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Patient-centred care and CKDu

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Some observations on the occasion of World Kidney Day

By Prof. M.W. Amarasiri de Silva

(Inaugural Fellow, International Society of Nephrology 2018, Adjunct Professor at the University of Pittsburgh, USA, and Professor Emeritus, University of Peradeniya)

Today is World Kidney Day, and this year the principal focus is on patient-centred care for people living with kidney disease. This theme highlights the increasing recognition of the need to identify and address patients’ priorities, values, and goals in order to advance the research, practice, and policy designed to improve the quality of life of people suffering from chronic kidney disease. Regardless of the type of kidney disease or the approach to treatment adopted, patients want to live well, retain their social place, maintain some semblance of normality, and have a sense of control over their health and wellbeing. 

A patient-centred approach is one where the patients are treated as social individuals and enabled to take control of and improve their health. Thus, they become active participants in their care. Their biology becomes secondary in this process. Members of patients’ families and communities can continue to focus on them as people, rather than on their illness or disability. Support should concentrate on achieving the patients’ aspirations and be tailored to their needs and unique circumstances.

A patient-centred approach to health requires building public policy, creating supportive environments, facilitating community action, and developing and improving patients’ skills and knowledge of disease management. Overall, any such programme requires a complete reorientation of the treatment system. Those who work directly with patients at the District Secretariat (DS) Division level – the public health inspectors, public health nurses, nurses, hospital attendants, community workers, health educators, rural development officers, childcare officers, and others – should be directed towards a patient-centred approach, and trained in good communication skills and to address patient needs effectively. A patient-centred approach should address those with chronic disease of unknown aetiology (CKDu) within their family and community, and become an integral part of everyday life in the family and community. If CKDu sufferers are uprooted from their social setting and placed in a clinic-based environment, the treatment system becomes an artificial one with no link to the patient’s cultural milieu. Such treatment systems do not work satisfactorily.

In western societies, community health workers, working in communities, facilitate this process by assisting the medical specialists in hospitals. They visit the homes of patients and help their families to overcome problems through counselling. In Sri Lanka, such a link between the community/family and the hospital, focusing on the patient, is missing. Especially with regards to CKDu patients, establishing a connection between the community and the hospital is crucial. Such a link would help to alleviate the stigma attached to CKDu patients in the community and the neglect and isolation that many have to endure. Visits by hospital staff and paramedics to patients in their homes can improve the understanding of hospital staff about how patients live at home, what problems do they face at home and in the community. It would improve the commitment of patients towards their treatment. This would also improve their compliance with their medical regimen. A change in the treatment procedures from a hospital-based system to a patient-centred one is necessary, as the existing approach has had little impact in assisting CKDu patients in addressing their grievances and improving their quality of life, or in reducing the incidence of and death rates from the disease.

In a patient-centred approach to the treatment and care of CKDu patients, essential elements are community engagement and empowerment. Educating the patients and their families on disease risk factors and treatments is a prerequisite. In Sri Lanka, government programmes have invested in developing people’s understanding of the risk factors for CKDu but have not paid much attention to improving people’s knowledge of treatments and testing procedures. Therefore, most people in CKDu-affected areas have knowledge of the causes of CKDu, but have limited understanding of treatments. As a result, patients are not able to make an informed decision on the type of treatment that they should undergo or to discuss the subject with their medical professionals. They blindly accept (or reject) the type of treatment recommended by the doctors.  

In Sri Lanka, people’s knowledge of treatments for kidney disease is fragmentary. Their knowledge of things like blood transfusion is limited and is very hospital centred. Experience in other countries shows that patients on a home therapy or haemodialysis at home were more satisfied than those with in-centre haemodialysis. In Sri Lanka, haemodialysis at home has not been promoted.

