Sunday, 21 April 2019 09:18

Andy’s Story: Why it matters to you

Have you ever wondered just how lucky you are to be reading this newspaper, whether in print or on a device? You’re lucky because that already puts you in the better-off 10 percent of the Sri Lankan population. This story is about my friend Andy Kularatne who died last month; through it, I want to show you, and the other 90 percent of our countrymen who cannot afford a newspaper, just how lucky we actually are.

Andy and I met first in 1961, as five-year olds, in the kindergarten of S. Thomas’ Prep School. We soon became best friends. He was precocious and came from a respected Colombo 7 family. His grandparents, PDS and Hilda Kularatne, were the celebrated educationists, having founded a number of now-prestigious schools including Nalanda College, Ananda Balika, Dharmapala Vidyalaya, Sri Sumangala (Panadura) and Maliyadewa Girls’ School (Kurunegala). His maternal grandfather, A. R. H. Canakeratne, was a celebrated justice of the Supreme Court. My folk, by comparison, were little-known tea planters. The teachers at school, as is their wont, therefore paid a lot more attention to Andy, than to me.

School days

Andy would often be invited to our homes on Bearwell and Tillicoultry Estates near Lindula, on which my father was superintendent. His impeccable manners and ability to strike up a conversation with interlocutors of any age soon led to his becoming a favourite of my parents, too. At the age of 11, however, we had to transfer to S. Thomas’ Mt Lavinia, he, a day-scholar and I, a boarder. The social divide between these two groups was trenchant, and we both found ourselves among different groups of friends. He still came to the estate for holidays, but now I suspect it was as much because he was my parents’ friend rather than mine. And our friendship was severed forever when he and his family migrated to New Zealand in 1971, when we were 15. That was the year of the JVP’s first insurrection and the country was in chaos: anyone who could get out just went. Andy’s passport shows that he was allowed to take just $8 with him, with special permission from the Central Bank. Sri Lanka had fallen on hard times.

Our lives went separate ways for the next four decades, and Andy had slipped entirely from my mind. When rifling through my mother’s photograph album one day in 2010, however, I chanced upon a photo of him and wondered what had become of him. Google couldn’t find an “Andy Kularatne”, but I remembered he had a baby brother named Rehan, whose email address was on Google. An email from the void led to Rehan putting Andy and me in contact once again, and after the exchange of a few tentative emails we finally met when he visited Sri Lanka in 2014, after a lapse of 45 years. We soon found ourselves exchanging confidences just as old school friends do, as if they had never been parted. His parents had died, and he had no close family save for his brother.

On his next visit to the island my wife and I invited him to stay at our home, and he soon became a frequent and popular visitor, maintaining a disciplined fitness regime, swimming, walking and playing with our dog Boko, whom he adored. When Andy was in the house, Boko simply had no time for us.

We also met him on our regular visits to London, and soon grew accustomed to the fact that he was a familiar figure at many of the best restaurants there, with the staff addressing him familiarly as Mr Andy. He spent most of his daytime swimming and cycling, then playing bridge at his club (the Savile, in Mayfair) followed by either the opera or theatre.

On each of our visits he would have tickets ready for us, and on our last visit we had front-row seats at the Royal Opera House for La Traviata thanks to him. The bar staff even there knew him by name, as did many of the other opera goers. It was surreal. Speaking of the Bar, Andy himself was a qualified barrister, although he never practised law.

In 2015 Andy was diagnosed with prostate cancer, which was successfully treated in the UK. He had an excellent private insurance cover which meant he had the best available treatment. And then he was fine until he visited us in October 2018, when he began experiencing an occasional stabbing pain in his chest and also feeling unusually tired when he exercised. He returned to London and saw his general practitioner (GP), who told him it was probably a muscle strain and asked him to rest.

A week later he returned to the GP, who this time said it was probably an infection and prescribed an antibiotic. When he called to tell me this, I told him outright that he should change his GP. He had been registered with that GP practice for 12 years and had been there only three times. Nevertheless, the GP was treating him as a hypochondriac. I told him outright, “Get on a plane and come here: we’ll find out what’s going on in 24 hours.” He had great faith in the UK’s National Health Service (NHS), however, and took his course of antibiotics. Meanwhile, the pain and tiredness grew worse.

CT scan

He diligently returned to the GP for the third time the following week and, at my urging, demanded a CT scan, failing which he would come to Sri Lanka for a diagnosis. A CT was accordingly prescribed, but he had to wait five days for an appointment for that. Having done the CT, it would be a further week before he could get an appointment to see his oncologist to find out what the report said. When he finally did, on December 18, six weeks after the initial presentation of symptoms, his oncologist simply said he had a cancer that had metastasized from his lung to his liver, adrenal glands and bones. He had a prognosis of two months; and he was referred to palliative care. His doctor had had his CT report for almost two weeks but never troubled to call and tell him. He probably hadn’t even read the report until Andy’s visit.

Andy called me on December 18 while he was still in the doctor’s surgery, and told me what he had heard. He asked if he could spend his final months at our home. After asking my wife, I called back to say yes he could, but that I thought it was a bad idea. After all, when I myself got kidney cancer six years ago, I was grateful to be treated in Australia rather than in Sri Lanka. So I offered to stay with him in London as he received his end-of-life care in a hospice in London, and his insurance would ensure he would have the best. To this Andy objected strenuously. “I want to come to Sri Lanka, and even if you will not have me in your home I’m coming”, he said.

