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The Unseen Victims: The Collateral Damage of COVID-19

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By Dr. Chiranthi K Liyanage

Senior Registrar in Rheumatology & Rehabilitation, National Hospital of Sri Lanka

Lecturer, Department of Pharmacology, Faculty of Medicine, University of Colombo

I am a doctor working at the National Hospital of Sri Lanka (NHSL), Colombo, and I lost two patients within 24 hours, last week.

The first was a young girl, just 19 years old, from a village in a district bordering Colombo. She was suffering from an autoimmune illness, which required close monitoring and long-term treatment. Her mother called me several times last week saying that her daughter had aches and pains, and that she was feeling a little feverish. I told her that I could not decide on specific treatment without seeing her and running tests. Every time I told her to bring the daughter to the hospital, her answer was “aney doctor, all the wheels (Tuks) are refusing to come to Colombo because of the travel restrictions.”

I asked her whether she could go to the nearest District General Hospital because we could liaise with the specialist there and arrange for a transfer to Colombo if necessary. The answer was “we have no way of going even there. No one is willing to take us”. She was also running low on medicines, and she could not afford to refill the prescription from a private pharmacy. Finally, she agreed to get the required tests done and send a relative to Colombo, so we could at least see the test results, talk to her daughter over the phone and do our best to treat her, given the circumstances. However, the next day morning, the mother called again. She said that her daughter has not passed urine the whole night. She admitted that the daughter’s face looked puffy, and I immediately knew that her kidneys were shutting down. Her disease was very likely flaring up again or she has got an infection and we had to act very quickly. I told her to take her to the nearest hospital as quickly as possible. I got two calls from that number after that. One, about an hour later; it was the patient’s sister this time. In between sobs, she said was “aney doctor, my sister is very ill. We are here and getting admitted now”. I was at NHSL, and she was miles away in another hospital. As we had informed the specialist team there about the patient ahead of admission, I assured the sister that she will be taken care of. Another hour later, the sister was on the phone again. All she said to me was “we lost her”. The pain in her voice was palpable, but she was not crying any more.

The same day, another young woman with a similar autoimmune condition who was already admitted to a medical ward at NHSL got critically ill. She died a few hours later as she developed uncontrollable bleeding into the lungs and her kidneys shut down. Earlier this week, as she lay propped up in a hospital bed with laboured breathing, I saw her for the first time in a long time, because she had not come for any follow up clinic visits for months. The first thing she said as she saw me was “Doctor, you are the one I take treatment from”. I asked her to lower her mask to see her face, but I still could not recall the patient. It has been too long. Perusing through her records, I saw my old notes and wondered how she recognized me even with the mask and the face shield on. She has not come to clinic for over a year because of the fear of catching COVID-19 and travel restriction. She has finally got admitted this week, as she became too ill and had no other choice. Although we tried our best, it was too late for her at the end.

 

As I thought about why we could not save these two young lives, I realized with a very heavy heart, that this is the collateral damage of COVID-19! They were either reluctant or unable to obtain the care they needed due to actual or perceived barriers to access healthcare imposed by the prevailing COVID-19 pandemic. However, their deaths will never be counted. They will be forgotten along with the hundreds or even thousands of others who would have lost their lives under similar circumstances, unable to reach a hospital, get medicines, or even see a doctor. We will never know. According to the official sources, the death toll from COVID-19 in Sri Lanka is just over 1600 now. However, this is just the tip of the iceberg. There are countless others who die in their homes, either of COVID-19 itself or other ailments because they do not get the medical care they need due to inaccessibility of healthcare faculties. As more and more healthcare resources are diverted to manage the ever-increasing numbers of the COVID-19 cases, the resources available to the millions of others who suffer from non-COVID illnesses contract and dwindle further. The preventive health sector including maternal and childcare services are also severely affected as all medical officers of health, public health midwives and public health inspectors are overburdened with COVID -19 related duties. If our state hospitals get overwhelmed with the soaring COVID-19 case load, not only COVID related deaths but deaths due to other illnesses will also rise exponentially due to the limited resources available. Therefore, the seemingly low number of deaths we see on paper today is a gross misrepresentation of actuality.