Most CKDu patients undergo harrowing experiences in their communities and at home. They report a substantial drop in their quality of life. Their illness means that they cannot draw water from the dug well to wash or use the toilets with squatting pans. They are advised to install commodes in their toilets, but most CKDu patients cannot afford to do this. Many say that they cannot cultivate their rice paddy land, so they don’t get any income from agriculture. Although they are paid Rs. 5,000 by the government each month, that is not adequate for a family of five people to live an ordinary life. As CKDu patients find it difficult to use public transport, they have to hire a vehicle at a significant cost each time they visit the clinic. In many families, children have dropped out of school because their parents cannot afford to provide for their education. About 15% of CKDu patients in the villages live alone, with, in many cases, their wives having left them and gone to the Middle East for employment. Family members say that the CKDu patients have become demanding. Many CKDu patients and their family members display signs of depression and uneasiness.  

Those patients on dialysis need to attend the clinic once every three days. Many patients do not attend the clinics as required due to financial difficulties. Each visit to the clinic requires Rs. 2,000 to 3,000 for transportation, which is beyond many patients’ means, and therefore, after a few visits, they drop out of the dialysis programme. A patient told me, ‘the doctor told me that I have to get a kidney transplant. I am on the waiting list like many thousands of patients. I have no great hopes anyway. I undergo blood transfusion. I was asked to come to the clinic every third day, but I don’t have money to pay for a vehicle every time. I mortgaged my two acres of rice paddy two years ago, and the money has been spent on my treatment and food for the family’. 

A patient-centred approach should highlight how to improve the quality of life of CKDu patients and families. The quality of life for patients should become the dominant preoccupation in health promotion in CKDu communities. Essential health professionals, such as health educators, public health inspectors, and public health midwives, should take the lead in educating the CKDu-affected population about the management of patients at home and in their communities. They should discuss how behavioural changes could improve health, for example identifying the adverse effects of smoking and chewing tobacco. Referring to her husband, a CKDu patient, a woman said, ‘My husband smokes a lot. He smokes a bundle of beedi a day. One bundle of beedi is Rs. 100 and contains 25 beedis. He smokes them at night, early in the morning, and at work… However much I tell him to, he doesn’t stop’. Many patients do not regularly take the medication given by the clinic or attend their appointments as scheduled.

People surveyed during the course of my research were not very aware of the difference between CKD and CKDu. Most CKDu patients identified having diabetes and high blood pressure as risk factors for CKDu. They are risk factors for CKD, and CKDu develops due to other factors in the absence of diabetes and hypertension. Most end-stage patients did not know what treatment options were available for them, and preferred to stay and die at home. Compared to affluent families in the CKDu-affected communities, the paddy farmers who own less than two acres of rice paddy are less educated and lacking in CKDu-related health knowledge.

Any community empowerment programme, focusing on CKDu patients, should discuss the basics of kidney function, CKDu testing procedures, and the management of CKDu at home and in the community.

 

Recommendations:

A reorientation of the hospital-centred approach to a patient-centred one. This requires training local officers at the DS Division level. A programme for this has to be identified and discussed at ministerial level with the participation of Community Based Organisations in the area, patients, carers, medical and paramedical practitioners. A sociologist/anthropologist working in the area of community empowerment and participation would also be an asset.  

The introduction of home dialysis should be considered as a measure to enhance the community/family role in CKDu disease management. Home dialysis needs a cleanroom, which is hard to find in farmer households in CKDu-endemic areas. Therefore, for each Grama Niladhari Division, the government should consider building a spacious room in a central location and constructing all the facilities for patients to come and undergo dialysis. A community member should be trained to handle the procedures.  

To effectively address the increasing incidence of CKDu in the epidemic regions in Sri Lanka, a well-developed intervention and a community education programme, focusing on behavioural change, should be aimed at lower socioeconomic groups.

The government should strengthen the patient-centred approach to treatment and care. Although medical education programmes in the universities prioritize medical professionals’ role in treatment, patient-centred approaches are seldom discussed. The universities should focus on CKDu-affected districts when selecting villages for students’ intervention and training on a patient-centred approach. Departments of Community Medicine should take the lead in this direction. 

A programme to address depression among CKDu patients, needs to be established. DS Division level officers appointed for community work should be trained to handle the psychological issues afflicting CKDu patients. The education and counselling of end-stage kidney patients are essential as many such people have refused to undergo dialysis or kidney transplants.

