‘The Probable Age Certificate’ (PAC) issued to children without a birth certificate for lack of key information required for its issue often means discrimination and social stigma despite the PAC’s legal validity. In a bid to renew discussion on this social dilemma and find more socially acceptable alternatives at policy-making level, we spoke to multiple stakeholders including those who had left care homes and have been at the receiving end of the consequences.

by Randima Attygalle

Dhanushka Kumara Jayaratne was rejected by several leading schools when seeking Grade One admission on the grounds of his holding a ‘Probable Age Certificate’ as opposed to a Birth Certificate. When he was finally admitted to a school, he was shut out of cultural events and sport competitions at various levels on the basis that he had no ‘proper birth certificate’. When applying for his national identity card and travel visas on several occasions, bottlenecks were many. One of the main problems was that the probable age certificate (PAC) did not specify any guardian in the absence of names of parents.

Today a 31-year-old executive, Dhanushka gives leadership to the ‘Generation Never Give up Network’ (GNGN), an initiative of the SOS Children’s Villages, Sri Lanka which advocates the causes of care leavers (children leaving child care institutions at 18 years). Lobbying for a more socially acceptable form of a birth certificate in place of the PAC is one of the top priorities of this collective.

“PAC often leads to discrimination and stigmatization due to its format,” observes this young man pushing for a more ‘dignified’ birth certificate with ‘better terminology’ and provisions for ‘guardians’ that could either be an individual or a child care institute. “The issue was taken up by the Parliamentary Sectoral Oversight Committee on Women and Children a couple of years ago and was discussed for a while but unfortunately no solution was tabled,” notes Danushka who hopes to renew the dialogue among relevant partners through the GNGN initiative.

“The probable age certificate of mine is nothing but a piece of paper with some dotted lines claiming that I was born within such a time frame. It is very humiliating to produce this piece of paper for government exams, employment etc,” says Nirmala Niroshini. Recollecting the emotionally traumatizing moments when she was viewed almost as an ‘abnormal’ individual on the basis of her PAC, Nirmala urges the authorities to revise its present format and enable a more acceptable document. She also proposes that an endorsement on the PAC by the Registrar General’s Department to make it as good as a normal birth certificate for official purposes. “It was an uphill task for me to get my NIC. I had to submit so many supporting documents verifying the legality of my PAC to convince the authorities. Finding employment was another battle,” says Nirmala, who is today employed as a clerical staffer at a dental clinic.

Current regulations

The Registrar General’s Department makes provisions to obtain a PAC for children who are in homes approved by the government, children who are not in such homes and even adults. Statistics on the exact number of children presently holding PACs in the country however remain unclear.

The PAC is issued to individuals (children as well as adults) who cannot be granted a ‘birth certificate’ due to lack of key information required for the latter. “This includes the absence of an exact date of birth or even the mother’s name. To issue a birth certificate, an informant is required and if the informant (who is often an authority from a child care institute in case of children under 14 years) cannot furnish the information required, providing a birth certificate would become difficult,” admits the Senior Deputy Registrar General G.A.L.D. Ganepola.

The Establishment Code and the Public Administration Circular 26/1995 provide for the acceptance of the PAC. The Public Administration Circular 26/1995 states that PAC ‘is acceptable for the purpose of confirmation of name and date of birth of persons.’

“Probable age certificate is a legitimate legal document which should be accepted by all agencies although in reality it doesn’t happen largely due to ignorance of the regulations,” notes Ganepola. Increased public awareness on this matter with wide media coverage is necessary for this, says the official. A unique ID number at birth is another alternative proposed by the Senior Deputy Registrar General which could be used for all administrative purposes including school admission, admission into children’s homes etc.

Social stigma

Despite the law recognizing all individuals to be treated equally regardless of any complications pertaining to their birth, children with the PAC are discriminated and stigmatized from all directions in society when they sit for government exams, apply for jobs, universitiy admission, competitive sports and government benefits, says Divakar Ratnadurai, National Director, SOS Children’s Villages Sri Lanka.

Out of 900 children currently living in SOS villages, around 300 have PACs. Also, many who have left the homes are similarly burdened. Lobbying for the reintroduction of the Extract (a shorter version of the birth certificate) with certain modifications enabling practical options where the required information is not available is a possible solution says Ratnadurai. This Extract which was once available was discontinued in the 1970s.

Constraints in obtaining basic information of destitute children is another bottleneck which has led to certain children receiving the PAC instead of a birth certificate, he points out. “Sometimes children are enrolled in care homes without basic information and care givers are faced with difficulties searching for this information.”

Ratnadurai proposes several measures to raise awareness among multiple stakeholders including school authorities to eliminate discrimination. Establishing a special unit in the Department of Probation and Child Care Services to provide continuous awareness on the PAC; lobbying policy makers and administrators for the ‘Extract’ to be given legal recognition etc. are among the correctional proposals made to make life easier for those carrying this burden.