The most disconcerting realisation is that the COVID-19 pandemic is disproportionately affecting the already disadvantaged populations more. It is widening the already existing health inequalities by limiting availability, affordability and accessibility of medicines and healthcare due to loss of income, lack of reliable information and education as well as paucity of transportation facilities. The more affluent who wish to avoid the crowded wards in a government hospital will seek medical care in a fee-levying private healthcare institute, while the underprivileged who cannot afford such a luxury will be forced to choose between getting the required treatment while running the risk of contracting COVID-19 or not getting any treatment at all. Over utilisation of public healthcare resources to combat COVID-19 further worsens this disparity. The video consultations and other telemedicine solutions, online pharmacies with delivery systems, drive-through laboratory services and mobile units all cater to a wealthier segment in our society. The thousands who are solely reliant on the public health institutions are inadvertently overlooked and underserved.

The System which should safeguard the right to health of all Sri Lankans, is miserably failing the neediest, already disadvantaged segments due to its many inadequacies. For example, the mechanism adopted very early on in the second wave to send medicines by post to clinic attendees in government hospitals is still not fully operational, although the country is in a much dire situation now. Albeit not a perfect system, it limited movement of people within the country, reduced usage of public transport and ensured continuity of care to a great extent. Moreover, the improperly planned, poorly regulated vaccination drive against COVID-19 paved way for those with the ‘right kind of connections’ to jump the queue while the disadvantaged high-risk populations were deprived of the same opportunity. A strictly enforced secure system based on eligibility, with transparency, phased out rolling out of the vaccine and stringent monitoring would have prevented such a fiasco as the public would have had faith in The System and awaited their due turn. The travel restrictions which are in place to prevent the spread of the disease is in fact driving the already impoverished societies into a miserable poverty-stricken abyss. Meanwhile, some more well-to-do fellow countrymen, political stooges and those in positions of power commit brazen acts of violation of the very regulations. They roam around in their big cars and jeeps under the guise of essential services, throw birthday parties, and dinner parties at a time the rest of the country is grappling with a deadly virus wreaking havoc and leaving death and destruction in its wake.

So, what can we do within a flawed System? It is a System that has been corrupted by a few which has in turn corrupted many more, who otherwise may have been decent, law-abiding citizens who value justice, equality and morality. It is a malady that is spreading like a pervasive, self-perpetuating parasitic disease. Yes, there is no doubt that the system MUST change. However, is it rational or even acceptable to simply blame The System and be complacent when each of us ARE in fact a part of it? Are we not complicit in one way or another in either being corrupted by The System, or worse, in corrupting it? Only you can answer for yourself. We as Sri Lankans citizens cannot disregard our duties and social responsibilities. We must self-examine and reflect on what we can do as individuals at this very moment to get our country out of the peril it is in. We must not forget that we are all a part of The System and therefore we have the ability and the power to change it from within.

All countries who have so far successfully curbed the spread of COVID-19 have used a multipronged approach encompassing strict enforcement of travel restrictions to limit the daily new infection rates to manageable numbers, rational testing to identify and remove sources of infection, with pre-planned, well-coordinated vaccination to immunize an adequate proportion of the population. While most of these strategies are already in place and operational to an extent in Sri Lanka, the success of these measures depends hugely on the compliance of the public. This is a virus. It is spread by humans to other humans. Our country’s need of the hour is to prevent further spread of COVID-19 and it should be the priority of its entire populace.

One must not forget that even if you are vaccinated and your whole family is vaccinated, it does not guarantee that you will not spread the disease. A significant proportion of the population has to be immunised to break the chain of transmission. Sri Lanka is not even close to achieving that target yet. If you are fully vaccinated, you are unlikely to get severe disease or develop complications, but another person you unknowingly transmit it to might not be so lucky. The poor patients in the outskirts of cities and villages who are unable to reach a hospital, the ones who are unable to put food on the table let alone get medicines for their loved ones are suffering because we as a nation is failing them. Soaring infection rates within a city not only affects those who are infected, but millions across the country as it distorts the very fabric of our society and disrupts an already imperfect System. The health guidelines and restrictions are in place not only to protect you, but to protect the rest of the society from you. Adhering to these guidelines will protect you, your family and countless others who you have never even met, as the spread of the disease will be prevented limiting the direct as well as collateral damage of COVID-19.