The basics of kidney function and the risk factors for CKDu should be taught to school pupils in areas where CKDu is endemic.



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Federalism and paths to constitutional reform

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Chelvanayakam (R) and S. W. R. D. Bandaranaike shaking hands.

S. J. V. Chelvanayakam: Visionary and Statesman

S. J. V. Chelvanayakam KC Memorial Lecture Delivered at Jaffna Central Collage on Sunday, 26 April, by Professor G. L. Peiris – D. Phil. (Oxford), Ph. D. (Sri Lanka); Rhodes Scholar, Quondam Visiting Fellow of the Universities of Oxford, Cambridge and London; Former Vice-Chancellor and Emeritus Professor of Law of the University of Colombo.

I. Life and Career

Had Mr. Chelvanayakam been with us today, he would no doubt be profoundly unhappy with the state of our country and the world.

Samuel James Velupillai Chelvanayakam was born on 31 March, 1898, in the town of Ipoh, in Malaya. When he was four years of age, he was sent by his father, along with his mother, for the purpose of his education to Tellippalai, a traditional village at the northern tip of Sri Lanka, or Ceylon as the country was then called, in close proximity to the port of Kankesanturai. He attended three schools, Union College in Tellippalai, St John’s College Jaffna and S. Thomas’ College Mount Lavinia, where he was a contemporary of S. W. R. D. Bandaranaike, with whom he was later destined to sign the Bandaranaike-Chelvanayakam Pact.

He graduated in Science as an external student of the University of London, in 1918. In 1927, he married Emily Grace Barr-Kumarakulasinghe, daughter of the Maniyagar, or administrative chief for the area, appointed by the colonial government. He had four sons and a daughter. His son, S. C. Chandrahasan, worked closely with me during my time as Foreign Minister on the subject of repatriation of refugees from India. Chandrahasan’s wife, Nirmala, daughter of Dr. E. M. V. Naganathan, was a colleague of mine on the academic staff of the University of Colombo.

Mr. Chelvanayakam first contested the Kankesanturai constituency at the parliamentary election of 1947. His was a long parliamentary career. He resigned from his parliamentary seat in opposition to the first Republican Constitution of 1972, but was re-elected overwhelmingly at a by-election in 1975. He died on 26 April, 1977.

There are many strong attributes which shine through his life and career.

He consistently showed courage and capacity for endurance. He had no hesitation in resigning from employment, which gave him comfort and security, to look after a younger brother who was seriously ill. As his son-in-law, Professor A.J. Wilson remarked, he learned to move in two worlds: a product of missionary schools, he was a devout Christian who never changed his religion for political gain. He was, quite definitely, a Hindu by culture, and never wished to own a house in Colombo for fear that his children would be alienated from their roots.

Gentle and self-effacing by disposition, he manifested the steel in his character by not flinching from tough decisions. Never giving in to expediency, differences of principle with Mr. G. G. Ponnambalam, the leader of the All Ceylon Tamil Congress, of which Mr. Chelvanayakam was a principal organiser, led him to break away from the Congress and to form a new party, the Ilankai Tamil Arasu Kachchi, or the Federal Party.

During the disturbances in March and April, 1958, he was charged in the Magistrate’s Court in Batticaloa and sentenced to a week’s imprisonment. He was also subject to house arrest, but he never resorted to violence and used satyagraha to make his voice heard. When, in 1961, he was medically advised to travel to the United Kingdom for surgical treatment, he had to be escorted to the airport by the police because he was still under detention. Although physically frail and ailing in health during his final years, he lost none of the indomitable spirit which typified his entire life.

II. Advocacy of Federalism: Origins and Context

At the core of political convictions he held sacrosanct was his unremitting commitment to federalism. A moment of fruition in his life was the formation of the Federal Party, Ilankai Tamil Arasu Kachchi, on 18 December, 1949.

Contrary to popular belief, however, federalism in our country had its origin in issues which were not connected with ethnicity. At its inception, this had to do with the aspirations, not of the Tamils, but of the Kandyan Sinhalese. The Kandyan National Assembly, in its representations to the Donoughmore Commission, in November, 1927, declared: “Ours is not a communal claim or a claim for the aggrandizement of a few. It is the claim of a nation to live its own life and realise its own destiny”.

