. Even the graduates appointments have been made by the Centre; CM cannot go around to places that have been under his purview; have they got necessary funding to implement any programme or projects. Despite these odds he has been facing, you want him to focus on this issue so the line ministry and the drivers of this procedure can be set free and be bailed out, that is understandable. I know CW will persevere all these odds and prevails on matters he thinks he should take care of. He is not there to dwell right away on one of the alleged wrongs Centre is pursuing in North and East but to work with it and get the best to people that elected him. I am sure he will prevail and set an example on how best an elected member would live up to the expectation of its people.
        Did not expect the comment I made about “Do not target poor peasants …” ended up in ridiculing Tamils for having inherited the caste system. You are legend in diverting tactics and in taking the focus out from the topic in discussion. And your apathy towards the low caste Tamils is there to be seen through your writings.
        Your apparent impatient with NPC for not taking up these sort of issues even after two months into office doesn’t resonate in the same amplitude when it comes to Centre, which is sitting on issues that have passed well over 4 years since, very pathetic ones too. How many trees have been planted in these years I know you would not know.
        There are two issues in regards to this death. Number one is apparent negligence, that requires a disciplinary hearing and actions, the Number two is what was the driver for implementing this procedure in this area which was severely affected by the recent war. The by-product of it is the questionable enticing tactics being used prey on mothers who are illiterate and with hand to mouth earning. What is the need for it such implementation and tactics?. If you present your comments with relevant statistic proving the area selected is indeed in need of this procedure, I am prepared to look at it. OMG, am very relieved that this time I had not to go through the cut and paste stings of GGP and Rasalingam. Propaganda, Hmm… the readership will judge who is doing what. Don’t they?.

        • Off the Cuff

          Dear Aia,

          You say “Will start back to front, funny you mentioned mine was propaganda and then asking to keep it to myself”

          propaganda noun : ideas or statements that are often false or exaggerated and that are spread in order to help a cause, a political leader, a government, etc.

          What you wrote fitted the above definition and hence is propaganda which damages peace efforts and hence should have been kept to yourself. It is not funny if you understands the implications though.

          You say “Propaganda is there to be spread, although my intent was not to spread or politicise issues that needs to be looked at a compassionate angle”

          Laughable logic. Guns are there to shoot but when you do you will be shot at or held accountable.

          Propaganda is a virus that needs to be countered. Truth is the perfect counter to it. Propagandist have a problem when they are confronted with the TRUTH. Hence your aversion to Sebastian Rasalingam’s writings. You cannot face the TRUTH of what was done to the Tamil majority of the North.

          Propagandists use the word “Tamil” to hide behind. But that word is an INCLUSIVE word. Tamil society in the North was anything but INCLUSIVE. It had a 25% ruling Class and a 75% Servile class as stated by a member of that ruling class Ms. Pearl Thevanayagam. If you still wont accept what Ms Thevanayagam, Mr Rasalingam and Mr Thomas Johnpulle (all Tamils) says then please read “My Village” written by Mr Nagalingam Ethirweerasingham the first president of the Global Tamil Forum at this link (http://tamilnation.co/forum/ethir/ode.htm).

          Octogenarian Mr Sebastian Rasalingam is a very rare educated member of the Servile class. He is very rare because despite all HINDU SCHOOLS in the North refusing admittance to a single member of the SERVILE class, his parents changed his religion and baptised him to secure an education from a Christian missionary school. An education that the Tamil society in the North denied the Servile class with the aim of keeping them ignorant. Even in that Christian School he had to sit on the ground or a low stool while his so called peers sat at a desk and a high chair!

          He provides a window into the Northern Tamil Society that was kept well hidden. He is exceedingly brave to write and give a voice to that Servile 75%. No wonder you want to discredit him instead of contesting what he says. Quoting someone requires writing down exactly what that person says. In this modern age only a fool will laboriously type out word for word in order to quote what another says. I have quoted you by copying and pasting and you want to belittle what these brave people write because I copy and paste them? (the word you used was cut). You can delude yourself but that will not work Aia, better to contest their writings. But contesting the TRUTH is a hard task isn’t it?

          You say “Your apparent impatient with NPC for not taking up these sort of issues even after two months into office doesn’t resonate in the same amplitude when it comes to Centre, which is sitting on issues that have passed well over 4 years since, very pathetic ones too. How many trees have been planted in these years I know you would not know”

          Again you have gone astray with your logic. The point that I made is that the above case, should in the FIRST instance, been taken up with the relevant authority. But making political capital was more important to the TSA.

