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Childhood malnutrition: the double-edged sword

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BY Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

In an article published in the prestigious British Medical Journal as far back as 2004, titled “Is there hope for South Asia? Yes, if we can replicate the models of Kerala and Sri Lanka”, two erudite medical scholars Zulfiqar Bhutta and Samiran Nundy, held up our Motherland and its health system as a prototype for other countries in the region to follow. The authors noted that after gaining independence from the British, Sri Lanka invested heavily in education and health as a cornerstone of socioeconomic development. They also went to the extent of complimenting our country on achieving superlative results in achieving the very best health indices despite an ongoing civil war. The publication clearly documented that these results were due to committed political will, grassroots support, and an important policy plank based on primary healthcare, especially in maternal and child health, through a multi-layered health system with adequate provision of basic services at the community level. Indeed, we were top-of-the-pops in our Asian region.

Fast-forward 18 years. The very same British Medical Journal in an article published in November 2022, titled “Sri Lanka’s health crisis: Urgent action is needed to maintain vital services”, written by two Sri Lankan authors Shashika Bandara and Inosha Alwis, has taken an about turn of a complete 180 degrees. They state categorically that Sri Lanka is facing a severe political and economic crisis, and the health system is at risk of collapse. The authors say, “Interconnected challenges, including a severe shortage of essential medicines, a worsening socioeconomic landscape, and human rights violations, remain substantial threats to health in Sri Lanka”. Then the authors go on to describe two vitally important pieces of information that should make us sit up bolt-upright and take intense notice. They document that nearly six million Sri Lankans; three in every 10 households, are food insecure and face an 80% inflation rate for food. Then they go on to state that UNICEF estimates that over two million children in Sri Lanka require humanitarian assistance. The authors conclude that as far as policy imperatives go, Sri Lanka’s leaders need to improve their policy on health system strengthening in both the short term and the longer term.

All this brings us pointedly to the current situation regarding the fiasco in providing optimal nutrition for the children of our land. They are the jewels that would shape the future of our beautiful country. This author in an article titled: The “Feed a Child” initiative: A laudable effort of love from the Sri Lanka College of Paediatricians, published in The Island newspaper, as far back as 17th October 2022, in a telling lamentation stated “Childhood Malnutrition is the miserable topic of our times in the current fiasco of the crisis in our country. Many international organisations, as well as local authorities, have placed our land at the rock bottom of the abyss of childhood malnutrition”.

Then later on in that article, I went on to say “However, make no mistake, the current state of inadequate childhood nutrition is the harbinger of the resurgence of such dangerous forms of clinical states in the not-too-distant future. If steps are not taken to arrest the current trend, these would be the likely consequences that would threaten the lives of children”.

It is noteworthy that a so-called top legislator, not too long ago, in the citadel of the legislature, totally denied that there is childhood malnutrition in our country. That took place even despite compelling evidence to the contrary from several sources. The opposition, which usually breathes fire and shouts till they are hoarse, was silent. Their lot included several medical personnel too. Their silence too was deafening.

Then, hey presto., just a week after that incident, the same legislator had to eat humble pie and admit in the well of the citadel itself that childhood malnutrition was rampant. The opposition was still silent, perhaps in the belief that silence is golden, even when a person had lied through that person’s back teeth. As the former Prime Minister of Russia, Nikita Khrushchev once said about politicians “they are all the same”. Shame on all of them.

Here is something that is not all that well known. There is a gradual and most surreptitious increase in the number of low-birth-weight babies over the last couple of years. That is, at least in part, due to maternal malnutrition. The foetus needs all nutrients to grow within the womb and if the pregnant mother does not get sufficient essential nutrients in her diet, it will be the baby inside her who will suffer. That baby will be born malnourished.

The sword of childhood malnutrition is double-edged. It will lead to a stunted, frail, physically disadvantaged cluster of young people and adults. I do not have to spell out the obvious problems that may arise as a result of that. The other cutting edge of the sword is that we will have an intellectually disadvantaged and cognitively impoverished population as the growth of the young brain and the development of intellectual abilities depend on optimal nutrition. We have some of the best brains in our country at present. If we allow malnutrition to take root in our population, in 10 to 20 years, it may not be the case at all.

