The first and the last lesson

It was past 6 PM when we finished the Sri Lanka Medical Association (SLMA) Council meeting and my friend Chandana told me that he was going to see Carlo at the Cardiology unit at the National Hospital of Sri Lanka in Colombo. It was then that I realised why he hadn’t replied to my email for over a week. I said I was coming with him.

When we entered Carlo’s cubicle in the Cardiology unit it was getting dark. Carlo lay in bed propped at 45 degrees, inhaling oxygen through nasal prongs. He was very frail and seemed to have become smaller and shrunk in size from a few months ago. I could see that he was breathing with an effort. He was pale and his half-closed eyes opened as he saw both of us entering the cubicle. Chandana, who saw him regularly, asked if he knew who had come to see him. He looked at me and gave a faint smile and said, ‘Why don’t I know, this is Kumara’.

I couldn’t speak for a few moments as this was the first time I had seen Carlo in a hospital bed. I had always seen him in positions of authority as a teacher, the Dean of a medical school or, as I had seen him last in 2019, in jacket and tie, as the chief guest of an annual meeting of healthcare administrators.

After a few seconds I said that I did not know that he was in hospital. I said now I know why he didn’t reply to my email. He took my hand and asked me to sit by his bedside. Then he asked me what I emailed him. I said an article was about the ‘The Soul in Medicine’ that appeared in the Lancet. He asked whether I have it with me and I said I probably have it on my phone. He asked whether I could read it to him. I said, ‘certainly Sir’ and got the article from my phone started reading it.

Prof Carlo Fonseka was the founder Dean of the Faculty of Medicine, University of Kelaniya Sri Lanka (appointed in 1991) and before that, the Professor of Physiology at the Colombo Medical School for over two decades. He was an atheist, a Catholic by birth and came into the public limelight when he proved that firewalking does not need any supernatural powers. He made normal people do firewalking (after a tot of alcohol) by instructing them to keep the contact with the charcoal fire to a minimum. He was also a prominent Marxist who represented a left-wing socialist party in Sri Lanka. He was a songwriter. He taught economics in Finland during a brief period where he had to go abroad because of threats to his life from the extremists in the 1980s. Prof Carlo was a versatile person who had extraordinary skills of oratory in both English and Sinhala.

Personally, Prof Carlo contributed hugely to my academic career from the time I was recruited as a lecturer to the Faculty of Medicine, University of Kelaniya in 1995. It was about three years since the new medical faculty was started in Sri Lanka. I was a full-time general practitioner having a lucrative private practice, who was a bit disillusioned with private practice. I was recruited for the combined department of Community and Family Medicine. In 1993-4 before I came to the Faculty, I had purchased a desktop computer, a PC-XT and was doing some initial work in medical computing. In early 1996, Prof Fonseka, walked into my office room and asked me to accompany him to see some space where he wanted me to start a computer lab for the medical students. I just could not believe what I heard, which was probably the best news I ever heard in my academic career. After we decided on the location, he gave me funds to purchase ten IBM PC-XT computers for the first computer lab in a medical faculty in Sri Lanka. Prof Fonseka did learn the very basics of how to operate a personal computer few years after 1997, but had a vision and insight to determine that medicine will need computer technology in the years to come. Therefore, the Faculty became the first to teach Information and Communication Technology to first year medical students in Sri Lanka along with English language as a part of medical curriculum.  

I remembered why I had emailed Carlo. The last time I saw him, it was because I wanted to talk to him urgently, because I was facing a problematic situation regarding opposing the inappropriate use of foreign funds by a leading national organization. I objected this and resigned from a committee, I was all alone with the national organization and the world organization carrying on as usual. I had few people to speak to and Carlo came into my mind. He asked me to come to a leading five-star hotel the next day to talk about this when he was the chief guest at the gathering. He came out in the middle of this meeting as I said I wanted to meet him urgently. We discussed and planned a strategy what can be done for about 15-20 minutes outside in the hotel lobby. This is where I asked him what has happened to the conscience or soul or morals of medicine in Sri Lanka.

 

I started reading the article. On a few occasions I stopped and asked him, what exactly do they mean by a certain phrase or sentence. He slowly but clearly explained to me from the way I pronounced to the meaning e.g., how I pronounced some of the words such as transmogrified, derision etc. All the time he was breathless and talked slowly but clearly – the same clarity of thought Carlo has always shown. We again briefly touched on the soul or morals of some of the healthcare administrators and clinicians in Sri Lanka, but I was particularly sensitive to the situation Carlo was in and did not want him to talk too much. I knew my teacher was near the end. He urged me that we should not give up and go forward. I had a gut feeling that this may be my last lesson from Carlo.

I remembered the first lesson, in 1975, during the welcome talk at the Colombo Medical School. I was 17 years and knew Prof Carlo Fonseka as the firewalking professor. I was a 14-year-old schoolboy when the Colombo Medical School celebrated its centenary with a medical exhibition which I went to see. Prof Carlo was very famous at that time, and did the firewalking during the exhibition.

We were seated at the prestigious physiology lecture theatre and Prof Carlo Fonseka gave the welcoming address. It was about finding the truth. He told us the story of the Kalama people from North India. When Buddha was visiting villages, he came to this village called

Kesaputtanigama in India. Their village was in a place through which many religious teachers passed. Each of these teachers taught that his personal doctrine was the only truth, and that all others before and after him were wrong. The Kalama’s could not decide which doctrine they should accept and follow. So, the Buddha taught them what is now known as the Kalama Sutta. He gave ten basic conditions to beware of in order to avoid becoming the intellectual slave of anyone, even of the Buddha himself. 

Do not accept and believe just because something has been passed along and retold through the years

Do not believe just because some practice has become traditional

Do not accept and believe merely because of the reports and news spreading

Do not accept and believe just because something is cited in the scriptures

Do not believe just because something is correct on the grounds of naya (deductive and inductive reasoning) alone.

Do not believe or accept just because something appeals to one’s common sense, 

Do not believe just because something stands up to or agrees with one’s preconceived opinions and theories 

Do not believe just because the speaker appears believable 

Do not believe just because the Samana or preacher, the speaker, is “our teacher”  

The Buddha’s purpose regarding this important point was that no one should be the intellectual slave of someone else, not even of the Buddha himself. This Prof Fonseka stressed and actively practiced.

This story and the circumstances that was told to about 125 students, by Prof Carlo Fonseka, a physically small made man of five foot five (not an imposing figure at all), in off-white trousers and a white national top (without any jacket or tie) was etched in my memory for ever from the moment I heard it in 1975. The moment he started talking, he was the sole focus of attention, as his oratorical skills was extraordinary. So was his logical reasoning and simple but precise language.

I had quite a few professional disagreements with Carlo, especially during the time he was the President of the Sri Lanka Medical Council, the legal body that regulates the medical profession in Sri Lanka. He strongly advocated that all Sri Lankan medical schools should be  public /government controlled, a stance which resulted in a prolonged strike action by medical students for more than nine months in Sri Lanka. I strongly believed that private sector medical schools should be allowed in Sri Lanka, but under the full control from SLMC. We had on many occasions exchanged our views verbally and via email. 

I knew when I came out of the Cardiology unit that I was unlikely to have another lesson from Carlo, my teacher. Two days later he passed way. His long-time wish was to donate his body to the Department of Anatomy for student dissections which was done by his family and for the last time, I bade farewell to my teacher.

Kumara Mendis

31-12-2020  

This was published in the Sunday Island 2021-01-08 

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