Brief Bio:
Shanthi is from Sri Lanka where she did her medical training and continued with graduate studies in North America. As a University lecturer, she enjoys teaching students and making them question and think deeply about what they truly understand. While she studied Buddhism in high school; read some Buddhist philosophy as an undergraduate; and identified as Buddhist in her formative years, she describes herself today as a feminist who is committed to social justice and the project of decolonization. (*Shanthi uses her pen name)
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I was born in Colombo which is the capital of Sri Lanka. My mother is also from Colombo, but my father’s family is from India. His father had come to Sri Lanka for work in the 1940s, retired and didn’t go back to India; after he died, my grandmother stayed too because she wanted to die in their family home. They were a Hindu family, and in those days, marriages were typically arranged but my parents met at university.
Sri Lanka has a diversity of ethnic and religious groups and my mother is from the majority Sinhala group. I don’t identify as ‘Tamil,’ neither do I identify as ‘Sinhala’. I check the ‘Other’ box when it comes to ethnicity. My parents didn’t make a big deal about our ethnic heritage. My father’s parents were Malayali; they were from Kerala which is the state next to Tamil Nadu in southern India and they spoke Malayalam, not Tamil. Since I grew up mostly with my mother’s family, as a child I didn’t realize I was not ‘Sinhala.’
I was close to both my grandmothers because six months after I was born, my parents went to do their postdoctoral work in Canada. My sister was five years old at the time and went with them. So, for about a year, I didn’t see my parents and got close to both my grandmothers, staying 6 months with one and 6 months with the other.
When my parents returned from Canada, I moved with them to Kandy which is in the hill country in the middle of the island. They were both lecturers in chemistry at the University of Peradeniya but worked on different projects.
During this time, my sister developed asthma and the doctors advised that it would be good for her to be in Colombo as many people had asthma problems in Kandy. So, we were both sent to Colombo and stayed with my maternal grandmother and my uncle’s family in my mother’s family home. My mother’s siblings and their families were in Colombo too. We lived there for 2 years, and I went to an elite all-girls’ private missionary school.
The 1983 riots happened while we were in Colombo. I was 5 and I remember seeing the shop at the top of the road on fire. Tamil homes and shops were attacked by Sinhala mobs because some military personnel had been killed in the north of the island which is largely populated by Tamils. When the bodies were brought back to Colombo, the riots began. The government didn’t do much to curb the violence, and many Tamil people were killed.
During the riots, my uncle and aunt sheltered their Tamil friends, including my paternal grandparents, in their home. There were lots of people at the house. I remember playing cricket, table tennis, and cards with my cousins and other children. As a child, I did not understand the violence that had unfolded.
That major riot in 1983 was when many Tamils left Sri Lanka. My father’s parents had a shop in Colombo and it was looted like many Tamil-owned businesses. Although we were not Tamil, my father’s family name sounded Tamil. I remember going in a car and my cousin’s fiancé was driving us; he was bringing my grandparents on my father’s side to my aunt’s house which is on my mother’s side of the family. The car was stopped for inspection and I remember the fear we all felt; if they had spoken directly to my grandparents, they would have recognized their accents as not being Sinhala.
I don’t remember my father being around much in our childhood because he was very involved in Marxist politics and busy with university work. When we schooled in Colombo, my mother came to see us every weekend.
My sister and I moved back to Kandy two years later and I went to Grade 1 at a convent in Kandy. I hated it. One of the Sisters—the principal of the lower school—used to cane us and I had never had that experience before. I was very unhappy at school. My parents then went on sabbatical to Sweden when I was 8 and this time, I went along. We attended an International school in Stockholm. I loved the snow. We also went to Canada during that time because my mother’s sister lived in Vancouver; my parents did a short research stint at the University of British Columbia and we had our cousins there as well.
I forgot all my Sinhala within that short period in Sweden and Canada. When we returned to Kandy, I went back to the Convent and had to take a placement test. Of the three classes within Grade 3, I was marked for Class 3 with the academically weaker students; many of them were orphans and I remember that some didn’t even have shoes. Then the teacher from Class 2 took me into her class because I did well in English. But the caning continued when I forgot to take my books to school. I really wanted to go back to my school in Colombo to be with my cousins. My mother finally agreed to send me back on condition that I stayed at the hostel.
