🩺 Staying or Leaving: A Doctor’s Reflection in a Time of Exodus 🇱🇰✈️

By Dr. Shane Halpe | The Family Doctor Blog

In clinics and corridors across Sri Lanka, a single question echoes more than any other:
“When are you leaving?”

It’s not about leaving for the day. It’s about leaving the country—for good. The reality is sobering. Over 10,000 doctors, nurses, and allied health professionals left Sri Lanka last year alone, heading to the UK, Australia, the Middle East, or beyond. The result? Public hospitals are overwhelmed. Doctors are burning out. And yet, the exodus continues—forming a vicious cycle that’s hard to break.

---

📉 A System Under Strain

As someone still serving in the public system, I see this daily. Wards are packed. Clinics overflow. Patients wait for hours. The load on those who stay behind keeps growing, pushing many to the edge. Burnout isn’t theoretical—it’s real, personal, and creeping into every consultation room.

Government leaders offer mixed messages: On one hand, they speak optimistically at global forums. On the other, they assure us “there are enough doctors” or announce new hospitals in rural areas—plans that sound good on paper, but seem out of step with the shrinking workforce.

---

🌍 “When Are You Going?”

As a Senior Registrar in Family Medicine, currently awaiting foreign training, I too hear the familiar questions:

• “Where will you do your training?”

• “Are you leaving for good?”

• “Why stay back when there’s no future here?”

• “Wouldn’t your children be better off abroad?”

It’s tempting. The idea of a more stable income, a predictable future, a comfortable lifestyle for my family—all are powerful draws.

Yet… something in me hesitates.

---

🙏 A Bible Study, A Miracle, A Reminder

That hesitation deepened during a recent evening spent with a small group of Christian doctors and medical students. We had gathered for prayer and discussion. The topic? Career decisions and the desire to migrate.

We opened to a well-known passage: The Feeding of the Five Thousand (Matthew 14:13–21). A miracle I’d heard countless times—but this time, it struck a different chord.

“They do not need to go away. You give them something to eat.”
(Matthew 14:16)

The disciples had just returned from their own missions—tired, hungry, seeking rest. Yet, the crowd followed them, pressing in with needs and illnesses. Exhausted, the disciples asked Jesus to send them away. But Jesus, filled with compassion, responded differently. He saw the people. He felt their pain. And He chose to stay and serve.

With only five loaves and two fish, the disciples saw scarcity. Jesus saw abundance.

---

🏥 Modern Echoes in Ancient Words

Reading that story again, I saw ourselves. The doctors, nurses, and medical officers working in rural hospitals. The interns stretched beyond limits. The specialists juggling too much with too little. We are the disciples—saying:

• “It’s too late now.”

• “This is a remote place.”

• “We don’t have enough.”

And Jesus still replies:
“You give them something to eat.”

We often focus on the miracle of multiplication. But what struck me this time was the compassion that moved Jesus to act. The same compassion we are called to reflect.

---

🇱🇰 What Do We Have?

We may not have high salaries or world-class infrastructure. But what do we have?

• We have freedom.

• We have natural beauty.

• We have communities rich in resilience and heart.

• We have people—our people—waiting to be healed.

Maybe our wants have outgrown our means. Maybe simple living has fallen out of fashion. But as I reflected that evening, one question surfaced:

Is it really about what we lack—or is it about what we’ve lost sight of?

---

❤️ I Stay Because of Compassion

In the end, it’s not an economic calculation that keeps me here. It’s a calling.
A pull that’s deeper than convenience.

Yes, I will pursue my foreign training. But not to escape.
Yes, I will go abroad. But I also intend to return.
Because our five thousand are still waiting.
And they are ours.

“What good is it for someone to gain the whole world, yet forfeit their soul?”
(Mark 8:36)

So I stay. I serve.
Not because it’s easy.
But because compassion still compels me.

---

📝 If this reflection resonated with you—or if you’re a fellow health professional navigating similar questions—feel free to reach out or share your thoughts. Let’s journey together, with purpose.

A Costly Prescription: A Doctor’s Dilemma in a Broken System

💊 A Costly Prescription: A Doctor’s Dilemma in a Broken System

In clinical medicine, we’re trained to focus on the science—diagnosing the disease, selecting the most effective treatment, and prescribing accordingly. But what happens when the real challenge isn’t the disease, but the system meant to deliver the cure?

A recent encounter in my general practice made me pause and reflect on something I often overlook: the true cost of the medicines we prescribe, and the unseen burden it places on our patients.

The Patient Who Could Afford It—But Still Got Exploited

She’s a 65-year-old patient I’ve known for years—a respected general manager of a leading company. I’ve been managing her chronic conditions: diabetes, hypertension, dyslipidemia, and early renal impairment. She’s intelligent, disciplined, and financially well-off. In short, not someone who would flinch at the price tag of her medications.

But I was the one who flinched.

As a matter of policy and principle, I always prescribe using generic names. For example, I write Metformin, not the brand name. I do this to avoid pharmaceutical influence and to give the patient freedom to choose an affordable option. In my private practice, I usually stock essential medications myself—purchased wholesale from State Pharmaceutical Corporation (SPC) or State Pharmaceutical Manufacturing Corporation (SPMC) at a fair price.