Now to a suggestion for a remedy in the short-term, perhaps to be undertaken even in the longer term.

The government should make sure that ALL students in ALL the schools, right around the country, will be provided breakfast in the school. It need not be exotic food., even manioc, sweet potatoes, yams, rice, sambol, gravy and an egg would do. A glass of fresh liquid milk will be a real bonus if the authorities can manage it. All these will give the students sufficient calories and proteins to work on during the day. None of them will faint due to hunger and low blood sugar levels.

Then they will go to their classes and will be taught, and taught well. That is entirely up to the teachers.

During the lunch interval, ALL students in ALL the schools, right around the country, should be provided lunch in the school. A simple meal of rice and curry with all locally available ingredients. The authorities can alternate different carbohydrates such as rice, manioc, sweet potatoes, yams, etc., with some locally available lentils, vegetables, fish/meat/eggs or textured vegetable proteins (TVP).

Of course, all of this will need money., loads of it. The government will have to somehow provide it. Just tax the high flyers. An extra two to five per cent tax for all those who are earning more than five million a year will easily cover the cost. Of course, the authorities will have to round up those liable to it, irrespective of caste, creed, political affiliations, etc. The henchmen and henchwomen of politicians, as well as the latter breed themselves, should not be allowed to escape at all costs. In addition, I am quite sure that there will be many local philanthropists who would like to join in this initiative. Their voluntary contributions should be tax-free donations. Parents and well-wishers could be roped in to attend to the logistics of the entire initiative as well.

Now, here is the crunch. For a start, all children will attend school, even simply for food. If the children get some evening meal or dinner at home, it will be nice. But…, and this is a BIG BUT; in the case of severely impoverished families, even if the children do not get anything substantial to eat after they come home from school, it would not matter that much as their daily nutrition would already have been looked after by the government…, at least to a reasonable degree.

It is most definitely a tall order. Are the legislators up to this? It will need real patriotism to somehow achieve this plan. It should be reiterated that with great power comes even greater responsibility. With the all-encompassing power they wield, they should shoulder this responsibility. They owe it to the people of our island nation.

As to whether they are up to it, your guess is as good as mine. My considered opinion is that none of the current lots would fit the bill. We will need a benevolent and far-sighted statesman or stateswoman to get this job done. Once accomplished, the rewards would be very many.



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Features

Cyclones, greed and philosophy for a new world order

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Floods caused by Cyclone Ditwah in Sri Lanka

Further to my earlier letter titled, “Psychology of Greed and Philosophy for a New World Order” (The Island 26.11.2025) it may not be far-fetched to say that the cause of the devastating cyclones that hit Sri Lanka and Indonesia last week could be traced back to human greed. Cyclones of this magnitude are said to be unusual in the equatorial region but, according to experts, the raised sea surface temperatures created the conditions for their occurrence. This is directly due to global warming which is caused by excessive emission of Greenhouse gases due to burning of fossil fuels and other activities. These activities cannot be brought under control as the rich, greedy Western powers do not want to abide by the terms and conditions agreed upon at the Paris Agreement of 2015, as was seen at the COP30 meeting in Brazil recently. Is there hope for third world countries? This is why the Global South must develop a New World Order. For this purpose, the proposed contentment/sufficiency philosophy based on morals like dhana, seela, bhavana, may provide the necessary foundation.

Further, such a philosophy need not be parochial and isolationist. It may not be  necessary to adopt systems that existed in the past that suited the times but develop a system that would be practical and also pragmatic in the context of the modern world.