I was ready for Grade 5 and happy to be back in Colombo even though I initially did not like living in a dormitory. I moved back in 1989 in the midst of more violence. I had been in Kandy in 1987 when the second JVP, Janaka Vimukthi Peramuna, insurrection took place. The JVP were a so-called Marxist movement. It included frustrated, unemployed youth and some University students were also part of the movement. The government wanted to crush this movement and the military were killing these youth and anyone under suspicion. At the same time, civilians as well as police and military were being killed by the JVP.
At the University of Peradeniya near Kandy, there was a pond and some people were killed and their heads placed around it. It was a horrifying time. Schools were shut down, we couldn’t turn on the lights, the JVP set rules about what we could do or couldn’t do. People were disappearing. University professors weren’t in too much danger, but other people were and the violence came from both sides, the government as well as the insurgents.
In some ways I feel that people who grew up in the 1980s in Sri Lanka got numbed to violence. I knew of people who saw their loved ones being burnt and killed. I saw violence but it wasn’t very close to me; I can’t say the same for some of the people who are close to me now.
Life went on. From Grade 5 till my Advanced A-levels (tier above the US Grade 12), I was in Colombo. My sister stayed in Kandy. She’s always been closer to my parents, I think. In Colombo, my mother’s sister was the Principal’s assistant at school and I would visit her home on the weekends. But soon, with my older cousin preparing for her A-level exams, I stopped visiting on weekends and became a monthly boarder, which meant I visited them more rarely, about one weekend per month.
For the most part, I schooled with about the same cohort in Colombo even though I had those absences with returning to Kandy and traveling overseas for a bit; it was nice that my friends remembered me when I came back.
I remember growing up wondering about my religious identity, what was I? My father always had a very negative thing about religion. He is an atheist and believes that science will explain everything. For my father, religion was not based on scientific principles, and therefore not worthy of consideration. My mother, Ammi, is from a Sinhala Buddhist family but isn’t a temple going type or into the rituals.
With the Sri Lankan school syllabus, you have to declare what your parents’ religion is and study that at school. So, I studied Buddhism in school but my father would make fun about the monks and rituals. At school, teachers who knew my mother wanted me to be in the Buddhist students’ association; I was in the ‘Buddhist Society’ but left it because I didn’t want to take “Sil.” “Sil” is taken by laypeople, simulating monastic values, and on those observance days, I would feel like I really didn’t belong.
From very early on, my mother made me read. I read a lot of fiction at a level higher than my class level. I loved reading and would read during class by hiding my book in the hole beneath my desk.
In Grade 8, I had an amazing English teacher. We had a text to read in each grade. For Grade 8, we read The Tale of Two Cities. This teacher brought in a lot of extra material, we watched the movie as well, and read many poems; she made English so interesting. Her essay topics were also unusual and she encouraged me to write. I loved creative writing. She had bad asthma and used an inhaler several times during class. I didn’t realize that she was quite sick. In the 3rd term, she was not around, she had died during the holidays. If she had continued being my teacher, I may have ended up doing English literature.
In Sri Lanka, after the Ordinary O-level exams when you’re about 16, you decide what you’re going to do. I hadn’t thought very much about what I would do for my A-Levels. There weren’t many choices: just the math, science, commerce and languages streams. Math and science were always in the background. My sister was very good at Math; I was fine but not as good as her. I never really liked Science although I performed well. I was more into the Languages track but my friends would say, “You’re good in science, why do Languages?” I think losing my Grade 8 English teacher influenced my decision to go into Science.
There was also quite a lot of pressure for me to do science from my teachers, some of whom had been taught by my parents. Although my parents never really told me what to do, my father was always saying stuff like, “Science is the greatest thing in the world.”
I’d also always wanted to be a teacher but people, including my teachers, would tell me that was not a good choice, that I could do better. My mother didn’t discourage me though. My mother was more present during my childhood. My father was more into his Marxist interests but he made us always feel that we could do anything and be anyone we wanted to be. I got that message from school as well.