          If the TSA’s intent was genuinely obtaining redress, it should have initially complained to the ADMINISTRATION of the MOH office where the neglect occurred, which is The Provincial Director of Health Services (PDHS), Dr(Mrs) S.R.Jude. If that failed to address the issue, then the TSA should have gone to the next higher authority, which is the NPC, the Head of which is CM Vigneswaran. The TSA did nothing of the sort because their intent was anything but obtaining redress to the bereaved family.

          I am not impatient with the NPC. They can take all the time they want and keep on planting trees at the Jaffna Educational office premises and elsewhere accompanied by high officials of the NPC. However I am certain that the CM would have put the Health needs of the Northern population far above tree planting if he was made aware of these despicable acts of alleged forced / coerced Family Planning!

          The TSA are proven lairs (please see my reply to the TSA’s response). They claimed they did not know the names of the medical personnel which they now claim they do. The reason they did not disclose the names was because all those who are involved were Tamil. They did not disclose that ALL MOH offices in the Northern Province was Administered by the Northern Provincial Council because they had an ulterior motive. They did not take it up with the Medical Administration because they had no leg to stand on. You came to their defence ignoring the FACTS. Which makes you complicit.

          Since I have now dealt with your argument let’s take a look at what you have written.

          You say “CM cannot go around to places that have been under his purview;”

          Why? Is he prevented from visiting the MOH’s Office?

          You ask “have they got necessary funding to implement any programme or projects”

          It is an acknowledged fact that the Northern Province received the HIGHEST fund allocation since independence, after the war. Are you looking for further handouts disproportionate to the rest of the island? Anything in excess of a percapita allocation necessarily means that you are asking the other provinces to subsidise the NPC.

          If the NPC has not received an allocation proportionate to the population within then I am with you in asking for funds but if it is not the NPC has to find it’s own from within the province. Is that not equality?

          You say “Despite these odds he has been facing, you want him to focus on this issue so the line ministry and the drivers of this procedure can be set free and be bailed out, that is understandable”

          Let me reiterate, the Line Ministry does not administer the MOH, the NPC does. Other than the Jaffna Teaching Hospital all other 275 Health care institutions are administered by the NPC of Mr Vigneswaran.

          The TSA forgot that and they thought like you when they decided to stir the pot. Blame the govt which is called the Sinhala govt (though it is not). Unfortunately for them and you the Line Ministry provides the resources, the NPC administers them. The facts of the case NEVER pointed a finger at the Line Ministry but it did point to the NPC.

          This unfortunate medical misadventure is due to the neglect of the MOH and his/her staff at the Primary Health Centre in Malaiyalapuram and the MOH office in Kilinochchi. The Staff there are Tamil and would have had an empathy with the Tamil civilians (assuming untouchability did not kick in). Please don’t try to use the grief of this Tamil family as a political tool to create dissension.

          • Aia

            Dear Off the cuff

            Thanks for your comprehensive response.

            I know the definition of propaganda but what I meant by funny was, you who tagged my comment as propaganda and then you who had requested to keep it to myself. My comment was not intended to spread falsehood but to help bring an awareness among fair minded people about issues that are cruel in nature faced by the very people who had gone through the brunt of the war only recently.

            My intent in making comment under this item is to get to the bottom of this issue, not alone the one is being discussed. I said there was two issues: I agree with you on the first, the staff who were responsible for this woman’s death due to their negligence should be held responsible. The second issue which you try to ignore was far more important, that is knowing what is the driver for this procedure to be implemented in this area, and more notably, immediate aftermath of the war where almost all the younger ones perished. You are muted about this issue, instead harping on the caste issue engrained only in Tamil community. Your calculated effort veering this debate from this far more important issue into the caste system is only a diversion tactic which you have mastered with rolling out your cut and paste stuffs as and when you felt the need to do so, such practice, you claim is an intelligent way of doing your business- I don’t disagree.

            Regarding the funding allocation to NP I made, you are readily raising the disproportionate issue, you bring this into if it was for development; if it for destruction of it there no bound. I agree with your caste comments, it is shameful really, however it is not a high priority now. We have moved on and is improved quite a lot now. But you have got to take it in correct perspective, we knew Sinhala community has also this problem though not to the extent Tamils have where forks of Kandian origin think they are the superior lots. Aren’t they.

            You have conveniently skipped from making comments for the following matters raised:

            4years in power since war ended as opposed to 2 months; CM cannot visit around places as he wishes; most importantly, prove the need to have this procedure implemented at this time, location and adopting the method.

          • Off the Cuff

            Dear Aia,

            Thank you for a much better response than what you wrote before.