So I flew out to London on Christmas day and returned with him, weak and barely able to walk, on January 1. He already had severe pain and had been given only mild painkillers by his NHS doctor. At my insistence, before leaving he called his NHS palliative care specialist, explained that he was in unbearable pain, and asked for stronger painkillers. The doctor asked him to take Panadeine, which is at the mildest end of the analgesic arsenal. “That’s all I’m allowed to give you”, he shrugged.

When we arrived in Sri Lanka, we went straight to a private hospital and did a fresh CT scan. The report was ready the same day. Armed with that, we went to the clinic at the Cancer Hospital at Maharagama. There Andy needed to register as a patient, for which purpose he needed a national identity card number. Having left Sri Lanka in 1971, however, he had no NIC. He was, however, a dual citizen. I explained this to the registrar. “No problem”, he said. “I’ll just leave that box blank.” Clutching his registration card, we joined the queue outside the clinic. The line of patients seemed endless. But soon a house officer took Andy’s history and then ushered us in to see the consultant.

Apeksha doctors

The consultant was at her desk, surrounded by her medical assistants, all of them surrounded by a milling throng of patients. When it was our turn, doctors gave us their undivided attention.

Andy got about 12 minutes of their time, but in those 12 minutes he received closer consideration than he ever got in decades of living in London. They reviewed his diagnosis and seemed horrified that he had been referred to palliative ‘end-of-life’ care in the UK without a biopsy or a bone scan. “We can treat this”, said the consultant confidently.

The treatment, however, would involve chemotherapy, which Andy rejected. After some argument, the consultant accepted Andy’s position that he was interested not so much in the length of his remaining time as its quality. “So we’ll give you a course of palliative radiotherapy to reduce your pain and the risk of paralysis later on”, she said, “together with some injections to strengthen your bones.” Neither of these options had been offered to him in the UK. Although they wouldn’t slow the progression of his disease, they would improve his quality of life.

Andy said he would like to have the radiotherapy at a private hospital, simply because he could afford private care. “Why?” said the oncologist, “we can do it right here for free, starting today”. As it happened he took the private option anyway, and even that was incredibly efficient and reasonably priced.

Finally, given that he was already experiencing moderate to severe pain, he was given morphine. And all this, was free. We left the hospital within two hours of having arrived, medicines in hand. Having got into the car, Andy told me that for the first time since he had developed symptoms six weeks previously, he felt as if he was in the hands of people who cared.

He lived on for a further 10 weeks, cheerful, and with his pain almost entirely under control, with periodic visits to Maharagama for injections of bone-strengthening zoledronic acid. He was astonished by the level of care he received at the Cancer Institute. Eventually, when he was too feeble to travel, I consulted his oncologist privately, to get advice on his care at home. The doctor gave me his mobile number and asked me to call if ever I needed help. I did, twice. And each time he picked up and gave detailed and helpful advice to the GP attending on Andy. When Andy finally died, on March 9, thanks to the palliative care he received from his oncologist, his private home-nursing service and daily visits by the ambulance GP service, he was entirely free from the pain and distress that so often accompanies the final stages of bone cancer death.

Andy wasn’t a typical patient: he had the resources to blend the best of government care with the best of private care Sri Lanka has to offer. But he spent those final 10 weeks at home, happy in his surroundings. And there was no doubt in his mind that the care he received in Sri Lanka was substantially better than what he received in the UK. Andy made me promise that I would write this story, not because of him, but because he was so grateful for the system of cancer care we have in this country. Sri Lanka spends about Rs 70 per day on average on healthcare for each of its citizens. The UK spends 37 times as much. Our hospitals may not be the Ritz, though if you visit the Ahmed Brother’s wing of Maharagama you could be forgiven for thinking it is, but the care and concern the staff at all levels extend to patients, especially considering the pressure they are under, is simply incredible. Just as we should not judge the USA by the violence portrayed by Hollywood, we should not judge our health service by the wilder utterances of the GMOA. There are many wonderful human beings there, who deserve all the support we can give them.

No doubt there are many things about our state service that could be much better. But we need to be grateful for those services which are already more advanced than their counterparts in the “developed” world.

For Andy to get a copy of his birth certificate and parents’ marriage certificate from the Divisional Secretariat in Narahenpita took just 40 minutes; a new Sri Lankan passport in 4 hours; an NIC, which eventually he did not want, would have been issued the same day. And when he died, on a Saturday evening, our Grama Niladhari issued his death certificate within 30 minutes of being called, while our local Registrar of Births, Deaths and Marriages registered his death the next morning, a Sunday, both free of charge, to boot. I’ve lived many years in the West and can vouch for the fact that none of these things can be done so quickly or easily in the “developed” world. Andy for one, was so grateful for what is right about our country and we would all do well to pay attention to the fantastic services we get from our state, in return for the very modest amounts we pay in taxes.

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Tomo -Therapy and Linear Accelerator Machines

After the well received project that was initiated to raise funds to obtain a PET scanner for the National Cancer Institute Maharagama (NCIM) the new initiative is to purchase similarly or even more important Tomo-Therapy and Linear Accelerator machines for the hospital. The project requires raising one billion rupees and if everyone can make a contribution with Rs. 50 the task may not be as large as it may seem. M.S.H. Mohamed who initiated the project to obtain the PET scanner after his son lost the battle against cancer, signed a MoU with the Ministry of Health to purchase the two machines said at a press conference held recently to launch the project that the people could also play its role as the Government is already spending up to about 50 million rupees for cancer patients, on surgery and drugs.

Anyone who wishes to contribute to this worthy cause can make a donation by depositing to the following account.

Account Name: APEKSHA CANCER HOSPITAL

Bank: Bank of Ceylon, Maharagama

Account Number: 71275069

(Sunday Observer)

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