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Why hide the truth about CKDu?

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By Dr PARAKRAMA WAIDYANATHA

An open letter to the new Minister of Health

The chronic kidney disease (CKDu) has been a major non-communicable disease prevalent essentially among the Rajarata’s agricultural communities in the last three decades that had, on average, killed several thousand people annually. The disease aetiology is now known, with a high degree of certainty to be hard water in dug wells on high ground contaminated with fluoride. Because it largely affected the farming families, agro-chemicals were justifiably suspected as the cause although without evidence; and many, especially the ignorant politicians, including several key ministers without knowing the facts of the matter, have blamed agrochemicals.

In fact, the term wasa visa krushikarmaya (toxic- agriculture) was coined on conventional agriculture largely because of the misinformation. Ridiculous boards displaying that fruits and vegetables sold in wayside shops are ‘toxin-free’ have been a common sight. The shopkeeper hardly knows the origin of the produce!

Then, there was the much-hyped ‘toxin-free agriculture” or organic farming drive of the Yahapalana government, led by the then President and Ven. Ratana, which again was on the premise that agrochemicals are the cause of the disease. It was, however, a total failure. And it would appear that the current President too, rushed to organic farming with the misinformed judgment that agrochemicals are the cause of CKDu, and probably also of other non-communicable ones, although there has been no evidence for it! He should have consulted the scientists and academics in the relevant fields before rushing to the decision.

However, the new Finance Minister has, in a recent gazette notification, dated 31st July 2021, claimed to be published in order to “regulate the importation of chelated minerals and micronutrients” which were previously banned, has also ‘surreptitiously’ reverted the Presidential decision; allowing imports of virtually all straight chemical fertilizers and mixtures thereof, but on license! So, hopefully, farmers should have access to chemical fertilisers for the coming Maha season!

Be all that as they may, the writer’s concern is that despite the overwhelming research, as also supportive numerical evidence the Health Ministry/Department has been generating on the prevalence of CKD, through a broad surveillance with nationwide sentinel sites that has also supported the observation that drinking water quality is the major cause of the disease, it has hitherto made no formal pronouncement on the disease causation. Regrettably, neither the former Health Minister nor the Agriculture Minister seem to be aware of this fact, from the utterances they have made recently in Parliament and outside. In fact, both of them were seen yelling in Parliament, some days ago, that the cause for the kidney disease is agrochemicals! Further, at a meeting with the farmers some weeks ago, the Agriculture Minister exclaimed that the government has rushed into organic farming to save the kidneys of farmers!

Mr. Minister, please be aware of the following facts and take necessary action to clear the myth in the minds of the President, ministers and other authorities, that agrochemicals are the cause of CKDu, the number one non-communicable in the country:

1.

The scientific and medical community have developed an understanding of the origins of this chronic disease. Steps to control it have shown increasing success as the numbers stricken by the disease have decreased since 2016, following supply of clean drinking water to the residents of the endemic areas. And it is now critically important that people of all affected areas are provided with good quality drinking water. Apparently, when the Yapahalana authorities then “flogging the dead agrochemical horse” came to learn that polluted water was the cause of the disease, rumour was doing the rounds, that the authorities did not want people told about it for fear of an outcry for quality water!

2.

Research by at least five groups and many individuals, local and foreign, have shown that the disease is caused by the consumption of water from wells containing hard water and fluoride, found in geological formations known as Regolith aquifers that hold the water in the relevant dry zone areas. People who were settled rapidly during the Accelerated Mahaweli Programme on higher ground in the late 1970s, had to dig shallow wells or tube wells for their water supply. Estimates reveal that there are some 176,000 such wells in the Rajarata! CKDu is found essentially in villages drinking water from such wells. Residents who get their water from agricultural canals, rivers or reservoirs DO NOT CONTAMINATE CKD, whereas one would have expected them to do so if agrochemicals were the cause of the disease. Please see the attached graph (Fig. 1) from a publication by none other than Dr Asanga Ranasinghe, Coordinator of the CKDu Programme, Ministry of Health and others (BMC Nephropathy, Aug 2019) that reveal a sharp drop in the number of patients in the two most CKD affected districts of Anuradhapura and Polonnaruwa. This was a consequence of provision of safe drinking water, and in fact the people themselves in the affected areas realised that polluted water was the cause of the disease, and not drinking it. Further, the Table 1 below compiled from the data of 2018 Annual Health Bulletin (page 70), also confirm a sharp decline in the increase in patient numbers from 52% between 2014 and 2016 to just 12% between 2016 and 2018, which should essentially be a consequence of drinking good quality water. There is no other evidence to explain this prominent decline.