            The NPC’s Health Ministry is organised as shown here. http://farm5.static.flickr.com/4078/4766800405_4804419ec1_b.jpg

            As you can see, the Regional Director of Health Services (RDHS) is not the Head of the Provincial Ministry of Health, the Provincial Director of Health Services (PDHS) is. The RDHS is apparently Dr. Karthikayan, as per TSA report “Above the Law”, but it has no mention of the Head of the Health Ministry, the PDHS Dr(Mrs) S.R.Jude! She must have been invisible to them.

            In fact their report deceitfully projects the RDHS as the Head of the Central govts’ Ministry of Health in the region. Why?

            Why did their high powered “Fact Finding Mission” (of reproductive rights specialists, human rights experts and local activists) fail to interview the Head of the Northern Province Health Ministry, the PDHS?

            Their report further states “The organization spoke with women in these villages, neighboring villages, local doctors, village level leaders, community leaders, and doctors at the Ministry of Health (MOH) in Kilinochchi”

            The deception that is practised by the TSA is nauseating.
            The “Ministry of Health” in Kilinochchi is the PROVINCIAL Ministry of Health not the Central Govt Ministry of Health! That Provincial Ministry is under the Northern Province Council, headed by the CM, Justice Vigneswaran! How very convenient to omit the word “Provincial”!

            They say “Dr. Karthikayan, Regional Director of Health Services, told the fact-finding team that Sri Lanka’s unmet need for contraception, defined as the number of married women aged fifteen to forty-nine who do not use contraception even though they wish to delay the birth of their next child or wish to prevent pregnancy, is only 4%”

            What does that mean?
            96% of women in Lanka who desire contraception already practices it!
            Why do we have so many illegal abortions?

            Dr. Karthikayan the RDHS is supposed to have stated “However, for women who live in Umaiyalpuram, Malaiyalapuram, Keranchi, Veravil, and Valaipaddu the unmet need is at 30%.”

            Goodness, the demand for birth control is 750% the National Average!!!!
            With such a ravenous demand what is the need for coercion?

            In 2012 the NPC had 2798 Tubectomies.
            Tubectomies cannot be reversed says the TSA in their report.

            In the same year 2615 implants were done.
            Why would a govt promote an expensive REVERSIBLE contraceptive when their supposedly “ulterior” motive is better served by the cheaper and IRREVERSIBLE Tubectomy? Defies Logic.

            The Functions of the NPC’s Ministry of Health are as follows (numbering is mine)
            1. Improve the clinical training facilities and ensure the regular staff training.
            2. Ensure the quality services rendered by implementing quality assurance programme.
            3. Ensure the availability of Drugs and other medical supplies.
            4. Co-ordinate with health policy matters at the provincial level and provide technical assistance in making decisions.
            5. Link Provincial Ministry and line Ministry.
            6. Regulate private health sector within the province.
            7. Attend to public complaints promptly and ensure the investigation and disciplinary actions are carried out.
            8. Organize ways and means of inventory control and ensure periodic Board of Surveys at least once a year.
            9. Organize disposal of unserviceable and obsolete items and grant write off authority.
            10. Co-ordinate the health activities among districts with all Regional Directors of Health Services.
            11. To provide Primary Health Care Services to the returnees and internally displaced population.
            12. Organise activities of prevention of Communicable diseases like Malaria, Sexually transmitted diseases and Rabies.
            13. Implementation, Supervision, Monitoring and Evaluation of Annual Implementation Programme and other Capital Programmes.
            14. Collecting & Maintaining Health Sector Data Base including Sectoral Atlas for the Health Sector, Northern Province.
            15. Coordinate Mental Health activities in the Province.
            (http://www.np.gov.lk/index.php?option=com_content&view=article&id=189&Itemid=16#functions_magri)

            I request you to read TSA’s recommendations given in section 3 of the report and compare that to the Functions that are the responsibility of the Provincial Council. You will find that the ball the TSA is trying to pass around has stopped at the PROVINCIAL Council’s Health Ministry.

            I think you should read the TSA’s putrid report to understand their motive. It has nothing to do with obtaining redress to this bereaved family or in preventing a repetition. The TSA is using the understandable emotion generated by this unfortunate death to whip up dissension internally in Lanka and externally.

            Dhammika Perera a doctor by profession states “combining nutrition and contraceptive services is a universally advocated practice in both nutrition and reproductive health and you can find technical papers on the benefits of that approach in websites such as K4H (Knowledge for Health) and the Family planning sections of USAID”

            Prove him wrong please.