Mr. S. W. R. D. Bandaranaike, soon after his return from Oxford, as a prominent member of the Ceylon National Congress, was an ardent advocate of federalism. He went so far as to characterise federalism as “the only solution to our political problems”. With Thomas Hobbes in his famous work, The Leviathan, he conceived of liberty as “political power broken into fragments”. Bandaranaike went on to state in a letter published in The Morning Leader on 19 May, 1926: “The two clashing forces of cooperation and individualism, like that thread of golden light which Walter Pater observed in the works of the painters of the Italian Renaissance, run through the fabric of civilisation, sometimes one predominating, sometimes the other. To try and harmonise the two has been the problem of the modern world. The only satisfactory solution yet discovered is the federal system”.

Federalism had a strong ideological appeal, from a Marxist-Leninist perspective. The constitutional proposals, addressed by the Communist Party of Ceylon to the Ceylon National Congress on 18 October, 1944, go very far indeed. They envisioned the Sinhalese and the Tamils as two distinct “nations” or “historically evolved nationalities”. The high watermark of the proposals was the assertion that “Both nationalities have their right to self-determination, including the right, if they so desire, to form their own separate independent state”.

These proposals received further elaboration in a memorandum submitted to the Working Committee of the Ceylon National Congress by two leading members of the Communist Party, Mr. Pieter Keuneman and Mr. A. Vaidialingam. Their premise was set out pithily as follows: “We regard a nation as a historical, as opposed to an ethnographical, concept. It is a historically evolved, stable community of people living in a contiguous territory as their traditional homeland”.

The Soulbury Commission, which arrived in the country in December, 1944, had no hesitation in recognising that “The relations of the minorities – the Ceylon Tamils, the Indian Tamils, Muslims, Burghers and Europeans, with the Sinhalese majority – present the most difficult of the many problems involved in the reform of the Constitution of Ceylon”.

They took fully into account the apprehension expressed by the All Ceylon Tamil Congress that “The near approach of the complete transfer of power and authority from neutral British hands to the people of this country is causing, in the minds of the Tamil people, in common with other minorities, much misgiving and fear”.

III. Constitutional Provisions at Independence

The Souldbury Commission, like the Donoughmore Commission before it, was not friendly to the idea of federalism, principally because of their commitment to the unity of the body politic. Opting for a solution, falling short of federalism, they adopted the approach that, if the underlying fear related to encroachment on seminal rights by capricious legislative action, this anxiety could be convincingly assuaged by enshrining in the Constitution a nucleus of rights placed beyond the reach of the legislature.

The essence of the solution, which commended itself to the Soulbury Commission, was a carefully crafted constitutional limitation on the legislative competence of Parliament, encapsulated in Article 29(2) of the Independence Constitution. The gist of this was incorporation of the principle of non-discrimination against racial or religious communities by explicit acknowledgement of equal protection under the law.

The assumption fortifying this expectation was the attribution of an imaginative role to the judiciary in respect of interpretation. It was lack of fulfillment in this regard that precipitated a setback which time could not heal. Judicial attitudes, including those of the Judicial Committee of the Privy Council, which constituted at the time the highest tier of the judicial hierarchy, were timid and diffident.

When the Citizenship Act of 1948, by means of a new definition, sought to deprive Tamils of Indian origin of the suffrage, no protection was forthcoming from the courts on the ground of impermissible discrimination. This refusal of intervention was premised on an implausibly narrow construction of the word “community”, in that, according to the Courts’ reasoning, in the landmark case of Kodakkan Pillai v. Madanayake, Indian Tamils were not identifiable as a community distinct from the larger community of the Tamils of Ceylon. It is hard to disguise the reality that this was, at bottom, a refusal to deal with the substantive issues candidly and frontally.

The resulting vulnerability of minority rights, which judicial evasion laid bare, was a major contributory cause of the erosion of confidence on the part of minority groups. This mood of suspicion and despair, arising from an ostensibly weak method of protection of human rights, presaged ensuing developments.

