Connect with us

Features

Possible resurgence of childhood measles; last thing we need

Published

on

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.

The disease measles, also known as rubeola and morbilli, is an extremely contagious infective viral illness in children, characterised by fever and a skin rash, with the potential to cause diarrhoea, respiratory complications, like pneumonia, ear infections and inflammation of the brain. It has a very characteristic clinical picture, and the diagnosis is clinically quite obvious to those doctors who have seen it before. Currently, there are sophisticated antibody and viral isolation tests that could be used to confirm a definitive diagnosis of a measles infection.

Measles, though often recognised as a usual childhood illness and, perhaps, as just a part of growing up, was, however, well known to be a killer of some affected children, right up to about the middle of the 1980s. The younger the affected child, the more the likelihood of the occurrence of complications; infants under one year are the most vulnerable. Many children succumbed to the development of intractable respiratory infections and acute brain inflammation. This author, who saw loads of measles cases in his medical student days, early career and consultant stages, can vouch for what is documented here.

Of course, in many affected children, it was a rather mild disease. Yet for all that, in some, it caused very many problems. The crux of the matter was that it was not at all possible to predict which of those affected by the virus was likely to develop major complications. The acute involvement of the brain in the form of inflammatory encephalitis could kill or leave the child with permanent brain damage. There is no treatment or anti-viral drugs to treat this condition.

Even more importantly, measles was recognised in the late 1960s to be the cause of delayed onset brain damage known by the technical term Sub-acute Sclerosing Panencephalitis (SSPE). In that condition, known as a ‘slow-virus’ infection, the virus remains in the brain and slowly eats into the tissues of the brain over months and years. It is a slow but relentlessly progressive terrible complication of measles and is characterised by disturbances of motor functions with uncontrollable jerky movements of the head, trunk or limbs, overt convulsions or fits, progressive cognitive and higher brain function deterioration, changes in behaviour and even blindness.

In the advanced stages of the disease, individuals may lose the ability to walk as their muscles stiffen or spasm. There is progressive deterioration to a comatose state, and then to a persistent vegetative brain-dead state. Death is inevitable as there is no effective curative treatment. It kills and the diagnosis is a very definitive death certificate. Even if one child gets SSPE, it is one too many as there is no known treatment. It is a terrible complication of measles and doctors are entirely helpless in treating it.

This scenario completely changed, totally for the better, when Sri Lanka started an island-wide immunisation programme against measles in 1984. Later, we used the Measles-Rubella (MR) vaccine from 2001 and then we started using the Measles-Mumps-Rubella (MMR) vaccine from 2011. This author was the Consultant Paediatrician in Badulla when the measles vaccination was started and then he was transferred to the General Hospital, Ratnapura, in January 1985. In both these institutions, we saw a dramatic reduction in measles cases and later on in cases of SSPE.

From then onwards, over the years, there were a few catch-up campaigns of vaccination to vaccinate those who had missed. There was practically 100 percent coverage of all children through our Expanded Programme of Immunisation with fantastic results. The World Health Organisation (WHO) certified Sri Lanka as a measles-free country in 2016.

Having been put through the mill over the years, and through many a natural as well as man-made catastrophe in the not-too-distant past, we need a resurgence of measles, just like a hole in the head. We have got more than our fair share of problems to worry about without having to deal with the resurrection of an awfully contagious viral disease, like measles.

However, there are very loud alarm bells being sounded this year. Around the middle or so of May 2023, there was a diagnosed case of measles in a 23-year-old admitted to the National Hospital in Colombo. Then there were confirmed cases being reported from the Lady Ridgeway Hospital for Children and also from other areas of the country. Up to the time of writing this article, close to 50 cases have been reported, mostly from Colombo and the suburbs of Colombo, and some sporadic cases from several other areas of the country.

One thing was a common denominator for all these cases. THEY HAVE ALL NOT BEEN PROPERLY AND COMPLETELY VACCINATED AGAINST MEASLES. Eighty-seven percent were not given even one dose of the vaccine, and 17% had only one dose. None of those with measles had both doses of the vaccine. It was all due to vaccine hesitancy and vaccine refusal on the part of the parents. The vast majority of the patients were from one ethnic group.

Many things worry all of us in situations like this. From experience, this could just be the start of an epidemic as we know to our cost that this is how such things start. This is particularly so because we have an extremely vulnerable cohort of 6- to 9-month-old babies who have not been vaccinated and who do not have natural immunity transferred from the mother. Originally, it was decided to give the first dose of the vaccine at nine months of age because the immunity in the mothers as a result of acquiring the natural disease during their childhood, had sufficient antibodies to be transferred to the babies which lasted up to around nine months of age.