Sadly, however, the 2019 Annual Health Bulletin does not carry any information on the CKDu status, despite there being a nationwide Sentinel Survey of patient numbers; and the 2020 Annual Health Bulletin too has not been published to date! Why are the health authorities so negligent about the number one non-communicable disease in the country! Table 1

3. There is CKDu in areas like Mullaitivu where no agro-chemicals whatsoever have been used due to the Eelam wars. So it is now amply evident that residents who drink hard water rich in fluoride contract CKDu, but not those who drink water from streams, reservoirs and wells in the planes.

4.

No CKDu is found in the Hill Country (vegetable and tea cultivation) and in most other areas such as Kalpitiya (vegetable cultivation) where agrochemicals are used much more heavily than in the Rajarata.

5.

The WHO Report, 2013, concluded, amongst other things, that some CKDu patients secreted pesticide residues above the reference (permissible) levels, but did not refer to the pesticide residue status in the urine of the control subjects (from Hambantota) in the trial! Our subsequent analysis of the pesticide residue raw data, revealed that the numbers of subjects with urine pesticide levels were two to three times higher from the non-CKD (Control) area than among the CKD patients (See Table 2). Why did the WHO Report omit this critically important control data? Referring to pesticides, the Report merely stated that some CKDu patients had residues of some pesticides above reference limits! Was it to give the impression that pesticides were probably the cause? However, an International Expert Consultation held in 2018 on CKDu in Colombo, concluded that there is no evidence to implicate agrochemicals in the causation of the disease.

6.

Several ministers and most importantly even the President of the GMOA, Dr Padeniya have been repeatedly claiming that Sri Lanka is the country consuming the highest quantities of agrochemicals in the world. However, the published data of the World Bank (see Table 3) reveals that in this part of the world, we are the country consuming the lowest amount of fertiliser and the second lowest amount of pesticide per unit area!

In conclusion, the disease is evidently caused by consuming naturally contaminated well water. It has nothing to do with fertilisers or pesticides. The disease is prevented by supplying clean water to the endemic villages. This has been done largely by the distribution of rain-water collection tanks, and by the installation of reverse-osmosis water filtration plants by benevolent donors. Moreover, people in the affected areas are now aware of the cause of the disease and are taking preventive measures themselves, as evident from the data.

Please bring this information to the attention of the President and other authorities, so that vital national decisions are based on facts, and not myths!



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Opinion

The shadow of a Truman moment in the Iran war

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Wars often produce moments when leaders feel compelled to seek a decisive stroke that will end the conflict once and for all. History shows that such moments can generate choices that would have seemed unthinkable only months earlier. When Harry S. Truman authorised the atomic bombings of Hiroshima and Nagasaki in 1945, the decision emerged from precisely such wartime pressures. As the conflict involving the United States, Israel and Iran intensifies today, the world must ensure that a similar moment of desperate calculation does not arise again.

The lesson of that moment in history is not that such weapons can end wars, but that once the logic of escalation begins to dominate wartime decision-making, even the most unthinkable options can enter the realm of strategic calculation. The mere possibility that such debates could arise is reason enough for policymakers everywhere to approach the present conflict with extreme caution.

As the war drags on, both Donald Trump and Benjamin Netanyahu will face mounting pressure to produce decisive results. Wars rarely remain confined to their original scope once expectations of rapid victory begin to fade. Political leaders must demonstrate progress, military planners search for breakthroughs, and public narratives increasingly revolve around the need for a conclusive outcome. In this environment, media speculation about “exit strategies” or “off-ramps” for Washington can unintentionally increase pressure on decision-makers. Even well-intentioned commentary can shape the climate in which leaders make decisions, potentially nudging them toward harder, more dramatic actions.