Humans, however, are driven by the primal instinct of self-preservation. Most are self-serving by nature. There is an inherent need to fulfill one’s own desires and needs and protect their own even at the expense of another. That is why there is an intrinsic disinclination to let go of personal liberties and compromise for the betterment of the society at large, unless there is a perceived direct benefit. However, I believe that most are compassionate human beings who tend to overlook the potential damage they may cause as they are simply unaware of it. Those who clamour to get the gyms and bars open, use their connections to throw clandestine parties and simply try to enjoy their usual indulgences, do so because they probably do not understand the harm it causes not only to those in their immediate circles but the entire population. There are no perpetrators in this pandemic, all are victims in one way or another. It is not an exaggeration when I say that there has never been a time in history when the actions of each and every person in this country has mattered as much. Every single Sri Lankan, man, woman or child has a role to play in combating this horrid pandemic. Even in the absence of a System that firmly enforces regulations externally, self-discipline could right the wrongs and make an imperfect System work. We could still save hundreds of lives if each of us fulfill our duty to the nation and be socially responsibile.

The real extent of death and devastation caused by this pandemic will probably never be known. However, for those of us who see these people suffer, fight for their lives and still loose, it is unimaginable and immeasurable. They are not just another number to be added or disregarded from a daily report. To us, these are mothers, fathers, daughters, sons or siblings of another fellow human being. Every life matters, and every life is precious. So, this is my plea to my fellow Sri Lankans…. please be socially responsible, put the societal needs above your own personal liberties. Each of you have an immense power to stop the spread of this deadly pandemic, so please do your part as Sri Lanka needs you now.



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Opinion

“Ye are the light of the world.”

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A mystical approach to Easter

by Hiran Perera

The resurrection of Christ is the corner stone of Christian mystical thought. As such, there are no neutral or idle thoughts for the spiritual seeker. In this way, all thought produces form at some level but they are either true or false. For the spiritual aspirant, the resurrection, correctly speaking, is the highest level of thought; for it acknowledges that there is no thought but God.

Christ’s thinking differs from mortal man’s insofar as the latter dissipates his creative energy by thinking of everything else other than God. Christ is one-mindedness and his creative energy is a constant in God and his mind is filled with no thought but God. Our ordinary senses depict a world of duality whereas all mystical experiences overcome this dichotomy.

The Bible uses a term such as to “Know” God which is similar to a direct experience of unspeakable love. A close parallel to understanding this concept was documented by Huxley after having ingested a hallucinogenic substance when he thereupon directly experienced becoming the flower he observed — breaching the dichotomy between the observer and the observed.

In some religious disciplines, meditation, which is replete in Buddhist scripture has the purpose of attaining one-mindedness or a state of stillness as a prelude to enlightenment. Thus, the body becomes neither a hinderance nor an aid to in this process.  Purpose is.

Spells and possession

In Christian thought, the resurrection is about transcendentalism of the body. To be body-conscious and to identify one’s self with the body is an unnatural state for those in quest for the kingdom of God. As thought produces form, lower vibrational thought is expressed as dense matter being physical in nature, whereas, in a higher state of consciousness, it engenders spiritual light and translucency of energy.

Spells cast on people or even demonic possessions occur to them resonating at lower frequencies, but, for them who are on a higher plane, those spells boomerang on the initiator. The black arts work only against people who have already condemned themselves and who operate at the lower level of the psychical field.

For this reason, it is important to understand that the original sin of man — or the decent from a sublime plane to a lower one — represents the mind’s decision to replace the Knowledge (Thought) of God with perception. In the latter realm, the body symbolises the expression of duality or a perceptual state of separation from God and every-body, which is experientially real. The “Word,” therefore, cannot in a real sense become flesh because the Word is God (higher plane) whereas the flesh (lower plane) is outside the domain of His kingdom and are in two different orders of reality.