It must be reiterated that without controlling the force of collective greed the present destructive socioeconomic system cannot be changed. Hence the need for a philosophy that incorporates the means of controlling greed. Dhana, seela, bhavana may suit Sri Lanka and most of the East which, as mentioned in my earlier letter, share a similar philosophical heritage. The rest of the world also may have to adopt a contentment / sufficiency philosophy with  strong and effective tenets that suit their culture, to bring under control the evil of greed. If not, there is no hope for the existence of the world. Global warming will destroy it with cyclones, forest fires, droughts, floods, crop failure and famine.

Leading economists had commented on the damaging effect of greed on the economy while philosophers, ancient as well as modern, had spoken about its degenerating influence on the inborn human morals. Ancient philosophers like Plato, Aristotle, and Epicurus all spoke about greed, viewing it as a destructive force that hindered a good life. They believed greed was rooted in personal immorality and prevented individuals from achieving true happiness by focusing on endless material accumulation rather than the limited wealth needed for natural needs.

Jeffry Sachs argues that greed is a destructive force that undermines social and environmental well-being, citing it as a major driver of climate change and economic inequality, referencing the ideas of Adam Smith, John Maynard Keynes, etc. Joseph Stiglitz, a Nobel Laureate economist, has criticised neoliberal ideology in similar terms.

In my earlier letter, I have discussed how contentment / sufficiency philosophy could effectively transform the socioeconomic system to one that prioritises collective well-being and sufficiency over rampant consumerism and greed, potentially leading to more sustainable economic models.

Obviously, these changes cannot be brought about without a change of attitude, morals and commitment of the rulers and the government. This cannot be achieved without a mass movement; people must realise the need for change. Such a movement would need  leadership. In this regard a critical responsibility lies with the educated middle class. It is they who must give leadership to the movement that would have the goal of getting rid of the evil of excessive greed. It is they who must educate the entire nation about the need for these changes.

The middle class would be the vanguard of change. It is the middle class that has the capacity to bring about change. It is the middle class that perform as a vibrant component of the society for political stability. It is the group which supplies political philosophy, ideology, movements, guidance and leaders for the rest of the society. The poor, who are the majority, need the political wisdom and leadership of the middle class.

Further, the middle class is the font of culture, creativity, literature, art and music. Thinkers, writers, artistes, musicians are fostered by the middle class. Cultural activity of the middle class could pervade down to the poor groups and have an effect on their cultural development as well. Similarly, education of a country depends on how educated the middle class is. It is the responsibility of the middle class to provide education to the poor people.

Most importantly, the morals of a society are imbued in the middle class and it is they who foster them. As morals are crucial in the battle against  greed, the middle class assume greater credentials to spearhead the movement against greed and bring in sustainable development and growth. Contentment sufficiency philosophy, based on morals, would form the strong foundation necessary for achieving the goal of a new world order. Thus, it is seen that the middle class is eminently suitable to be the vehicle that could adopt and disseminate a contentment/ sufficiency philosophy and lead the movement against the evil neo-liberal system that is destroying the world.

The Global South, which comprises the majority of the world’s poor, may have to realise, before it is too late, that it is they who are the most vulnerable to climate change though they may not be the greatest offenders who cause it. Yet, if they are to survive, they must get together and help each other to achieve self-sufficiency in the essential needs, like food, energy and medicine. Trade must not be via exploitative and weaponised currency but by means of a barter system, based on purchase power parity (PPP). The union of these countries could be an expansion of organisations,like BRICS, ASEAN, SCO, AU, etc., which already have the trade and financial arrangements though in a rudimentary state but with great potential, if only they could sort out their bilateral issues and work towards a Global South which is neither rich nor poor but sufficient, contented and safe, a lesson to the Global North. China, India and South Africa must play the lead role in this venture. They would need the support of a strong philosophy that has the capacity to fight the evil of greed, for they cannot achieve these goals if fettered by greed. The proposed contentment / sufficient philosophy would form a strong philosophical foundation for the Global South, to unite, fight greed and develop a new world order which, above all, will make it safe for life.

by Prof. N. A. de S. Amaratunga 
PHD, DSc, DLITT

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SINHARAJA: The Living Cathedral of Sri Lanka’s Rainforest Heritage

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Damp and thick undergrowth

When Senior biodiversity scientist Vimukthi Weeratunga speaks of Sinharaja, his voice carries the weight of four decades spent beneath its dripping emerald canopy. To him, Sri Lanka’s last great rainforest is not merely a protected area—it is “a cathedral of life,” a sanctuary where evolution whispers through every leaf, stream and shadow.