IV. Further Quest for a Constitutional Solution

Chelvanayakam

The central theme of this lecture, in honour of a statesman who was an epitome of restraint and moderation, is that the deterioration of ethnic relations, which culminated in a war of unrivalled savagery over a span of three decades, was progressive and incremental. There was no inevitability about the denouement. It was gradual and potentially reversible. At several crucial points, there was opportunity to arrest a disastrous trend. These windows of opportunity, however, were not utilised: extremist attitudes asserted themselves, and polarisation became the outcome. This trajectory was, no doubt, met with dismay by far-sighted leaders of the calibre of Mr. Chelvanayakam.

The formation of the Federal Party was a turning point. With Mr. S.J.V. Chelvanayakam, King’s Counsel, as founder-president, and Dr. E.M.V. Naganathan and Mr. V. Navaratnam as joint secretaries, the party embarked on a journey which marked a radical departure from the conventional thinking of the past. This was plain from the text of seven resolutions adopted at the national convention of the party held in Trincomalee in April, 1951. The foundation of these resolutions was the call to establish a Tamil state within the Union of Ceylon, and the uncompromising assertion that no other solution was feasible.

The path was now becoming manifest. The demand up to now had been for substantial power sharing within a unitary state. This was now giving way to a strident demand for the emergence of a federal structure, destined to be expanded in the fullness of time to advocacy of secession.

Although standing out boldly as a landmark in constitutional evolution, the Federal Party resolutions did not carry on their face the hallmark of finality or immutability. The call of the Tamil leadership for secession yet being some years away, the ensuing decades saw further attempts by different governments to resolve the vexed issues around power sharing.

The first of these was the Bandaranaike-Chelvanayakam pact, signed by the Prime Minister and the leader of the Federal Party on 26 July, 1957. There was an air of uneasy compromise surrounding the entire transaction. This was evident from the structure of the pact, which, as one of its integral parts, contained a section not reduced to writing in any form, but consisting of a series of informal understandings.

The essence of the pact was the proposed system of regional councils which were envisaged as an intermediary tier between the central government and local government institutions. This did break new ground. Not only did the pact confer on the people of the North and East a substantial measure of self-governance through these innovative councils, including in such inherently controversial areas as colonisation, irrigation and local management, but territorial units were conceived of as the recipients of devolved powers. Of particular significance, the regional councils were to be invested with some measure of financial autonomy. The blowback, however, was so intense as to compel the government to abrogate the pact.

The next attempt, eight years later, was by the United National Party, which had vehemently opposed the Bandaranaike–Chelvanayakam Pact. This was the Dudley Senanayake–Chelvanayakam Pact, signed between the leader of the United National Party, at the time Leader of the Opposition, and the leader of the Federal Party. It differed from the Bandaranaike–Chelvanayakam Pact, both contextually and substantively.

As to context, it was signed on 24 March, 1965, on the eve of a parliamentary election, to ensure for the United National Party the support of the Federal Party. A disheartening feature was the plainly evident element of duplicity. Once in government, the Prime Minister’s party showed little interest in implementing the pact. Within three years, the Federal Party left the government, and its representative in the cabinet, Mr M. Tiruchelvam QC, Minister of Local Government, relinquished his portfolio.

Substantively, the lynchpin of the pact was a system of district councils, but there was entrenched control of these bodies by the central government, even in regard to action within their vires. This was almost universally seen as a sleight of hand.

Despite the collapse of these efforts, room for resilience and accommodation had by no means disappeared. Nowhere is this better exemplified than in the events which led up to the drafting and adoption of the “autochthonous” Constitution of 1972. This involved the historic task of severing the centuries-old bond with the British Crown and bringing into being the Republic of Sri Lanka.

One of the Basic Resolutions, which eventually found expression as Article 2 of the new Constitution, characterised Sri Lanka as a unitary state. The Federal Party proposed an amendment that the word “federal” should be substituted for “unitary”. Mr. V. Dharmalingam, the spokesman for the party on this subject, in his address to the Constituent Assembly, on 16 March, 1971, showed flexibility by declaring that the powers of the federating units and their relationship to the centre were negotiable, once the principle of federalism was accepted. Indivisibility of the Republic was emphatically articulated, self-determination in its external aspect being firmly ruled out.

