A man who achieved much amidst many obstacles

Prof. Kumariah Balasubramaniam, eminent pharmacologist and former advisor and coordinator, Health Action International Asia-Pacific (HAIAP) passed away this week. Following are excerpts from a tribute to him by Prof. Colvin Gooneratne published earlier in the Ceylon Medical Journal.

Had fate been less kind to young Kumariah when he contracted drug resistant pulmonary tuberculosis with axillary and cervical adenitis soon after completing his 2nd MB in March 1947, and allowed the tubercle bacillus to notch up yet another infamous victory, the world would have lost an individual who became, in the fullness of time, one of the most knowledgeable, resolute, articulate, versatile, resilient and in many other ways exceptionally brilliant health activists it has produced. The attack of tuberculosis halted the steady flow of academic successes he had achieved up to that time.

Born in September 1926 in Sandilipay, a serene pastoral village in the Jaffna peninsula, he had his first 10 years of schooling in the village school. He then joined Jaffna Central College, from where he passed in 1942 both the Senior School Certificate and the London Matriculation, placed in the First Division, a grand achievement in that era.

He entered the Faculty of Medicine of the University of Ceylon in 1945. and had passed the 2nd MB in 1947 when he contracted tuberculosis, Left with no other alternative his parents took him back to his village for Ayurvedic treatment of allopathic drug resistant tuberculosis, which took four years to complete, with annual checkups at Chest Hospital, Welisara.

At last in 1952 he was declared free of the dreaded disease, and allowed to rejoin the medical school. He went on to obtain second classes in the 3rd MB (with a distinction in Pharmacology), and in the Final MBBS, after being virtually full-time bedridden for nearly 6 years.

Dr Kumariah Balasubramaniam (Bala to his friends and everyone who knows him) joined the Department of Pharmacology in the University of Colombo headed by Professor Senaka Bibile - whom Bala described as his role model as a Demonstrator in 1959, and in 1964 after a short stint in the Department of Health Services, as a lecturer in the Department of Pharmacology at the University of Peradeniya, again under the tutelage of Professor Bibile. He proceeded to the University of Manchester in the UK in 1967, from where he obtained the Diploma in Clinical Pharmacology in 1968, and the PhD in 1970 for his research on the biotransformation of amylobarbitone in healthy adults and patients with chronic renal insufficiency.

When he returned to Peradeniya in 1970), he was the only permanent academic staff member in his Department, Professor Bibile having been made the first Chairman of the newly established State Pharmaceuticals Corporation and later a Consultant to UNCTAD, and Dr. (Pep) Jayasena, the only other lecturer in the Department, taking up duties as Registrar of the University of Sri Lanka.

During this period Bala accomplished what I regard as his second miracle, the first of course being his recovery from drug resistant tuberculosis by a combination of will power and Ayurvedic medication. The second miracle comprised doing all the lectures, tutorials and examinations in Pharmacology by himself in English, Sinhala and Tamil, in addition to doing Physiology lectures in Tamil at the request of Professor Valentine Basnayake, and conducting Professor T. Varagunam's hypertension clinic at the General Hospital, Mahanuwara, at his request.

By this time, Senaka Bibile had introduced Bala to the social, economic, cultural and political dimensions of pharmaceuticals and health care delivery, on the way to formulating a pharmaceuticals policy for Ceylon, key elements of which have found worldwide acclaim and application. And so, Bala knew by then what he must do.

To no one's surprise he left the University of Peradeniya in 1978 to join the Technology Division of UNCTAD (United Nations Conference on Trade and Development) in Geneva to participate in an inter-agency Task Force comprising UNCTAD, WHO and UNIDO (United Nations Industrial Development Organisation) to examine and develop the pharmaceutical sector in developing countries.

The Task Force visited 15 countries in Africa, Asia and Latin America and submitted a comprehensive report. Bala continued to work in UNCTAD implementing some of the recommendations, and at the request of the relevant governments he worked with Health Ministry officials to develop policy documents to strengthen the pharmaceutical sectors in Ethiopia, Nepal, Cuba, Philippines, and the Republic of Tanzania.

In 1981 Bala participated, at the invitation of the United Nations Non-Governmental Liaison Service, in an international seminar on pharmaceuticals held in Geneva, Health Action International (HAI) was born at that meeting.

HAI soon became a global coalition of consumer groups, development and health related organisations, medicinal drug action groups, academic institutions and health activists dedicated to promoting rational use of medicinal drugs and ensuring social justice and equity in health care, Bala was a founder member of HAI, and continued to be one of its stalwarts.

In 1987 Bala moved to Penang in Malaysia to accept the post of Advisor and Co-ordinator of HAI Asia-Pacific, and from Penang to Colombo in 2002 when it was relocated here. Bala edited the HAI News from 1987 todate.

He presented papers, by invitation, at international conferences in nearly all capital cities in Europe, and SAARC and ASEAN countries. He received the prestigious Commonwealth Vice-Chancellors' Fellowship Award for 1994-95 and the equally esteemed Olle Hanson Award for 2006.

Bala had to overcome numerous obstacles along the way - political, fiscal, bureaucratic and personal and he succeeded nearly always against tremendous odds. I am impelled to cite a few of Bala's seminal writings for the benefit of readers who may not be familiar with their range and import: (i) National Health Insurance and Financing the international Scene and Foreign Models (1996. Kuala Lumpur) (ii)Models of Health Care Financing (2000, Kuala Lumpur; (iii) Sri Lankan Peoples Health charter (iv) Charter of Patients' Rights and Responsibilities (2005.

Colombo) (v) Patent Policies and Pharmaceutical Prices (2004, Colombo (vi) Access to Medicine and Public Policy Safeguards under TRIPS (2002, Bangladesh) (vii) Heads - Transnational Companies Win, Tails The South Loses.

(1996 Builefeld Germany) (viii) International Drug Policies: consumer Concerns (1997, Oslo) (ix) Right to Health and Relation to Globalization (2004, Chennai) (x) Traditional Medicines (2004). (xi) Herbal Medicines. Consumer Protection Concerns (1997 Honolulu, Hawaii).

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