Neither the United States nor Israel lacks the technological capability associated with advanced nuclear arsenals. The nuclear arsenals of advanced powers today are far more sophisticated than the devices used in 1945. While their existence is intended primarily as deterrence, prolonged wars have historically forced strategic communities to examine every available option. Even the discussion of such possibilities is deeply unsettling, yet ignoring the pressures that produce such debates can be dangerous.

For that reason, policymakers and societies on all sides must recognise the full range of choices that prolonged wars can place before leaders. For Iran’s leadership and its wider strategic community, absorbing this reality may be essential if catastrophic escalation is to be avoided. From Tehran’s perspective, the conflict may well be seen as existential. Yet history also shows that wars framed as existential struggles can generate the most dangerous strategic decisions.

The intellectual climate in Washington has also evolved. A number of influential voices in Washington now argue that the United States has become excessively risk-averse and that restoring global credibility requires a more assertive posture. Such arguments reflect a broader shift toward the language of renewed deterrence and strategic competition. Yet this very logic can make it politically harder for leaders to conclude conflicts without visible demonstrations of strength.

The outcome of this conflict will also be watched closely by other major powers. In 1945, the atomic decision was shaped not only by the desire to end a brutal war but also by the strategic message it sent to rival states observing the emergence of a new geopolitical era. Today, other significant powers will similarly draw lessons from how the United States manages both the conduct and the conclusion of this conflict.

This is why cool judgment is essential at this stage of the war. Whether the original decision to go to war was wise or ill-advised is now largely beside the point. Once a conflict has begun, the overriding priority must be to prevent escalation into something far more dangerous.

In such moments, the international system can benefit from the quiet diplomacy of actors that retain a degree of strategic autonomy. Among emerging nations, India stands out as a major emerging power in this regard. Despite its energy dependence on the Gulf and deep economic engagement with the United States, India has consistently demonstrated a capacity to maintain independent channels of communication across geopolitical divides.

This unique positioning may allow New Delhi to explore, discreetly and without public fanfare, avenues for de-escalation with Washington, Tel Aviv and Tehran alike. At moments of heightened tension in international politics, the world sometimes requires what might be called an “adult in the room”: a state capable of engaging all sides while remaining aligned exclusively with none.

If the present conflict continues to intensify, the value of such diplomacy may soon become evident. The most important lesson from 1945 is not only the destructive power of nuclear weapons but the pressures that can drive leaders toward choices that later generations struggle to comprehend. History shows that when wars reach their most desperate phases, restraint remains the only safeguard against catastrophe.

(Milinda Moragoda is a former Cabinet Minister and diplomat from Sri Lanka and founder of the Pathfinder Foundation, a strategic affairs think tank, can be contacted via email@milinda. This was published ndtv.com on 2026.03.1

by Milinda Moragoda

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Opinion

Practicality of a trilingual reality in Sri Lanka

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Dr. B.J.C. Perera (Dr. BJCP) in his article ‘Language: The symbolic expression of thought’ (The island 10.03.2026) delves deeper into an area that he has been exploring recently – childhood learning. In this article he writes of ‘a trilingual Sri Lanka’, reminding me of an incident I witnessed some years ago.

Two teenagers, in their mid to late teens, of Muslim ethnicity were admitted to the hospital late at night, following a road traffic accident. They had sustained multiple injuries, a few needing surgical intervention. One boy had sustained an injury (among others) that needed relatively urgent attention, but in itself was not too serious. The other had also sustained a few injuries among which one particular injury was serious and needed sorting out, but not urgently.

After the preliminary stabilisation of their injuries, I had a detailed discussion with them as to what needed to be done. Neither of them spoke Sinhala to any extent, but their English was excellent. They were attending a well-known international school in Colombo since early childhood and had no difficulty in understanding my explanation – in English. The boys were living in Colombo, while their father would travel regularly to the East (of Sri Lanka) on business. The following morning, I met the father to explain the prevailing situation; what needs to be done, urgency vs. importance, a timeline, prioritisation of treatment, possible costs, etc.

