Coaxing the brightest young people away from Sri Lanka, as some rich countries do, will prolong the nightmare left by the Indian Ocean tsunami, says David Weatherall
Early on the morning of February 5, Sri Lanka's 57th Independence Day, I set off with two Canadian doctors to drive from the capital, Colombo, to Galle on the south coast, one of the regions worst hit by the tsunami. We had planned our visit before the events of December 26, 2004. It was one of a number of regular trips we had been making over nine years since a Sri Lankan paediatrician asked for international help in treating children with thalassaemia, a hereditary blood disease.
The first half of the journey, on the outskirts of Colombo and down the beautiful coast road, left us completely unprepared for what was to follow. Suddenly, we faced scenes of devastation reminiscent of newsreel footage of Hiroshima after the Second World War. The roadside was lined with mounds of debris - all that remained of the homes of those who had lived and worked by the sea. Trees were uprooted or bent into bizarre shapes, the hulls of upturned boats bobbed up and down in the sea, and there were rows of newly prepared graves. Among the rubble there were small groups of tents, and families attempting to deal with the hopeless task of rebuilding their homes. We stopped briefly at a large camp at which aid workers from all over the world were handing out food to the community; the twisted remains of a train hit by the tsunami, in which more than 1,000 people lost their lives, formed a grotesque backdrop.
After another stop at a makeshift clinic staffed by local doctors and volunteers, we arrived at Galle. The first sight that greeted us on the waterfront was Mahamodera Hospital, the main maternity centre for the region. When the first wave of the tsunami started to flood the building, hospital staff were able to move many of the women to the first floor, although several babies were drowned when the main wave completely flooded the ground floor. Although the fine old building withstood the blow, the wards were completely gutted; all that remained were rows of metal beds, piles of bent baby cots and tangled equipment.
In the fading light on the long journey back to Colombo, we saw a group of children holding candles outside a temple. But despite this deeply moving scene and the devastation and human suffering that it reflected, it is the memory of the total, eerie silence in the vast wards of the maternity hospital in Galle that will stay with me forever.
On January 28, the Centre for National Operations published estimates of the overall effects of the tsunami on Sri Lanka. Approximately 40,000 people are believed to have died and another 6,000 to 7,000 are missing.
There are about 97,000 displaced families; 283,557 members live in 498 welfare camps and 220,893 with friends. Of the 500,000 displaced people, 36 per cent are children. Initial surveys suggest that more than 3,000 children have lost one parent, and close to 900 both parents. The World Bank estimates the overall damage to Sri Lanka at approximately $1 billion (?524 million), although the island probably needs closer to $1.5 billion to recover.
But can Sri Lanka recover? Years of civil war and internal strife, with their inevitable effects on economic growth and development, left the country particularly vulnerable to a disaster of this kind. The aid and charitable gifts that are pouring in will no doubt allow Sri Lankans to rebuild homes and coastal industry and improve social services in the short term. But all this is ephemeral. Unless Sri Lanka can achieve political and economic stability, and this is far from certain, it will need much longer-term support to sustain improvements stemming from this short period of financial help. As we were leaving, I read a leading Sri Lankan Sunday newspaper bemoaning the lack of creative and professional talent in the country, pointing out that 80 per cent of students who complete secondary education have no opportunity to advance further. There is a massive workforce drain at every level, from doctors and engineers to women who have to disrupt their families by leaving to find menial work in the Middle East, a pattern that is all too common in poor Asian countries. How can a society achieve economic stability with this continuous drain of talent and the loss of those who support its social structure?
The awful events that followed the tsunami were a jolting reminder to rich countries that they have neglected the plight of the developing world over the past 20 years; the millions dying in Africa of poverty and preventable disease have been much less newsworthy than the overnight annihilation of Asian populations. Although the solutions to many of these problems are in the gift of governments of the developed world and large non-governmental organisations, these events should also be a reminder to their universities that they have a role to play in improving the prospects for developing countries.
Much could be achieved in evolving more focused and long-term help if universities in rich countries established partnerships with those in the developing world to pursue collaborative education and research, including a regular exchange of staff, students and technology. These programmes would have to be sustainable; over the nine years we have been working in Sri Lanka, while progress has been agonisingly slow, it has been possible to create new treatment and diagnostic centres for children with blood diseases and gradually to improve clinical services. The handful of similar extended programmes between universities in the UK and the developing world are making a difference. But if this valuable approach is to be expanded, there will have to be a major alteration of emphasis in education in our universities towards a much more global view of affairs, with a similar change of outlook on the part of funding bodies.
At the same time, we must re-examine how we educate young people from developing countries. At the bottom of the same page of the Sri Lankan newspaper that bemoaned the lack of professional people on the island, there was a short article describing a British education fair in Colombo.
Apparently, the British Council was extolling the virtues of education in the UK and how it enables students to obtain jobs in rich countries. Sri Lanka's inhabitants, particularly children, are bound to experience a long period of emotional stress and the country has one of the highest suicide rates in Asia. Yet it has only 30 psychiatrists and 40 trained counsellors.
There are more Sri Lankan consultant psychiatrists in the British National Health Service than in the whole of Sri Lanka. While we continue to poach talented young people from developing countries, they will have little chance to build up their own resources.
There is, therefore, an overwhelming case for the development of long-term university partnerships between rich and poor countries. Sustained programmes of this type greatly improve the standards and facilities of universities in developing countries, making it more likely that their most talented graduates will wish to stay in their own country, or return after training abroad. At the same time, we must ensure that the kind of education we give them is directed at the needs of their countries rather than those of the developed world.
The tragic events of December 26 and their aftermath should have jolted the governments of richer countries into the realisation that they can no longer ignore the needs of the developing world; it is a message that universities must also heed.
Sir David Weatherall is regius professor of medicine emeritus at Oxford University and chancellor of Keele University.