There was no reciprocity, however. Mr. Sarath Muttettuwegama, administering a sharp rebuke, declared: “Federalism has become something of a dirty word in the southern parts of this country”. The last opportunity to halt the inexorable march of events was spurned.

The pushback came briskly, and with singular ferocity. This was in the form of the Vaddukoddai Resolution adopted by the Tamil United Liberation Front at its first national convention held on 14 May, 1976. The historic significance of this document is that it set out, for the first time, in the most unambiguous terms, the blueprint for an independent state for the Tamil nation, embracing the merged Northern and Eastern Provinces. The second part of the Resolution contained the nucleus of Tamil Eelam, its scope extending beyond the shores of the Island. The state of Tamil Eelam was to be home not only to the people of the Northern and Eastern Provinces, but to “all Tamil-speaking people living in any part of Ceylon and to Tamils of Eelam origin living in any part of the world who may opt for citizenship of Tamil Eelam”.

The most discouraging element of this sequence of events was the timid and evasive approach adopted by prominent actors at crucial moments. The District Development Councils Act of 1980 presented a unique opportunity. Disappointingly, however, the Presidential Commission, presided over by Mr. Victor Tennekoon QC, a former Chief Justice and Attorney General, lacked the courage even to interpret the terms of reference as permitting allusion to the ethnic conflict. Despite the persevering efforts of Professor A.J. Wilson, son-in-law of Mr. Chelvanayakam, and a confidant of President J.R. Jayewardene, and Dr. Neelan Tiruchelvam, the majority of the members were inclined to adopt a narrow, technical interpretation of the terms of reference. The setting of the legislation was one in which Tamil formations, such as the Tamil United Liberation Front, were struggling to maintain their moderate postures in an increasingly polarised environment, with pressure from radical elements proving almost irresistible.

The whole initiative paled into insignificance in comparison with a series of tragic events, including the burning of the Jaffna library during the run-up to the District Development Council elections in the North and the calamitous events of Black July 1983. Policymakers, at a critical juncture, had, once again, let a limited opportunity slip through their fingers.

The next intervention occurred in the sunset years of the United National Party administration. This was the Parliamentary Select Committee on the ethnic conflict, known after its Chairman as the Mangala Moonesinghe Committee, appointed in August, 1991.

The Majority Report made a detailed proposal which was intended to serve as the basis of a compromise between two schools of thought—one stoutly resisting any idea of merger of the Northern and Eastern Provinces, and the other demanding such merger as the indispensable basis of a viable solution. An imaginative via media was the concept of the Apex Council, which formed the centrepiece of the Majority Report. It adopted as a point of departure two separate Provincial Councils for the North and the East. This dichotomy would characterise the provincial executive as well: each Provincial Council would have an Executive Minister as the head of the Board of Ministers. However, over and above these, the two Provincial Councils together would constitute a Regional Council for the entire North-East region. Although presenting several features of interest, as a pragmatic mediating mechanism, the proposal did not enjoy a sufficiently broad support base for implementation. (To be concluded)

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Procurement cuts, rising burn rates and shipment delays deepen energy threat

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Norochcholai power plant

Coal crisis far worse than first feared

Sri Lanka’s coal supply crisis is significantly deeper than previously understood, with senior engineers and energy analysts warning that a dangerous combination of reduced procurement volumes, rising coal consumption and shipment delays could place national power generation at serious risk.

Information reviewed by The Island shows that Lanka Coal Company (LCC) had originally planned to secure 2.32 million metric tons of coal for the relevant supply period to meet generation requirements at the Lakvijaya coal power complex.

Following procurement discussions, the final arrangement was to obtain 840,000 metric tons from Potencia, including a 10 percent optional quantity, and 1.5 million metric tons from Trident, equivalent to 25 vessels.

However, subsequent decisions resulted in the cancellation of four Potencia shipments, reducing that supplier’s volume to 627,000 metric tons. This brought the total expected procurement down to 2.16 million metric tons, creating an immediate 160,000 metric ton deficit, even before operational demand is considered.