The closest analogy to reconcile the irreconcilable is that “God is light (the word) and in Him there is no darkness” (the flesh). But in experience, the physical plane is very real with souls (light) appearing to be trapped in bodies (matter). No wonder, Einstein’s famous equation E= MC2 equates matter to being trapped light! On the other hand, when translucency is attained the resurrection restores this misperception by raising the thought vibration where the physical and material are completely undone. Thus, “Ye are the light of the world,” the Holy Bible proclaims with certainty and clarity.

Meditation

Most religions either exalt the body or condemn its purpose. Some exalt its beauty while others scorn its appetite. Worse still, in meditation, some focus on its impermanence, corruptibility and disintegration while others venerate its supposedly strange powers and abilities. This preoccupation with the body makes the error real and diverts the energy of the spiritual aspirant.

Such extreme distortions actually happen from a psychological standpoint of resistance or fear to mask the true nature of man — who is Spirit — and, therefore, this action perpetuates the sense of victimisation and vulnerability and, in some bizarre way, justifies this notion to be true. In contrast, the resurrection demonstrates invulnerability.

By unnecessarily focussing on the body, the mind continues to harbour lower frequency thought forms with self-aggrandisement of needs. The only way out of this dilemma is the middle path prescribed by Lord Buddha: we must neither exalt nor degrade the body but use it as an instrument to transcend its earthly trappings so that we re-align the purpose of mind to attune with its true nature of being while relinquishing the ego.

False construct of reality

Concepts such as Absolute Reality where nothing but God exists is difficult to grasp in post-separation world. In contrast, this post-separation world is based on perception, and perception is highly variable and always uncertain. This uncertainty always demands a need to fill the vacillating mind with illusory thoughts.  In a group study of behavioural perception, a renowned psychologist played a chanting of, “That is embarrassing!” several times.

Then he scripted a message on the screen while the same chant was played, “That isn’t my receipt.,” and the audience were bewildered to hear that this same chant fitted the words on the screen. The eyes take on an electrical signal based on expectations and reconstructed the chant to fit the message. He concluded that we see nothing that is real but that we construct our own false reality.

To correctly perceive the body, we should become aware that it exists outside the mind. Properly speaking, the mind of man is a function of the Mind of God. Here there is no dichotomy and thus cause and effect are therefore really one and the same thing. Since God has no body, man yet believes he exists as a body but he is free to believe infinitely even in a lie no matter how strong the impression is. Strictly speaking, this thought is an illusory one, at any rate. Therefore, from the mystical perspective, we cannot accord the body any reality because only God is Real. Either the body exists or God ceases or vice versa.

Focussing wrongly on the body in this sense is a barrier to knowing God. Yet God is not mocked according to St. Paul. This may run contradictory to formal beliefs, but there are compellingly reasons to see it in another light. As the body is a separation device, “The wages of sin (cause) is death (effect).” The resurrection is therefore the overcoming of death, which is simply the re-establishment of the separated mind with that of God’s. It is akin to a state of oneness-joined-as-one.

Reversing cause and effect

Birth and death have no special merit except that they both re-enact and perpetuate the separation notwithstanding the entry into or the exit of the world at a lower state of vibration. Life in the physical plane manifests as though thought has no power or causal effect. We are buffeted and bruised by everything external and the impact of them is experienced by the body where it “perceptually” witnesses to this schema.

Thus, from a state of mindfulness to a state of mindlessness, the descent which reflects the separation from God, the body becomes the hallmark of all who “have sinned and come short of the glory of God.” But the resurrection, on the other hand, is one of great importance since it restores the function of Causation to cause in the mind. Accordingly, the Bible says, “If you have faith as a grain of mustard seed, ye, shall say unto this mount, remove hence to yonder place and it shall be removed and nothing shall be impossible.”

The practice of mindfulness is therefore essential to the path of redemption. Here a reversal of thought — cause and effect — is urgently required so that what was an external infliction is no longer perceived that way but is instead perceived as a projection of mind. All misperceptions have to be healed within the mind, for there is no external world “out there” to adjust and manipulate. This idea also resonates with modern scientific thought.