However, once the disease was wiped out, the current set of mothers have immunity against measles only through two doses of the vaccine that they have had during their childhood rather than through natural measles infection. Research work done internationally and in Sri Lanka has very clearly shown that the babies of those mothers have very little, if any, antibodies against measles from six months of age. They belong to the lot of an extremely susceptible and defenceless group in whom the disease could spread like wildfire. By their age, they are also a group of children in whom the propensity to develop all complications of the disease is sky high.

The Epidemiology Unit and the Family Health Bureau of the Ministry of Health have responded ever so promptly to the current situation by instituting certain measures. To their eternal credit, no stone has remained unmoved in a dedicated quest towards thwarting the development of an epidemic of measles.

However, there is a limit to what they could do. The success of it all depends on public cooperation and reinvigorating a sense of public-spiritedness and intense responsibility on the part of all Sri Lankan parents. All these vaccine-avoider parents may have their reasons for taking such a course of action and on closer scrutiny, all of them are based on myths. None of those reasons stand up to scientific scrutiny and as I said before, any death from measles, EITHER IN THE ACUTE PHASE OR YEARS LATER DUE TO SSPE, IS A DEATH THAT IS ONE DEATH TOO MANY.

All parents in our country, irrespective of age, caste, creed, religion, or ethnicity, simply owe it to our nation to put their collective shoulder to the wheel to prevent a dismal and disastrous calamity of a measles epidemic in our country. This writer has fought many valiant battles in the past to protect our children from infectious diseases. He has even crossed swords with the Health authorities for the sake of the children of our Motherland. All he is asking now is unstinted cooperation from the parents. If you have the slightest regard for what I say, PLEASE, PLEASE, VACCINATE ALL CHILDREN. Let none of them be left behind.

I have said this before, even very recently at that, and I will say it again, even ad nauseam…, even to ad infinitum…., VACCINATION SAVES LIVES!



Features

Cricket and the National Interest

Published

on

The appointment of former minister Eran Wickremaratne to chair the Sri Lanka Cricket Transformation Committee is significant for more than the future of cricket. It signals a possible shift in the culture of governance even as it offers Sri Lankan cricket a fighting possibility to get out of the doldrums of failure. There have been glorious patches for the national cricket team since the epochal 1996 World Cup triumph. But these patches of brightness have been few and far between and virtually non-existent over the past decade. At the centre of this disaster has been the failures of governance within Sri Lanka Cricket which are not unlike the larger failures of governance within the country itself. The appointment of a new reform oriented committee therefore carries significance beyond cricket. It reflects the wider challenge facing the country which is to restore trust in public institutions for better management.

The appointment of Eran Wickremaratne brings a professional administrator with a proven track record into the cricket arena. He has several strengths that many of his immediate predecessors lacked. Before the ascent of the present government leadership to positions of power, Eran Wickremaratne was among the handful of government ministers who did not have allegations of corruption attached to their names. His reputation for financial professionalism and integrity has remained intact over many years in public life. With him in the Cricket Transformation Committee are also respected former cricketers Kumar Sangakkara, Roshan Mahanama and Sidath Wettimuny together with professionals from legal and business backgrounds. They have been tasked with introducing structural reforms and improving transparency and accountability within cricket administration.

A second reason for this appointment to be significant is that this is possibly the first occasion on which the NPP government has reached out to someone associated with the opposition to obtain assistance in an area of national importance. The commitment to bipartisanship has been a constant demand from politically non-partisan civic groups and political analysts. They have voiced the opinion that the government needs to be more inclusive in its choice of appointments to decision making authorities. The NPP government’s practice so far has largely been to limit appointments to those within the ruling party or those considered loyalists even at the cost of proven expertise. The government’s decision in this case therefore marks a potentially important departure.

National Interest

There are areas of public life where national interest should transcend party divisions and cricket, beloved of the people, is one of them. Sri Lanka cannot afford to continue treating every institution as an arena for political competition when institutions themselves are in crisis and public confidence has become fragile. It is therefore unfortunate that when the government has moved positively in the direction of drawing on expertise from outside its own ranks there should be a negative response from sections of the opposition. This is indicative of the absence of a culture of bipartisanship even on issues that concern the national interest. The SJB, of which the newly appointed cricket committee chairman was a member objected on the grounds that politicians should not hold positions in sports administration and asked him to resign from the party. There is a need to recognise the distinction between partisan political control and the temporary use of experienced administrators to carry out reform and institutional restructuring. In other countries those in politics often join academia and civil society on a temporary basis and vice versa.

More disturbing has been the insidious campaign carried out against the new cricket committee and its chairman on the grounds of religious affiliation. This is an unacceptable denial of the reality that Sri Lanka is a plural, multi ethnic and multi religious society. The interim committee reflects this diversity to a reasonable extent. The country’s long history of ethnic conflict should have taught all political actors the dangers of mobilising communal prejudice for short term political gain. Sri Lanka paid a very heavy price for decades of mistrust and division. It would be tragic if even cricket administration became another arena for communal suspicion and hostility. The present government represents an important departure from the sectarian rhetoric that was employed by previous governments. They have repeatedly pledged to protect the equal rights of all citizens and not permit discrimination or extremism in any form.