Sensitizing stakeholders

Proposing a probable ‘birth’ certificate replacing the present probable age certificate, Commissioner, Department of Probation and Child Care Services, Chandima Sigera calls for sensitizing the stakeholders at every level including education authorities, other government officials, private sector and the community at large on this issue. In the best interest of children moving for a more socially acceptable form of identity which wouild eliminate dicrimination is urgent says the Commissioner who alludes to the fundamental rights of ‘non discrimination’ and and ‘best interest’ of children upheld in the United Nations Convention on the Rights of the Child.

Determining the age of a child

The current regulations require for a medical certificate estimating the age of the child (probable age) to be submitted to the Registrar General’s Department to obtain a probable age certificate. This is issued by a JMO who collaborates with other specialists.

“In estimating the age of a child, factors such as development of teeth and bones are taken into account. If there is any other medical evidence such as a diagnosis card, we take it into consideration as well,” explains the Consultant JMO, Dr. Uthpala Attygalle. Once the probable time frame of birth is established, the applicant’s date of birth is recorded either as January 1 or July 1, depending on each case.

A vicious cycle

Care leavers sadly become victims of a vicious cycle points out Prabodhini Munasinghe Wickrematunga, Attorney-at-Law with special interest in gender issues. “When women are unable to care for them, children are abandoned. Often the mother is unable to reveal the identity of the father because the pregnancy is a result of rape, sometimes by a relative.

Most employers know nothing about PACs making it difficult for their holders to find decent work and sometimes out of sheer desperation are driven to prostitution. This vulnerability exposes them to risks both in terms of health and security.

Uncertain identity arising as a result of not having a birth certificate which is regarded as an essential document can lead to many negative emotions, explains Dr. Neil Fernando, Consultant Psychiatrist and Senior Lecturer from the Kotelawala Defence University. “Uncertainty frequently brings with it unpredictability which reduces the mental well being and frequently acts as a stress factor. Long term stress is a predisposing factor in causing many non-communicable diseases which include heart disease and diabetes,” he said. Feelings of alienation from the community can lead to social isolation and depression, he added.

Indra Kuruppu, a senior researcher at the Economics Section of the Parliamentary Research Centre of the Parliament of Australia Articulate, has with a penchant for political science nurtured through undergraduate studies at the university of Peradeniya. She owes her knowledge to Dr. K. H. Jayasinghe, Professor of Political Science at Peradeniya and all other senior lecturers, Dr Ranjith Amarasinghe, Dr KC Perera who helped her achieve her
objectives.

BY Zanita Careem

Indra Kuruppu a Sri Lankan domiciled Down Under has been a longstanding member of the Economic Policy section of the Australia Parliament Library.

For 30 years Indra’s contribution in this senior position has won the acclaim of the members of the Australian Parliament. Until her retirement recently. I provide information and analytical research and advise on policy matters to members of the Senate and their staff, Parliamentary Committees and the office of the Governor-General.

A student of Ladies College Colombo, she enters the university of Peradeniya where she excelled in both curricular and extra activities After obtaining the degree she was attached to the Asian Institute of Technology Bangkok, (Thailand) and the University of Tasmania. Later migrated to Australia with her family. Her work experience gave her the opportunity to excel in her profession and soon after she joined the Parliament as a senior researcher. This was her stepping stone to success

The speaker of the Parliament and MP Smith Tony and MP described Indra as a well liked, well known and well respected member of Parliament team.

Knowing Indra from my campus days (she was my junior) I knew she was passionate about global issues, and a vivid reader on political history and political thoughts.

The speaker of Australian Parliament. Smith Tony paid a great tribute to her work. He said she is a well known and well respected member of the library team. She is also well versed about political. and economic affairs He complimented herwhen he said. “Whenever I asked Indra about policy and research matters, she had the answers at the finger tips. This is a rare trait, which I did not come across among other working women, She is a fountain of knowledge and experience.

Q How interesting is your job

Over the years my research has led me to meet with many politicians, and. I came to realise they differ immensely from what we hear or see in the newspapers which are generally unflattering. The Prime Ministers from Bob Hawke to Scott Morrison and even the leaders of the opposition have been extraordinary hard working. I was very impressed about their simplicity and their memorable speeches andalso down-to-earth personalities. Their memorable speeches still linger in my memory.

Q: Some of the highlights

I witnessed the PM’ Kevin Rudd delivering the Parliamentary national apology to stolen generations in February 2008. I also saw Julia Gillard being sworn in as the first woman Prime Minister. The most interesting aspect was listening to Prime Minister Julia Gillad’s Misogyny speech in October 2020 on alleged sexism by the then leader of the opposition, Tony Abbott. I had the opportunity to see former parliamentary staffers and backbenchers now risen to high offices in the Parliament.