The awakening

In summary, it must be understood that the body is a projection of a misthought — an illusory thought, so to speak. Only thoughts, which are in accord with God’s are Real, whereas all others are outside His Realm.  Once a misthought is corrected — or the sleep of forgetfulness which weaves a dream-like world is undone — it inevitably gives rise to the “wakened” state of mind akin to the resurrection.

In this wakened state was Jesus crucified on the cross. Logically, if you take a cause and show it has no effect then the cause ceases to exist. The body symbolises the separation (effect), but when Christ demonstrated that the resurrection was possible, he reversed cause and effect that — sin had no effect — thus reestablishing the relationship between man and God. As a result, man is no longer under the spell of the separation or bondage but is set free from bondage if he now chooses so.

Our purpose in this world is to choose the resurrection where we join with Christ and seek his power of thought to restore our minds to their original glory.

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Opinion

What is wrong with Sri Lanka?

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By Dr Laksiri Fernando

It is not the country per se, but the politicians and the people who are wrong. While politicians should take 70 percent responsibility, the people also should take 30 percent. It is true that these wrongs on the part of the politicians or the people are not limited to Sri Lanka. Even in a country like Australia where I now live, there are intermittent corruption, crime, gender abuse, killing, and misguided politics. However, the difference is extremely vast. Sri Lanka’s wrongs are perhaps 50 times higher than a country like Australia.

One may pinpoint this to the economic difference or development. There is some truth in it. However, the whole truth is not that. It is rooted in the political culture and social culture in general. That is one reason why Sri Lanka was not being able to develop after independence like Singapore, Malaysia, South Korea, etc. India also has come to the forefront of development today. Sri Lanka became caught up in a vicious cycle where political culture prevented development, while underdevelopment influenced the political culture.

What is this political culture? It is mainly renovated feudalism with family at the core of politics that dominates the political culture. It is also the same in social culture, families dominating business, religion, entertainment, and the media. Only female members are set apart. It is in a way natural for members of a family to follow their fathers, brothers, or other close members. Or it can happen the other way around, fathers or uncles helping and promoting their siblings.

Even in America or the UK, this could be seen. The Kennedy family promoted members into politics. However, in Sri Lanka this is overwhelming, some families completely dominating politics and social arena. While the Rajapaksas are the most prominent example with abhorrent practices, the Bandaranaikes, the Senanayakes and the Jayewardenes (Ranil Wickremesinghe with links) were also playing the same game. In Australia, I have not come across this process. When John Howard was the Prime Minister, his brother Bob Howard continued to serve as an academic at the University of Sydney whom I used to meet often.

In 1995, I decided to come back to Sri Lanka to serve the country. I applied and got the appointment as the Director of the Sri Lanka Foundation Institute (SLFI) through a competitive interview. It was a great institute with many capabilities and the people working there were quite flexible and committed. However, when it came to filling vacancies and expanding the staff for new tasks, I came across political influences and pressures.

I managed to overcome them luckily as the SLFI came under the purview of Chandrika Kumaratunga as the President and as she did not make any interference at least in my case. However, I resigned and came back to Australia within six months as the situation was unbearable. People who tried to influence me were either top ministers or bureaucrats.

Again, when I finally came back in 1997, I first joined the University of Colombo before undertaking any other appointments. By that time, I had fairly learned how to overcome political influence. The university system was fairly reasonable (not completely) and on that basis it was possible for me to follow my impartial principles. However, there was at least one instance where a former friend of mine tried to blame me publicly, claiming that I myself asked for favours! It was heartrending.

Sri Lanka’s public service is large and widespread. There are around 1.5 million people working in its various institutions, departments, and branches. Although there is the Public Service Commission which is supposed to be independent, even in its appointments political and other influences are paramount. The most discriminated people in this service are Tamils, Muslims, and Women. Although there are over 15 percent of Tamils in the population, their presence in the public service is less than 10 percent. Apart from discrimination on the reason of ethnicity and gender, there are discriminations on the basis of caste, religion and region. The dissolution of Provincial Councils since October 2019 has enlarged these discriminations overwhelmingly.