The recent international peace march in Sri Lanka led by the Venerable Bhikkhu Thich Paññākāra from Vietnam with its message of loving kindness and mindfulness to all resonated strongly with the masses of people as seen by the crowds who thronged the roadsides to obtain blessings and show respect. This message stands in contrast to the sectarian resentment manifested by those who seek to use the cricket appointments as a weapon to attack the government at the present time. The challenges before the Sri Lanka Cricket Transformation Committee parallel the larger challenges before the government in developing the national economy and respecting ethnic and religious diversity. Plugging the leaks and restoring systems will take time and effort. It cannot be done overnight and it cannot succeed without public patience and support.

New Recognition

There is also a need for realism. The appointment of Eran Wickremaratne and the new committee does not guarantee success. Reforming deeply flawed institutions is always difficult. Besides, Sri Lanka is a small country with a relatively small population compared to many other cricket playing nations. It is also a country still recovering from the economic breakdown of 2022 which pushed the majority of people into hardship and severely weakened public institutions. The country continues to face unprecedented challenges including the damage caused by Cyclone Ditwah and the wider global economic uncertainties linked to conflict in the Middle East. Under these difficult circumstances Sri Lanka has fewer resources than many larger countries to devote to both cricket and economic development.

When resources are scarce they cannot be wasted through corruption or incompetence. Drawing upon the strengths of all those who are competent for the tasks at hand regardless of party affiliation or ethnic or religious identity is necessary if improvement is to come sooner rather than later. The burden of rebuilding the country cannot rest only on the government. The crisis facing the country is too deep for any single party or government to solve alone. National recovery requires capable individuals from across society and from different sectors such as business and civil society to work together in areas where the national interest transcends party politics. There is also a responsibility on opposition political parties to support initiatives that are politically neutral and genuinely in the national interest. Not every issue needs to become a partisan battle.

Sri Lanka cricket occupies a special place in the national consciousness. At its best it once united the country and gave Sri Lankans a sense of pride and international recognition. Restoring integrity and professionalism to cricket administration can therefore become part of the larger task of national renewal. The appointment of Eran Wickremaratne and the new committee, while it does not guarantee success, is a sign that the political leadership and people of the country may be beginning to mature in their approach to governance. In recognising the need for competence, integrity and bipartisan cooperation and extending it beyond cricket into other areas of national life, Sri Lanka may find the way towards more stable and successful governance..

by Jehan Perera

Continue Reading

Features

From Dhaka to Sri Lanka, three wheels that drive our economies

Published

on

Court vacation this year came with an unexpected lesson, not from a courtroom but from the streets of Dhaka — a city that moves, quite literally, on three wheels.

Above the traffic, a modern metro line glides past concrete pillars and crowded rooftops. It is efficient, clean and frequently cited as a symbol of progress in Bangladesh. For a visitor from Sri Lanka, it inevitably brings to mind our own abandoned light rail plans — a project debated, politicised and ultimately set aside.

But Dhaka’s real story is not in the air. It is on the ground.

Beneath the elevated tracks, the streets belong to three-wheelers. Known locally as CNGs, they cluster at junctions, line the edges of markets and pour into narrow roads that larger vehicles avoid. Even with a functioning rail system, these three-wheelers remain the city’s most dependable form of everyday transport.

Within hours of arriving, their importance becomes obvious. The train may take you across the city, but the journey does not end there. The last mile — often the most complicated part — belongs entirely to the three-wheeler. It is the vehicle that gets you home, to a meeting or simply through streets that no bus route properly serves.

There is a rhythm to using them. A destination is mentioned, a price is suggested and a brief negotiation follows. Then the ride begins, edging into traffic that feels permanently compressed. Drivers move with instinct, adjusting routes and squeezing through gaps with a confidence built over years.

It is not polished. But it works.

And that is where the comparison with Sri Lanka becomes less about what we lack and more about what we already have.

Back home, the three-wheeler has long been part of daily life — so familiar that it is often discussed only in terms of its problems. There are frequent complaints about fares, refusals or the absence of meters. More recently, the industry itself has become entangled in politics — from fuel subsidies to regulatory debates, from election-time promises to periodic crackdowns.

In that process, the conversation has shifted. The three-wheeler is often treated as a problem to be managed, rather than a service to be strengthened.

Yet, seen through the experience of Dhaka, Sri Lanka’s system begins to look far more settled — and, in many ways, ahead.