 “Sinharaja is the largest and most precious tropical rainforest we have,” Weeratunga said.

“Sixty to seventy percent of the plants and animals found here exist nowhere else on Earth. This forest is the heart of endemic biodiversity in Sri Lanka.”

A Magnet for the World’s Naturalists

Sinharaja’s allure lies not in charismatic megafauna but in the world of the small and extraordinary—tiny, jewel-toned frogs; iridescent butterflies; shy serpents; and canopy birds whose songs drift like threads of silver through the mist.

“You must walk slowly in Sinharaja,” Weeratunga smiled.

“Its beauty reveals itself only to those who are patient and observant.”

For global travellers fascinated by natural history, Sinharaja remains a top draw. Nearly 90% of nature-focused visitors to Sri Lanka place Sinharaja at the top of their itinerary, generating a deep economic pulse for surrounding communities.

A Forest Etched in History

Centuries before conservationists championed its cause, Sinharaja captured the imagination of explorers and scholars. British and Dutch botanists, venturing into the island’s interior from the 17th century onward, mapped streams, documented rare orchids, and penned some of the earliest scientific records of Sri Lanka’s natural heritage.

Smallest cat

These chronicles now form the backbone of our understanding of the island’s unique ecology.

The Great Forest War: Saving Sinharaja

But Sinharaja nearly vanished.

In the 1970s, the government—guided by a timber-driven development mindset—greenlit a Canadian-assisted logging project. Forests around Sinharaja fell first; then, the chainsaws approached the ancient core.

 “There was very little scientific data to counter the felling,” Weeratunga recalled.

“But people knew instinctively this was a national treasure.”

The public responded with one of the greatest environmental uprisings in Sri Lankan history. Conservation icons Thilo Hoffmann and Neluwe Gunananda Thera led a national movement. After seven tense years, the new government of 1977 halted the project.

What followed was a scientific renaissance. Leading researchers—including Prof. Savithri Gunathilake and Prof. Nimal Gunathilaka, Prof. Sarath Kottagama, and others—descended into the depths of Sinharaja, documenting every possible facet of its biodiversity.

Thilak

 “Those studies paved the way for Sinharaja to become Sri Lanka’s very first natural World Heritage Site,” Weeratunga noted proudly.

A Book Woven From 30 Years of Field Wisdom

For Weeratunga, Sinharaja is more than academic terrain—it is home. Since joining the Forest Department in 1985 as a young researcher, he has trekked, photographed, documented and celebrated its secrets.

Now, decades later, he joins Dr. Thilak Jayaratne, the late Dr. Janaka Gallangoda, and Nadika Hapuarachchi in producing, what he calls, the most comprehensive book ever written on Sinharaja.

 “This will be the first major publication on Sinharaja since the early 1980s,” he said.

“It covers ecology, history, flora, fauna—and includes rare photographs taken over nearly 30 years.”

Some images were captured after weeks of waiting. Others after years—like the mysterious mass-flowering episodes where clusters of forest giants bloom in synchrony, or the delicate jewels of the understory: tiny jumping spiders, elusive amphibians, and canopy dwellers glimpsed only once in a lifetime.

The book even includes underwater photography from Sinharaja’s crystal-clear streams—worlds unseen by most visitors.

A Tribute to a Departed Friend

Halfway through the project, tragedy struck: co-author Dr. Janaka Gallangoda passed away.

 “We stopped the project for a while,” Weeratunga said quietly.

“But Dr. Thilak Jayaratne reminded us that Janaka lived for this forest. So we completed the book in his memory. One of our authors now watches over Sinharaja from above.”