Doctor’s dilemma

The father did not speak any English and in conversation informed me that he had put both his boys into an International School (from kindergarten onwards) in order to give them an English education. The issue was that the father’s grasp of Sinhala was somewhat rudimentary and therefore I found that I could not explain the differences in seriousness vs, urgency and prioritisation issues adequately within the possible budget restrictions. This being the case and as the children understood exactly what was needed, I then asked the sons to ‘educate’ the father on the issues that were at hand. The boys spoke to their father and it was then that I realised that their grasp of Tamil was the same as their father’s grasp of Sinhala!

In the end I had to get down a translator, which in this case was a junior doctor who spoke Tamil fluently; explained to him what was needed a few times as he was not that fluent in English, certainly less than the boys, and then getting him to explain the situation to the father.

What was disturbing was having related this episode at the time to be informed that this was not in fact not an isolated occurrence. That there is a growing number of children that converse well in English, but are not so fluent in their mother tongue. Is English ‘the mother tongue’ of this ‘new generation’ of children? The sad truth is no and tragically this generation is getting deprived of ‘learning’ in its most fundamental form. For unfortunately, correct grammar and syntax accompanied with fluency do not equal to learning (through a language). It is the natural process of learning two/three languages (0 to 5 years) that Dr. BJCP refers to as being bilingual/trilingual and is the underlying concept, which is the title of Dr. BJCP’s article ‘Language: The symbolic expression of thought’.

“Introduction into society”

It is critical to understand at a very deep level the extent and process of what learning in a mother tongue entails. The mother’s voice is arguably the first voice that a newborn hears. Generally speaking, from that point onwards till the child is ‘introduced into society’ that is the voice he /she hears most. In our culture this is the Dhorata wedime mangalyaya. Till then the infant gets exposed to only the voices of the immediate /close family.

Once the infant gets exposed to ‘society’ he /she is metaphorically swimming in an ocean of language. Take for example a market. Vendors selling their wares, shouting, customers bargaining, selecting goods, asking about the quality, freshness, other families talking among themselves etc. The infant is literally learning/conceptualizing something new all the time. This learning process happens continuously starting from home, at friends/relatives’ houses, get-to-gathers, festivals, temples etc. This societal exposure plays a dominant role as the child/infant gets older. Their language skills and vocabulary increase in leaps and bounds and by around three years of age they have reached the so-called ‘language explosion’ stage. This entire process of learning that the child undergoes, happens ‘naturally and effortlessly’. This degree of exposure/ learning can only happen in Sinhala or Tamil in this country.

Second language in chilhood

Learning a second language in childhood as pointed out by Dr BJCP is a cognitive gift. In fact, what it actually does is, deepens the understanding of the first language. So, this-learning of a second language- is in no way to be discouraged. However, it is critical to be cognisant of the fact that this learning of the second language also takes place within a natural environment. In other words, the child is picking up the language on his own. As readily illustrated in Dr. BJCP’s article, the home environment where the parents and grandparents speak different languages. He or she is not being ‘forcefully taught’ a language that has no relevance outside the ‘environment in which the second language is taught’. The time period we (myself and Dr. BJCP) are discussing is the 0 to 5-year-old.

It does not matter whether it is two or three languages during this period; provided that it happens naturally. For as Dr. BJCP states in his article ‘By age five, they typically catch up in all languages…’ To express this in a different way, if the child is naturally exposed to a second /third language during this 0 to 5-year-old period, he /she will naturally pick it up. It is unavoidable. He /she will not need any help in order for this to happen. Once the child starts attending school at the age of 5 or later, then being taught a second language formally is a very different concept to what happens before the age of 5.

The tragedy is parents, not understanding this undisputed significance of ‘learning in/a mother tongue’, during the critical years of childhood-0 to 5; with all good and noble intentions forcefully introduce their child to a foreign tongue (English) that is not spoken universally (around them) i. e., It is only spoken in the kindergarten; not at home and certainly nowhere, where the parents take their children.