There is a growing structure in place. Meters, while not perfect, are widely recognised. Ride-hailing apps have added transparency and reduced uncertainty for passengers. There are clearer expectations on both sides — driver and commuter alike. Even small details, such as designated parking areas in parts of Colombo or the increasing standard of vehicles, point to an industry slowly moving towards professionalism.

Just as importantly, there is a human element that remains intact.

In Sri Lanka, a three-wheeler ride is rarely just a transaction. Drivers talk. They offer directions, comment on the day’s news, or share local knowledge. The ride becomes part of the social fabric, not just a means of getting from one point to another.

In Dhaka, the scale of the city leaves less room for that. The interaction is quicker, more direct, shaped by urgency. The service is essential, but it is under constant pressure.

What stands out, across both countries, is that the three-wheeler is not a temporary or outdated mode of transport. It is a necessity in dense, fast-growing Asian cities — one that fills gaps no rail or bus system can fully address.

Large infrastructure projects, like light rail, are important. They bring efficiency and long-term capacity. But they cannot replace the flexibility of a three-wheeler. They cannot reach into narrow streets, respond instantly to demand or provide that crucial last-mile connection.

That is why, even in a city that has invested heavily in modern rail, Dhaka still runs on three wheels.

For Sri Lanka, the lesson is not simply about what could have been built, but about what should be better managed and valued.

The three-wheeler industry does not need to be politicised at every turn. It needs steady regulation — clear fare systems, proper licensing, safety standards — alongside encouragement and recognition. It needs to be seen as part of the solution to urban transport, not as a side issue.

Because for thousands of drivers, it is a livelihood. And for millions of passengers, it is the most immediate and reliable form of mobility.

The tuk-tuk may not feature in grand policy speeches or infrastructure blueprints. It does not run on elevated tracks or attract international attention. But on the ground, where daily life unfolds, it continues to do what larger systems often struggle to do — show up, adapt and keep moving.

And after watching Dhaka’s streets — crowded, relentless, yet functioning — that small, three-wheeled vehicle feels less like something to argue over and more like something to get right.

(The writer is an Attorney-at-Law with over a decade of experience specialising in civil law, a former Board Member of the Office of Missing Persons and a former Legal Director of the Central Cultural Fund. He holds an LLM in International Business Law)

 

by Sampath Perera recently in Dhaka, Bangladesh 

Continue Reading

Features

Dubai scene … opening up

Published

on

Seven Notes: Operating in Dubai

According to reports coming my way, the entertainment scene, in Dubai, is very much opening up, and buzzing again!

After a quieter few months, May is packed with entertainment and the whole scene, they say, is shifting back into full swing.

The Seven Notes band, made up of Sri Lankans, based in Dubai, are back in the spotlight, after a short hiatus, due to the ongoing Middle East problems.

On 18th April they did Legends Night at Mercure Hotel Dubai Barsha Heights; on Thursday, 9th May, they will be at the Sports Bar of the Mercure Hotel for 70s/80s Retro Night; on 6th June, they will be at Al Jadaf Dubai to provide the music for Sandun Perera live in concert … and with more dates to follow.

These events are expected to showcase the band’s evolving sound, tighter stage coordination, and stronger audience engagement.

With each performance, the band aims to refine its identity and build a loyal following within Dubai’s vibrant nightlife and event scene.

Pasindu Umayanga: The group’s new vocalist

What makes Seven Notes standout is their versatility which has made the band a dynamic and promising act.

With a growing performance calendar, new talent integration, and international ambitions, the band is definitely entering a defining phase of its journey.

Dubai’s music industry, I’m told, thrives on diversity, energy, and audience connection, with live bands playing a crucial role in elevating events—from corporate shows to private concerts. Against this backdrop, Seven Notes is positioning itself not just as another band, but as a performance-driven musical unit focused on consistency and growth.

Adding fresh momentum to the group is Pasindu Umayanga who joins Seven Notes as their new vocalist. This move signals a strategic upgrade—not just filling a role, but strengthening the band’s front-line presence.

Looking beyond local stages, Seven Notes is preparing for an international tour, to Korea, in July.

Bassist Niluk Uswaththa: Spokesperson for Seven Notes

According to bassist Niluk Uswaththa, taking a band abroad means: Your sound must hold up against unfamiliar audiences, your performance must translate beyond language, and your discipline must be at a professional level.

“If executed well, this tour could redefine Seven Notes from a local band into an emerging international act,” added Niluk.

He went on to say that Dubai is not an easy market. It’s saturated with highly experienced, multi-genre bands that can adapt instantly to any crowd.

“To stand out consistently you need to have tight rehearsal discipline, unique sound identity (not just covers), strong stage chemistry, audience retention – not just applause.”

No doubt, Seven Notes is entering a critical growth phase—new member, multiple shows, and an international tour on the horizon. The opportunity is real, but so is the pressure.

However, there is talk that Seven Notes will soon be a recognised name in the regional music scene.

Continue Reading

Trending