Women’s rights were important for my mother and we talked about this topic in class for English literature. I then started thinking that salaries for teachers were really low and I didn’t want a job where I might have to depend on someone. So, what other jobs could I do that involved working with people? I wasn’t interested in banking or an office job.
People were impressed with medicine and there was also pressure from my teachers to do science, which generally meant medicine. I think that’s how I got into science and then medicine. I don’t remember wanting to do medicine for altruistic reasons.
I went into the A-level science stream. I didn’t do very well as my interests were elsewhere. I became a prefect, and then Head Prefect, and got involved in organizing events and all kinds of other things. I also spent time playing games at the hostel with my friends with tennis, table tennis and swimming. I stayed in Science even though I was not doing well.
It was now 1995 and I was in year 13 doing my A levels, the pre-university exams. Then, the Tamil Tiger group (LTTE) bombed the Central Bank in Colombo. There was talk that they were also targeting schools in Colombo. Schools in Colombo were closed for about 3 months and I went to Kandy during this time. With no friends, no distractions, and my mother putting me in tuition classes, my studies improved.
At school in Colombo, boarders could not take extra tuition classes, unless we performed poorly in a subject. I had physics tuition once a week and some tuition in zoology as well. When I came to Kandy I was individually tutored in botany and physics by past students of my parents, and my mother coached me in chemistry. I ended up doing well in my A-levels and got a place in medical school. It was totally unexpected considering my previous performance at school.
I was given a spot at the University of Colombo’s medical school, the place where everyone wanted to be. But I always knew I wanted to go to Peradeniya University, where my parents worked, and so I transferred through a mutual exchange with another student.
That really burst my bubble, coming from an elite All Girls’ private school to a public university.
Ragging was bad at the universities. The students’ union was very politicized. They wanted to control the students, especially their affiliation with political parties. If you didn’t get ragged, you wouldn’t be allowed to join many student groups and couldn’t rely on support from the student community.
We had studied up to the A-levels in Sinhala and the sudden switch to English was especially difficult for students from rural areas. Seniors would provide catch up classes to students who were struggling with language, but you couldn’t join these classes if you didn’t comply with ragging. Even though students didn’t like being ragged, they didn’t have a choice if they needed extra help with coursework. This was how the students’ union controlled the student body.
English speaking in a social setting is very class related in Sri Lanka. I grew up speaking English with my parents and their families because of my social background, and also because they were from two different language backgrounds. We spoke English at home and I spoke English with my friends and teachers even though classes were taught in Sinhala at high school. At University, there was a lot of resentment towards students from my social background.
Fortunately, there was also the “Anti-rag” group which you could join to avoid being ragged. In my batch, there were 8 or 9 of us out of 180 who went with Anti-rag; most of us were fairly good in English and confident we could manage without extra help. I remember not wanting to be dropped off in my parents’ car, that was a no-no. We also dressed in a certain way. Like no pants or sleeveless tops. I took off my nose ring.
The dress code at the Faculty of Medicine was different than in the other schools at University because we had to dress formally for classes and clinical rotations. Women students in Science and Arts wore chintz dresses and flip-flop Bata slippers during the rag period. This was an attempt by the students’ union to bring students from all social backgrounds to the same level.
The division between “Rag” and “Anti-rag” could have stretched over the 5-year course but at the end of the first year, we had a big social event that brought the two groups in our cohort together. My “Rag” class mates decided to invite us, the Anti-rag group, to the event. By the second year, I had friends from the Rag group. I remember they were quite careful to not take photos together with us so the seniors wouldn’t know we were getting together. By my final year, there was really no difference in who we hung out with.
But the gender issue remained awful throughout my time in University.
All the leadership positions, from student union president to batch (class) representative were all held by men. At any event, social or otherwise, the guys did the fun stuff and the girls made the food and drinks. The message that girls shouldn’t do Surgery or OB-GYN because of the work intensity and time schedule was driven into us by teachers and students. Things haven’t changed very much in the system since then, although more women than men enter medical schools today.