Jumping spide

An Invitation to the Public

A special exhibition, showcasing highlights from the book, will be held on 13–14 December, 2025, in Colombo.

“We cannot show Sinharaja in one gallery,” he laughed.

“But we can show a single drop of its beauty—enough to spark curiosity.”

A Forest That Must Endure

What makes the book special, he emphasises, is its accessibility.

“We wrote it in simple, clear language—no heavy jargon—so that everyone can understand why Sinharaja is irreplaceable,” Weeratunga said.

“If people know its value, they will protect it.”

To him, Sinharaja is more than a rainforest.

It is Sri Lanka’s living heritage.

A sanctuary of evolution.

A sacred, breathing cathedral that must endure for generations to come.

By Ifham Nizam

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How Knuckles was sold out

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Knuckles range

Leaked RTI Files Reveal Conflicting Approvals, Missing Assessments, and Silent Officials

“This Was Not Mismanagement — It Was a Structured Failure”— CEJ’s Dilena Pathragoda

An investigation, backed by newly released Right to Information (RTI) files, exposes a troubling sequence of events in which multiple state agencies appear to have enabled — or quietly tolerated — unauthorised road construction inside the Knuckles Conservation Forest, a UNESCO World Heritage site.

At the centre of the unfolding scandal is a trail of contradictory letters, unexplained delays, unsigned inspection reports, and sudden reversals by key government offices.

“What these documents show is not confusion or oversight. It is a structured failure,” said Dilena Pathragoda, Executive Director of the Centre for Environmental Justice (CEJ), who has been analysing the leaked records.

“Officials knew the legal requirements. They ignored them. They knew the ecological risks. They dismissed them. The evidence points to a deliberate weakening of safeguards meant to protect one of Sri Lanka’s most fragile ecosystems.”

A Paper Trail of Contradictions

RTI disclosures obtained by activists reveal:

Approvals issued before mandatory field inspections were carried out

Three departments claiming they “did not authorise” the same section of the road

A suspiciously backdated letter clearing a segment already under construction

Internal memos flagging “missing evaluation data” that were never addressed

“No-objection” notes do not hold any legal weight for work inside protected areas, experts say.

One senior officer’s signature appears on two letters with opposing conclusions, sent just three weeks apart — a discrepancy that has raised serious questions within the conservation community.

“This is the kind of documentation that usually surfaces only after damage is done,” Pathragoda said. “It shows a chain of administrative behaviour designed to delay scrutiny until the bulldozers moved in.”

The Silence of the Agencies

Perhaps, more alarming is the behaviour of the regulatory bodies.

Multiple departments — including those legally mandated to halt unauthorised work — acknowledged concerns in internal exchanges but issued no public warnings, took no enforcement action, and allowed machinery to continue operating.

“That silence is the real red flag,” Pathragoda noted.

“Silence is rarely accidental in cases like this. Silence protects someone.”

On the Ground: Damage Already Visible

Independent field teams report:

Fresh erosion scars on steep slopes

Sediment-laden water in downstream streams

Disturbed buffer zones

Workers claiming that they were instructed to “complete the section quickly”

Satellite images from the past two months show accelerated clearing around the contested route.

Environmental experts warn that once the hydrology of the Knuckles slopes is altered, the consequences could be irreversible.

CEJ: “Name Every Official Involved”

CEJ is preparing a formal complaint demanding a multi-agency investigation.

Pathragoda insists that responsibility must be traced along the entire chain — from field officers to approving authorities.

“Every signature, every omission, every backdated approval must be examined,” she said.

“If laws were violated, then prosecutions must follow. Not warnings. Not transfers. Prosecutions.”

A Scandal Still Unfolding

More RTI documents are expected to come out next week, including internal audits and communication logs that could deepen the crisis for several agencies.

As the paper trail widens, one thing is increasingly clear: what happened in Knuckles is not an isolated act — it is an institutional failure, executed quietly, and revealed only because citizens insisted on answers.

by Ifham Nizam

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