It is mistakenly claimed that the ‘large state sector’ is the primary defect of Sri Lanka’s economy. It is not the size of the sector that has mattered but its inefficiency, incapacity, unproductivity, and sometimes duplication. In Australia, out of the total workforce, 20 percent are in the state sector. But it is sufficiently productive and provides necessary services even to private enterprises. In Sri Lanka, if we count 12 million as the workforce (adult population 14 million), the state sector comprises only around 12 percent.

The state sector undoubtedly should be restructured, and the workforces should be retrained or even dismissed. There is no point in keeping people like Sirimanna Mahattaya in the public service if we take an example from the teledrama, Kolam Kuttama (Funny Couple)! Even privatising certain (loss-making) state enterprises is in order. However, there are certain sectors and services that the state should hold on to. Education and Health are the most priory sectors among others, depending on national dialogues. It could allow the private sector to participate, but the state should not give up its primary responsibilities.

There can be other strategic sectors where the private sector could be allowed like the ports, airports, airlines, electricity, gas, oil, and even water, but the state should not give up its responsibilities completely. Public-Private partnership can be a model in certain areas in this respect.

The stagnation of the education sector has been a primary problem area in Sri Lanka now for a long time. This applies both to school education and university education alike. In the case of university education there have been some curricula and teaching methodology changes but those are not up to modern and current needs.

We still get a huge number of Arts students while the country’s need is in the direction of Science, Technology, Medicine, Nursing and Business Management. Those who come from the Arts streams in schools, if it is not possible to change in the short run, should be able to move to scientific areas, if capable. In Australia, there is no prohibition of changing the stream if the students show high capability in whatever area that they qualify in. School education should be totally reformed with emphasis on scientific and international knowledge.

The discarding of English education (since 1956), in my opinion, has been the major mistake that the country has committed in degrading the educational system, the economy, and the country’s international profile. In recent times young generations are trying to overcome these barriers through private education, tuition, and social media. However, this is mostly limited to the well to do. English should not be considered as a superior or imperial language, but a practical and international language.

While this short article, with word limits, confine to only few areas of ‘wrongs’ that Sri Lanka is committing, a possible conclusion is to call for an overall change in the political and economic system in the country. Those political leaders and parties responsible for the country’s present political and economic crisis should be completely ousted.

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Opinion

Plan to transform country into an export economy

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Dear Mr. President,

A Presidential Media Division statement, titled “Country set for rapid transformation into an export economy” quoted remarks made by you at the inauguration ceremony of a historic temple in Kegalle.

As a caring citizen I said, “three cheers”, happily thinking that at last, the country was on the correct governance path focusing on the creation of new strategic leadership options and policy changes to encourage present and new investors to produce tradable goods and engage in external services. I was delighted that the statement began with a reference that Sri Lanka can no longer continue to rely on borrowings (presumably external?) to address the imbalance between imports and exports, which if pursued will inevitably lead to another economic crisis within a decade.

As I read the rest of the statement, I noted that your plan for achieving such a transformation by holding discussions with the World Bank, ADB and the IMF to initiate a programme and passing two new laws in April. The only other reference even as a vague statement was in relation to implementing an agricultural modernisation programme, where you anticipated results only after 6-7 years. Are you planning in addition to leverage the National Trade Facilitation Committee (NTFC) and its Secretariat as a part of your implementation strategy[ii] ?

I am sure that many highly competent Sri Lankan trade economists (including those who have guided you in the past), will be able to advise you on more important winning strategic policy/implementation and change management options.

They would surely stress the relative importance of developing strategic networking options with supply chains in the region, assisting capable SME’s to upgrade quality/productivity, and enhancing public infrastructure productivity; along with the need to remove para tariffs, enhance ease of doing business, and one stop facilitation center benchmarking services in South Indian states. These can bring big gains, well before dreaming as your short-term goal, leveraging Free Trade Agreements with India, China, Thailand, Singapore, Vietnam and attempting a high jump by  joining RCEP.

Chandra Jayaratne

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