However, this time, I had run out of stock. I sent her prescription—written generically—to a nearby pharmacy. What came back shocked me.

The Price Tag? Rs. 12,000 for One Month

Here’s what the pharmacy provided:

Empagliflozin – Rs. 2,900

Prazosin XL (2.5mg twice daily) – given at Rs. 5,000

Rosuvastatin 20mg – given in a brand name, costing Rs. 132 per tablet, totaling Rs. 3,920 for the month

That’s nearly Rs. 12,000 for just three medications. I couldn’t believe it. Yes, she could afford it. But is this fair? Is this ethical?

I immediately called the pharmacy and asked if they had any SPC or SPMC equivalents. They casually said yes. On requesting a refund and substitution, the Rosuvastatin brand was switched to an SPC version costing Rs. 42 per tablet—bringing the total for that drug down to Rs. 1,260. That’s a Rs. 2,640 difference—for one medicine, over one month.

Pharmacies First Offer the Most Expensive Brands

That experience opened my eyes. Pharmacies, especially when handed generic prescriptions, often offer the most expensive brand available by default. They don’t present options. They don’t explain price differences. They rarely ask if the patient prefers a state-supplied or more affordable version.

In a country where many families struggle to meet their basic needs, this practice is exploitative.

A Doctor’s Dilemma: What Should We Do?

This incident made me question my own approach. Should I start specifying not just the drug, but the manufacturer or brand? Should I write Rosuvastatin 20mg – SPC brand only? But that defeats the purpose of generic prescribing, which was meant to keep us impartial and patient-friendly.

It’s a real dilemma.

Should we prescribe the best-reviewed brand, the cheapest one, or the safest one—even if it's not affordable? When cost becomes a barrier, how do we balance clinical excellence with financial prudence?

The Bigger Picture: System Reform is Needed

This isn’t just a personal frustration—it’s a systemic problem. Without proper regulation, patients are vulnerable to profit-driven pharmacy practices. There must be guidelines requiring pharmacies to:

• Offer patients a choice between branded and generic versions
• Display transparent pricing for alternatives

• Honour prescriptions using state-manufactured medicines if available

Until then, doctors need to be more vigilant. Because not all our patients are company directors. For some, one month of medication is half their monthly income. That’s not just a clinical problem—it’s a moral one.

Prescribing With Heart—and With Eyes Open

Ultimately, this experience reinforced a truth I often forget: Prescriptions must be patient-centred—and pocket-centred. It’s not just about choosing the right drug for the disease. It’s about choosing the right drug for that patient, in that economic reality.

We may not be able to fix the system overnight, but we can start by being mindful, informed, and advocating for our patients at every step of their healing journey.

How Much Should We Help Others? A Reflection on Giving, Sacrifice, and Inner Peace

How Much Should We Help Others? A Reflection on Giving, Sacrifice, and Inner Peace

Growing up Catholic, certain teachings from the Bible etched themselves deep into my thinking. One in particular always stayed with me:

“If someone asks for your shirt, give him your coat as well. If someone forces you to go one mile, go with him two.”

I used to ponder: What does this really mean? Is it a call to blind generosity? To submission? Or something deeper?

For much of my life, I interpreted it quite literally — if someone asks for something I have, and if giving it brings more joy or benefit to them than it costs me, then I should give it. If someone makes my life difficult, perhaps I should still try to walk the extra mile — not because I must, but because choosing peace over resistance might serve me better.

But then I wondered: Is this foolishness? Shouldn’t we protect our time, our energy, our boundaries?

Over the years, I’ve come to understand these verses not as a call to passivity, but as a radical invitation to choose generosity and peace — intentionally. If someone wants to borrow something that still benefits me, yet benefits many others even more, I now try to share it freely. I might even give away the coat too.

And if resisting an unwanted burden only adds more tension and robs me of peace, sometimes it's wiser — and kinder to myself — to shoulder it quietly and move forward. It’s not weakness. It’s wisdom guided by peace.

After all, our journey on this earth is brief. The things we cling to — our possessions, our pride, our power — will not follow us when we go. What truly matters is the good we do, the lives we touch, the suffering we ease. Whatever faith or belief system we hold, if it leads us to love, uplift, and care for others — then it’s pointing us in the right direction.

Jesus made the ultimate sacrifice — not just by dying on a cross, but by choosing to give up what was rightfully His, so that others might live.

“If you want to gain your life, you must lose it.”

To me, that means letting go of our obsession with material things, power, lust, and greed — so we can embrace something deeper, something eternal.

Because in the end,

There is no greater love than to lay down one’s life for a friend.

And maybe, just maybe, the most generous thing we can give is not a coat or a mile — but our time, our presence, our peace.

A Medical Conference… and the Spark of a Story

It was the much-anticipated stroke conference in Jaffna. Our supervisor had encouraged us to attend—not just to stay updated on the latest in stroke care, but also to network with professionals in the field.