At university, I started reading more about Buddhism and its philosophy. This was different from my experiences at school where we learnt reductionist, moralistic, practice and ritual oriented Buddhism for the O-levels. Reading the philosophy about birth and death made me think about how we don’t really know much about our existence and purpose and it brought up a lot of questions for me. I liked what I read and thought it sounded more agnostic than atheist. I was not sure about whether an external God existed or not, and this seemed to matter very little in Buddhism. I think my reading from that period influenced how I see life or death. Even today, I don’t care to think about an afterlife, being dead is just part of the cycle of life, it’s not a sad event but also not a celebration.
In terms of career, I never really knew what I wanted to specialize in. In medical school, studies were so intense, and I was never fully into it. I also missed not having time for other reading. I didn’t do very well. I got a second-class honors degree and even that surprised me. I remember being interested in OB-GYN when I entered medical school, but without encouragement, I didn’t really pursue it.
After medical school, I really wanted to go somewhere far away. I also thought about skipping my internship because I was unhappy in medical school. I thought about teaching basic sciences or going into research. But I didn’t feel strongly about these things either. People advised me to not give up my residency. That’s how I ended up in Badulla, a 4-hour bus ride from Kandy. It was a plantation area and not a place that many people would have chosen for their internship. About half of the interns were from around that area and the rest were Sri Lankans who had studied medicine abroad like my roommate who was a Latvian graduate.
We worked hard because the hospital functioned as the referral center for the entire Province. But we also had a lot of fun and that’s when I began to really enjoy medicine. Because of understaffing, we had to work in the blood bank and also assisted in surgical theater. Since this wasn’t a teaching hospital, there was less hierarchy, and we had closer interactions with the senior house officers (post-resident doctors) and consultants. There was also a lot of drinking (among men), partying, and it was generally understood that most of us were not on track towards specialization.
My father became more influential in my life during this time. He was critical of the medical establishment even though I think he was secretly happy that I had gone into medicine. But he also talked about how doctors were money oriented and such. My sister and brother-in-law (now ex-BIL) had gone into psychology and there was a lot of discussion at home about medicine in relation to gender, power, who decides who’s sane and insane, etc. These conversations made me think about medicine in terms of society.
The hospital I worked at in Badulla served the plantations. I did my internship first in OB-GYN and then in medicine. I remember the plantation workers who came in at the very last minute for their delivery. These women were in situations of poverty and many were undernourished. I think they were one reason I got interested in public health. I think I would have got interested in public health much earlier if the community medicine curriculum had dealt with social aspects of health and illness in more depth when I was in medical school.
The consultant I trained with in internal medicine at Badulla was quite a dragon! People were scared of her but if you worked with her, you really learned your medicine. We had to start rounds at 6 in the morning and had to have seen all the patients and made sure everything was in order before she arrived at about 8:30 to do the ward rounds with us. If she wasn’t pleased with what you were presenting about the patients, she would pinch your elbow painfully and, under her breath, so the patients couldn’t hear, she’d say “Get out!” and you just had to leave.
In Sri Lanka, after the internship, you either join a hospital and work under the supervision of a consultant or work independently as a general practitioner. If you want to become a consultant, you need to take further exams and postgraduate work towards the title of MD. I decided to remain in Badulla for my first appointment and work in anesthesiology, mostly because I had made friends with several anesthetists and also knew anaesthesiology would be useful in terms of training. But I had no real intention to go into postgraduate training in anesthesia.
I had an amazing consultant in anesthesiology who practically lived in the hospital. I got a lot of good training in the operating theatres and also spent time in the intensive care unit and emergency obstetrics. I found that I actually loved the work and, on my consultant’s insistence, applied to specialize in anesthesiology. I got through the first level exams but changed my mind while working on the second set.
Awful things were happening in the country during this time with escalating ethnic tensions. Towards the end of the civil war, it became clear that the media were being manipulated, and things were very polarized. Many of the doctors I worked with, assumed I was Sinhala when discussing the war between the military and Tamil Tigers. There was a lot of talk about “us” versus “them.” Sinhala Buddhist nationalism was being used by politicians to consolidate power, and doctors seemed to be falling prey; it was all very disillusioning to me.