“This is a major shortfall in any generation planning model,” a senior engineer familiar with coal operations said. “When stocks are planned to the margin, a reduction of this scale can have serious consequences.”

Power sector sources said the deficit becomes more critical because coal consumption rates have increased by more than 10 percent, meaning larger volumes are now required to generate the same electricity output.

“In simple terms, the system is burning more coal for less efficiency,” an energy analyst told The Island. “That means the real shortage may be substantially larger than the paper shortage.”

Experts attributed the higher burn rate to ageing equipment, maintenance constraints and operating inefficiencies at the Norochcholai plant.

A third concern has now emerged in the form of shipment delays and possible unloading constraints, raising fears that even contracted supplies may not arrive in time to maintain safe reserve levels.

“If vessel schedules slip or unloading is disrupted, stocks can fall very quickly,” another senior engineer warned. “At that point, the country has little choice but to shift to costly thermal oil generation.”

Such a move would sharply increase electricity generation costs and place additional pressure on public finances.

Analysts said the convergence of three separate risks — procurement reductions, higher-than-expected consumption and delivery uncertainty — had created a serious energy planning challenge.

“This is no longer a routine procurement issue,” one industry observer said. “It has become a national power security issue.”

Calls are growing for authorities to disclose current coal inventories, incoming vessel schedules and contingency measures to reassure the public and industry.

With electricity demand expected to remain high and hydro resources dependent on rainfall, engineers caution that delays in addressing the coal gap could expose the country to avoidable supply disruptions in the months ahead.

By Ifham Nizam

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Lake Gregory boat accidents: Need to regulate water adventure tourism

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Gregory’s Lake

LETTER

The capsizing of two boats in Lake Gregory on 19 April was merely an isolated incident. It has come as a stark and urgent warning that a far more serious tragedy is imminent unless decisive action is taken without delay.

Mayor of Nuwara Eliya, Upali Wanigasekera has publicly stated that stringent measures have been introduced to prevent similar occurrences. However, it must be noted that such measures are unlikely to yield meaningful results in the absence of a comprehensive regulatory framework governing Inland Water Adventure Tourism (IWAT) in Sri Lanka.

For decades, this sector has operated without any regulation. Despite repeated calls for reform, there remains no structured legal mechanism to oversee operational standards, safety compliance, or accountability. Consequently, there is chaos particularly in critical operational aspects of this otherwise vital tourism segment.

The situation in Lake Gregory is not unique. Other prominent inland tourism destinations, such as Kitulgala and Madu Ganga, face similar risks. Without urgent intervention, it is only a matter of time before a major calamity occurs, placing both local and foreign tourists in grave danger.

At present, there appear to be no enforceable legal requirements governing:

*  The fitness for navigation of vessels

*  Mandatory safety standards and equipment

*  Certification and competency of boat operators

The display of permits issued by local authorities is often misleading. These permits function merely as revenue licences and should not be misconstrued as certification of compliance with safety or technical standards.

Furthermore, local authorities themselves appear constrained. The Nuwara Eliya Mayor is reportedly limited in his ability to enforce meaningful improvements due to the absence of legal backing. Compounding this issue is the proliferation of unauthorised operators at Lake Gregory, functioning with minimal oversight.

Disturbingly, there are credible concerns that some boat operators function under the influence of intoxicants, while enforcement authorities appear to maintain a lackadaisical stance. The parallels with the unregulated private transport sector are both evident and alarming.

In the absence of a proper legal framework, any victims of such incidents are left with no recourse but to pursue lengthy and uncertain claims under common law against individual operators.

The Minister of Tourism, this situation demands your immediate and personal intervention.

A robust regulatory framework for Inland Water Adventure Tourism must be urgently introduced and enforced. This should include licensing standards, safety regulations, operator certification, regular inspections, and strict penalties for non-compliance.

Failure to act now will not only endanger lives but also severely damage Sri Lanka’s reputation as a safe and responsible tourist destination.

The time for incremental measures has passed. What is required is decisive policy action.

Athula Ranasinghe
Public-Spirited Citizen

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