I was genuinely excited. It was a refreshing break from the regular rhythm of clinic life. Plus, I couldn’t deny my eagerness for the inevitable conference buffet—the kind of culinary delight that always adds a silver lining to academic events.

---

A Chance Encounter in the Lift

The venue was the Thiruvalluvar Cultural Centre, nestled close to the Jaffna Public Library. As we entered and stepped into the lift, just as the doors were about to close, they slid open once more.

A beautiful girl stepped inside.

She gave a shy smile and glanced briefly at the three of us before the lift ascended in silence to the second floor. As we exited, and she was safely out of earshot, my married colleague nudged me and whispered with a grin,

 “Why don’t you consider? She looks pretty.”

This had become a routine jest—the kind of light teasing I often received as the only single one in the group. I laughed it off, as always.

---

Lectures, Pharma Stalls, and Dessert

The conference rolled on. Some lectures were insightful, others not so much. We moved in and out of sessions, networked with old friends, and browsed through the pharma company stalls, collecting pens and pamphlets as one does.

Then came lunchtime. We were welcomed by a vibrant spread of curries, salads, and desserts. As we settled in to enjoy our meal, my other colleague—also unmarried—spotted the same girl from the lift now sitting alone at a table nearby.

“She looks nice,” he said thoughtfully. “Feels like talking to her.”

Without missing a beat, our ever-cheerful married friend grinned,

 “Machan, go for it.”

My friend’s eyes lit up. He smiled, nodded, and thanked him for the encouragement.

---

A Curious Excuse and a Bold Move

As we were about to leave the dining area and return to the hall, my friend suddenly announced,

“I need to wash my hands.”

I pointed toward the wash basin and continued chatting with my other colleague. A few minutes later, I turned around and—there he was. Not at the wash basin.

He was talking to her.

The two were engaged in conversation, smiling and laughing. And before long, we saw them exchange numbers.

It was only then that I remembered—he had been eating with a fork and spoon.

So why the urgent handwashing?

I laughed to myself. The “handwashing” was merely the exit strategy for something far more interesting.

---

The Beginning of a Story?

As I watched them talk, I thought, This could make a good story.

Or maybe, just maybe, it’s the beginning of one.

--

Sometimes, the most unexpected moments at a conference have nothing to do with medicine—but everything to do with life.

🩺 The Art of Breaking Bad News – A Lesson Beyond the Textbook

 🩺 The Art of Breaking Bad News – A Lesson Beyond the Textbook

Published by Dr. Shane Halpe – Family Doctor & Medical Educator
📍 Faculty of Medicine, University of Moratuwa | 🕊️ Inspired by a teaching moment in Jaffna

Modern medicine is not just about diagnosing illnesses or prescribing treatment. At its core lies the sacred responsibility of communication—especially when the news is hard to hear.

Whether it's informing a parent about their child’s autism diagnosis, telling a patient they have cancer, or discussing end-of-life care, breaking bad news is part of the everyday reality for doctors. And yet, it's one of the most emotionally demanding and least formally taught skills in medicine.

---

💬 Today’s Teaching Moment in Jaffna

This morning, I was part of a teaching session with 4th-year medical students doing their Psychiatry rotation at the Faculty of Medicine, University of Jaffna. The session was on breaking bad news—a topic often glossed over in textbooks, but deeply relevant in practice.

In one of the exercises, my colleague role-played the father of a 15-year-old boy diagnosed with an aggressive bone tumour: osteosarcoma. The student had the task of gently and clearly breaking this devastating news. As expected, the exercise was intense and emotionally charged—mirroring real-life clinical encounters.

---

🧠 A Story That Left an Impression

As the discussion unfolded, our consultant shared a powerful anecdote from his early career. He spoke of his time working as a junior doctor under a respected orthopaedic surgeon, Dr. Punchihewa.

Unlike many of his peers, Dr. Punchihewa spent less time in the operating theatre and more time with patients and their families—listening, explaining, and offering emotional support.

His philosophy?

> “You can always mend a broken bone, but you cannot mend a broken mind.”

This left a lasting impression on everyone in the room. It reminded us that the true essence of medicine lies not just in fixing bodies, but in healing hearts and minds.

---

💡 More Than Just Clinical Skills

This experience taught me an important lesson:

Being emotionally intelligent, empathetic, and sensitive to patients’ emotions is just as important as clinical knowledge and technical skills.

In an era dominated by AI and medical technologies, we must not allow the human touch to fade into the background. Machines may help us diagnose and monitor, but they can’t replace a kind word, a comforting presence, or a moment of shared silence in a time of grief.

---

📚 The Way Forward for Medical Education

As educators, we must ensure our students don’t just learn how to treat illness—but also how to treat people. Teaching soft skills like breaking bad news should be given the same importance as clinical training.

If not, we risk creating a generation of doctors who may know how to cure a disease—but not how to connect with the person behind the illness.

And that would truly be bad news for the future of our profession.

---

📖 “You can always mend a broken bone, but you cannot mend a broken mind.”

Let this be a guiding principle for every doctor, teacher, and medical student.