            Dr Dhammika further states “it is largely due to Sri Lanka’s high modern contraceptive use and low fertility rate that the country has managed to bring its maternal mortality below 30/100,000 when neighboring countries rates have stayed above 200. Painting a single incident into a disaster in this manner with no proof is simply the worst kind of irresponsible journalism one could fathom and you should be ashamed of yourselves”

            He is absolutely right.

            Please encourage the Public to complain to the PDHS as prompt Investigation and Disciplinary action is within the purview of that office (see item 7)

            You say “My comment was not intended to spread falsehood but to help bring an awareness among fair minded people about issues that are cruel in nature faced by the very people who had gone through the brunt of the war only recently”

            The current tone of your comment does lead me to believe that you did not intend to spread falsehoods. Fair minded people expects facts. Whatever your intentions are there is no proof or facts presented. Without proof it cannot be accepted as the Truth. You have been duped by the emotive content as the TSA intended.

            You say “The second issue which you try to ignore was far more important, that is knowing what is the driver for this procedure to be implemented in this area, and more notably, immediate aftermath of the war where almost all the younger ones perished. You are muted about this issue,…”

            I don’t ignore anything. I go by facts.
            You allude to a “program with hidden objectives” without providing proof of that objective.
            Please read the Facts I have presented about Tubectomies and Implants above.

            You say “instead harping on the caste issue engrained only in Tamil community”

            My comment was in response to your statement “…conspiracy which is deplorable and akin to Hitler’s. Do not target poor peasants, for them being illiterate”.

            It is the Tamil Cast system that made the 75% servile Tamils illiterate. You started the diversion by bringing in Hitler forgetting that Hitler was ever present within the minority Tamil Ruling class of the North. What was missing was only the gas chambers. The oppression practised on the servile Tamil majority had no parallel anywhere else in Lanka. Hence when anyone tries to make false accusations to gain political advantage by stating that they are oppressed by the Sinhalese I remind them where actual oppression, worse in form than slavery, was endemic. I do that by quoting Tamil writers by copying and pasting their own words without changing them.

            The Tamil cast system had the authority of the Hindu Religion. It enforced the Parent’s employment on the Children. A scavenger’s child could not become anything but a Scavenger even if that child had Einstein’s brain. The majority Tamil population (servile 75%) was denied a Hindu Education. They could not reside outside segregated villages and hence did not have freedom of movement. They could not quench their thirst from wells reserved for the minority ruling class. They could not practice religion with freedom. They could not even travel in public transport without facing dire repercussions. Only after the bus services were Nationalised in 1958, by PM SWRD Bandaranaike could they even travel in a bus. Luckily for the Tamil majority (servile) population, the attempts at getting that cast system written into the Constitution failed.

            Of course there is a cast system amongst the Sinhalese but it did not have the stamp of authority of a religion. It did not prevent anyone from acquiring an education and moving up the social ladder. It did not confine them to demarcated villages to prevent mobility and acquiring Land and Wealth. In short it was never the monster that the Tamil cast system is.

            Hence you need to be careful when you attempt throwing insinuations expecting to intimidate your opposition.

            You accuse me of not addressing the following “4years in power since war ended as opposed to 2 months; CM cannot visit around places as he wishes; most importantly, prove the need to have this procedure implemented at this time, location and adopting the method”

            This discussion was about Family Planning which IS the subject matter of the NPC (please refer the functions list above). Neither the TSA nor you have been able to prove otherwise because 275 Medical Institutions out of 276 are ADMINISTERED by the NPC. That administration was not held in Limbo for 2 months. Please also note item 7 which deals with Public complaints.

            Have you visited the North recently? That this was the place where a 27 year war was waged is hardly recognisable today (I have seen Jaffna during the war). That change took only 48 months and you are trying to show that Family Planning was the priority during that time. The NPC is in power for over 2 months (1/24 the that of the govt) what are its achievements? Anything close to 1/24? Was celebrating Maahveer Naal a higher priority than the Health of the Tamil population? You should read the recent article by DBS Jayaraj in the Daily Mirror about that celebration.

          • Aka

            Dear Off the cuff:
            Admire your hardworking. I could not afford to spend as much time as I would like to.
            Given the two races were not in good term since the independence, it is only natural to suspect whether this procedure has any ulterior motives, hence this was somewhat thrusted upon the community even without their knowledge. There was no this sort of issue or allegations in the past and I would like to see never will be.

            Although very detailed and articulative about the caste issue the Tamil community face, your comment fell short of meeting my expectation explaining the second issue. As with the current trend asking for proof when agitation to do more about alleged crimes come, this will also hard to prove the complicity of the State. You know, when the detective and the thief is the same, proving the theft is going to be a easy task. You won’t get justice if the judge and the accused are the same. Even the Chief Justice had been shown the doors for what she did right for the country. So who do you think would dire to find evidence when not only his/her job was at stake but lives.