Attending school

Once the child starts attending school in the English medium, there is no further (or minimal) exposure to his /her mother tongue -be it Sinhala or Tamil. This results in the child losing the ability to converse in his/her original mother tongue, as was seen earlier on. In the above incident that I described at the start of this article, when I finally asked the father did he comprehend what was happening; his eyes filled with tears and I did wonder was this because of his sons’ injuries or was it because his decisions had culminated in a father and a son/s who could no longer communicate with each other in a meaningful way.

Dr BJCP goes on to state that in his opinion ‘a trilingual Sri Lanka will go a long way towards the goals and display of racial harmony, respect for different ethnic groups…’ and ‘Then it would become a utopian heaven, where all people, as just Sri Lankans can live in admirable concordant synchrony, rather than as a splintered clusters divided by ethnicity, language and culture’. Firstly, it must be admitted from the aspect of the child’s learning perspective (0 to 5 years); an environment where all three languages are spoken freely and the child will naturally pick up all three languages (a trilingual reality) does not actually exist in Sri Lanka.

However, the pleasant practical reality is that, there is absolutely no need for a trilingual Sri Lanka for this utopian heaven to be achieved. What is needed is in fact not even a bilingual Sri Lanka, but a Sri Lanka, where all the Sinhalese are taught Tamil and vice versa. Simply stated it is complete lunacy– that two ethnic communities that speak their own language, need to learn another language that is not the mother tongue of either community in order to understand one another! It is the fact that having been ruled by the British for over a hundred years, English has been so close to us, that we are unable to see this for what it is. Imagine a country like Canada that has areas where French is spoken; what happens in order to foster better harmony between the English and French speaking communities? The ‘English’, learn to speak French and the ‘French’ learn to speak English. According to the ‘bridging language theory of Sri Lanka’, this will not work and what needs to happen is both communities need to learn a third language, for example German, in order to communicate with one another!

Learning best done in mother tongue

eiterating what I said in my previous article – ‘Educational reforms: A Perspective (The Island 27.02.2026) Learning is best done in one’s mother tongue. This is a fact, not an opinion. The critical thing parents should understand and appreciate is that the best thing they can do for their child is to allow/encourage learning in his/her mother tongue.

This period from 0 to 5 years is critically important. If your child is exposed naturally to another language during this period, he /she will automatically pick it up. There is no need to ‘forcefully teach’ him /her. Orchestrating your child to learn another language, -English in this instance- between the ages of 0 to 5 at the expense of learning in his /her mother tongue is a disservice to that child.

by Dr. Sumedha S. Amarasekara

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Opinion

Tribute to Vijitha Senevirathna

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APPRECIATION

On Friday, the 20th of March, Vijitha Senevirathna would have celebrated his 85th birthday if not for his sad passing away nearly a year ago.

The passing of Vijitha was a moment of great sorrow to all who knew him.

He was my classmate from Montessori to pre-university at Maris Stella College, Negombo. As a Maristonian, Vijitha excelled in his academic studies.

Eventually, he entered the Law College and practised as an Attorney-at-Law and Notary Public for over 50 years.

As an Attorney-at-Law, Vijitha earned the respect of the judiciary and a wide circle of clients. He upheld the highest and most cherished values of the legal profession and earned the trust of all who knew him. His 50th anniversary in the noble profession of law was celebrated with much pageantry, amidst a distinguished gathering of friends, relations, clerics, and the rich and famous of Sri Lanka.

Vijitha dearly loved his proud wife Nirmali and his six children, who are in the highest professions in Sri Lanka. He inculcated among his children professional efficiency, diligence, and honesty.

We who associated closely with Vijitha miss his warm friendship, sense of humor, and animated conversation. He was a raconteur, and people gathered around him and listened to his narrations and tales of yore, especially at the many celebrations at his residence in Dehiwala, where the waters of Scotland flowed generously.

I have personally admired Vijitha’s patience, grit, and lifetime achievements, despite a physical dysfunctionality he suffered over his lifetime.

For Vijitha, the song has ended, but the melody lingers on, in the words of the popular composer Irving Berlin.

Merrick Gooneratne

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