Around this time, I began to see Buddhism in light of politics. It was difficult to separate Buddhism from the state-sponsored religion it was. As I thought about issues of social justice and injustice, I began to wonder whether karma enabled setting aside certain forms of injustice as one’s lot in life. Also, practicing Buddhism in terms of its philosophy seemed too much a form of self-preoccupation for me.
This was also when I was getting more interested in social medicine. With my decision to abandon my postgraduate plans in anaesthesiology, and the traumatic end of a long drawn out relationship, it all came together for me to apply for graduate studies.
I was accepted into a Master’s program in Public Health in the US. I was in the Global Health and Population Department of a public health school. I had a supportive supervisor, which made all the difference. She was working on human rights and health which meshed with my interests in access to health care and women’s health. Through her, I got the chance to intern with the World Health Organization. This was when I began to understand the politics of global health. At the time, I remember I wasn’t even sure if I would return to Sri Lanka.
The university was so elite. We got to interact with all these big names. Although I enjoyed this aspect of it and was in a master’s program that led to the doctoral program, I decided to leave the university after my Master’s. For one, my supervisor who had been there for 10 years, didn’t get tenure. I also didn’t like the program requirements in global health. There was too much economics, and the overall approach to healthcare was driven by neoclassical economics.
I started looking at PhD programs which were more about medical sociology and that’s how I got to Canada with a fully funded fellowship at another elite institution to do my doctoral studies in public health. There were many exciting courses. I shared interests with a marginal group in my department where interests in critical social theory were dying out. But I enjoyed the program because it gave lots of flexibility in terms of my doctoral research.
Through various connections, I met many Sri Lankans in Canada who had faced violence at home and left. This was very different to my experience in the US, where I associated mostly with my cohort, many of whom were Americans from privileged social backgrounds. I didn’t really get a sense of racism or the black experience in the US since I lived in a largely college town. Being Sri Lankan in Canada was very different because people seemed to assume I was a refugee who had come to stay. Although cosmopolitan in many ways, at the higher levels, the city was also very white. Even within the university, the Undergrad population was quite mixed and then at the Master’s and PhD levels, it was more white. The Sri Lankan refugees I knew were really struggling to adjust and trying to get jobs and I saw that racism upfront.
With my studies in Canada, there was a center for critical qualitative health research, offering courses that dealt with epistemology and ontology. I started questioning how in public health, we label people and put them in categories. I certainly see the utility of quantitative research and numbers do help, numbers are convincing, and I want to use them to demonstrate health disparities. Normal distribution and probabilities are necessary, but we also don’t really know a lot. The hierarchy of evidence in medicine that places systematic reviews and randomized controlled trials at the apex has also colored our way of practicing medicine. We seem to be losing the relationship that we have with our patients as people. We’re trained as machines and not to think about what knowledge is.
In qualitative research, we are trained in another way. I use critical social science methodologies that demand questioning what we really know and how we know. It’s changed how I relate to clinical medicine. To practice medicine, you must believe in it, and I simply don’t. The valourization of randomized controlled trials is also of concern because even clinical trials are dictated by commercial interests. So, it’s hard for me to believe in protocols because I think about where those protocols came from and about individual variability. Like prescribing statins for cholesterol — is this all a big scam driven by Big Pharma or are they really beneficial to patients? If someone asked me whether they should take aspirin (advocated as a precautionary measure against stroke), I wouldn’t know what to say because there’s conflicting evidence and I’m not sure I would take aspirin myself.
I guess, the US and Canada experience gave me different ways of looking at things, especially the politics of health and to critically interrogate knowledge that I previously saw as black or white. Having returned to Sri Lanka, I find it frustrating not having people to discuss these questions. I still collaborate with colleagues from North America and write on the politics of global health, and this is what keeps me engaged.
I don’t regret for a moment that I returned. There’s lots of unexplored territory in terms of public health research. I really love my teaching because it gives me a chance to give medical students an opportunity to question and think about what they’re learning—something I did not have as a medical student. As a public health teacher in the university system, I try to push the boundaries of knowledge and what is possible.
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