            While criminals in SL have been apprehended immediately if they committed a minor crime, others who committed serious crimes are still at large. What is obvious though the crime being committed is real. The chance it would stop only if the perpetrator decided to stop.

  • Dave De Alwis

    This was very sad story about innocent woman. I heart is with the family of her. However I feel they also acted irresponsibly here. this article says that she was two months pregnant and she didnt know about it.. how can it be possible? … just after one month every woman can at least suspect she is pregnant (a Married woman ) .. this is a common sense so ,, they should have at least informed to the doctors about what they hadsuspected . after all this our lives and we have to be wise and very careful in specially countries like Sri Lanka, the medical field is becoming huge business and most of the doctors are just agent of mega pharmaceutical companies.

  • Dave De Alwis

    There was time that all Sri Lankans considered doctors as gods because they had that kind of quality and loved the human life but today situation changed totally changed. Majority of doctors are lovers of money and agents of Mega pharmas, when you go to any major channel centers in major hospitals, you can clearly see how many medical reps are around them? so we can not believe doctors in Sri Lanka at face value, we need to be wise and smart and carefully follow their instructions

  • Aia

    .Off the cuff
    TSA and I failed in our duty, and ashamed of- hmm you should be kidding. You know what kind of nonsense that was. If was an awareness and even live loss is prevented by this article the credit should go to the TSA. You know full well, despite written a lot, you have not yet answered the question, I posed to you. I am satisfied with your response that in the death of this young woman, negligent on the part of staffers that dealt with the case might have contributed. The second question was, how was this location selected for this contraceptive procedure; what was the burning need for it and how has it been implemented, the method. Only very simple answers were required. I am yet to see any response in this regard. What I could conclude in the absence of answers for this questions was you didn’t know the answer either. But your patriotism didn’t let you to accept the fact outright, instead you had been writing volumes to the First question, saying all those who involved in the bungle were Tamils. And, then you went onto say our writing might insinuate the masses: What kind of hypocrisy is that..
    Temples and mosques are being destroyed, who is insinuating this. But writing a comment to this article will do more harm that you think.
    People have the write to know what is happening around them and a free and fair media, not chanting the state alone, would be healthier. Trying to gag them is a disservice you do to democracy which you indulge in.

    • Off the Cuff

      Dear Aia,

      You say “The second question was, how was this location selected for this contraceptive procedure;…”

      Who did the selection? Evidence Points to the Northern Provincial Council (NPC). If you don’t agree please provide proof as to who else did.

      You say “what was the burning need for it …”

      Should you not ask the people who did the selection? Perhaps the 750% higher demand for birth control in comparison with the National demand was recognised by the NPC. This gives rise to a supplementary question. Why is it that the Tamil women of the North have such a ravenous appetite for birth control? Perhaps their men cannot control themselves! Perhaps educating the men would be in order.

      You say “and how has it been implemented,…”

      Should you not ask the people who implemented it? The NPC.

      You say “..the method….”

      Who decided on the method? Evidence points to the NPC. But I think they did the right thing by selecting the expensive but REVERSIBLE method instead of the cheaper and IRREVERSIBLE Tubectomy.

      You say “Only very simple answers were required. I am yet to see any response in this regard….”

      Simple answers were given though you fail to understand them or pretend not to do so. TSA have gone silent haven’t they?

      You say “If was an awareness and even live loss is prevented by this article the credit should go to the TSA”

      The problem is in order to create an awareness you must write the truth.
      The TSA has lied deliberately (they responded ONLY once and their devious Lies got exposed). You have already admitted to having an unfounded bias towards the Central Govt that prevents you from seeking the Truth.

      You and the TSA have both failed to Inquire from the PDHS of the PROVINCIAL Ministry of Health or the Provincial Govt or the Provincial Chief Minister WHO ARE the People responsible. You, like the TSA, disregard volumes of evidence that points to the Provincial Govt and instead try to pass the buck. I cannot answer for the Northern Provincial Council so please go and ask them. What is preventing you and the TSA from doing that?

      Hence IF you or the TSA wants to create and awareness and prevent further Birth Control, Please do so with the Driver who drove and caused the accident and not the inanimate Vehicle. But you or the TSA wont do it, as it will not achieve the propaganda objective of stirring the Ethnic Pot.

      Before you comment again, please have the courtesy to walk over to the NPC and ascertain the truth or request the TSA who has experts at their command to do the simple exercise of confronting the NPC and reporting back with the TRUTH.