My most memorable moments are seeing many world leaders in the building among them was George Bush, Bill Clinton, George W Bush. Barack Obama, Nelson Mandela, Aung San Suu Kyi and Dalai Lama.

Q: Any Sri Lankan events that you participated

As a Sri Lankan Buddhist. I was happy to be present when a copy of the Dhammapada was presented to the Federal Parliament by the President of the Australians Federations of Buddhist Councils. This was placed during Henry Jenkin office in 2009, in the despatch box, on the central table in front of the Prime Minister. This indeed a rare opportunity

Being a Sri Lankan Buddhist. I was proud when it was kept in the despatch box on the central label in front of the Prime Minister.

Q: What are other memorable moments

(A) Being able to work under pressure and as a member of the team to provide facts and figures called for by a member of the senate and their staff for a debate in the chamber or a for a press conferences or a radio interview., The information I give has to be 100% accurate.

Working for politicians of different political aspirations, was not a a difficult task

Q: Did you feel any kind of discrimination being from an Asian country?

No not at all. I had the recognition factor I was speaking on the phone I am elated when the client would say “Is that Indra? I have no issues working with politicians who held the highest offices.

International Parliamentary Union, Commonwealth Parliament Association. during these conferences I am appointed as the Liaison officer for the Sri Lankan Parliamentary delegations. As I can speak the language and they were happy to have a Sri Lankan among them who can speak their language.

Indra retired recently and she was held in high esteem at the parliament.

Good luck!

by Dr. Kayathri Periasamy

With the latest wave of COVID-19 infections sweeping steadily across Sri Lanka, attention has been directed towards persons with uncontrolled, pre-existing conditions, particularly diabetes; as a sect most vulnerable to get severely ill or die because of complications caused by the virus. This has shed light on another growing concern among healthcare providers and patients, which is that patients suffering from diabetes or other chronic conditions are finding it increasingly difficult or are unable to access the medical care they require due to mandatory albeit essential curfew measures combined with a deep fear of contracting the virus in communal healthcare settings.

With a staggering 463 million adult diabetic patients present worldwide, World Diabetes Day 2020 – falling on the 14th of November- is a critical time for diabetes support communities and healthcare advocates to rally together to create awareness about this debilitating medical condition and push for progress in the standards of care and the better management of diabetic patients during a pandemic. In Sri Lanka alone, 1 in 10 adults are approximated to suffer from the disease. It is also then vital to look at ways to help stop more people from getting this disease, particularly at a time when ‘lockdown’ lifestyles are more often than not likely to be sedentary, unhealthy and stressful; an ideal background for a diabetes diagnosis.

Why is uncontrolled diabetes such a potent accelerant for COVID-19?

A recent study conducted by Lancet on Diabetes & Endocrinology screened over 61 million medical records in the U.K. to find that 30% of COVID-19 deaths can be attributed to people with diabetes. After accounting for factors such as demography and chronic medical conditions, the risk of succumbing to the virus was shown to be about three times higher for people with Type 1 diabetes and almost twice as high for Type 2, versus those without the disease. 

There appears to be two primary reasons driving this predicament. Over a lifetime, poor glucose control inflicts widespread damage in our systems which can lead to strokes, heart attacks, kidney failure, eye disease, and limb amputations. The linings of blood vessels throughout the body weaken to an extent where they can’t ferry necessary nutrients adequately. Inflammation is another byproduct of poor diabetes control, which makes the body ill-prepared for the onslaught of the viral disease. Secondly, the rich environment of elevated blood glucose present in diabetic patients, makes them prone to superadded bacterial complications during the viral infection. Many diabetics also tend to have other co-morbidities such as obesity, hypertension, and heart disease, which are all factors that aggravate complications during viral illneses. These problems are seen in any infections in the setting of diabetes and not only with COVID 19. The pandemic has just highlighted the difficulties of having diabetes

What precautions can diabetic patients take?

So during this pandemic, apart from strict adherence to general COVID-19 personal safety protocols such as strict social distancing and sanitization, it is important for patients to regularly monitor their glucose levels to avoid complications caused by fluctuating blood glucose. Proper hydration is essential for good health. It is also crucial to have access to a good supply of the prescribed diabetes medications and healthy food so that patients are able to correct the situation if blood glucose levels fluctuate. Finally, sticking to a comfortable daily routine, maintaining an exercise program even within the confines of your home, reducing excessive work and having a good night’s sleep can go a long way in keeping you strong. In essence, maintaining good blood sugar levels may be their best defense against severe COVID-19.

Disruption to continuity of care for diabetes patients

A rapid assessment survey conducted by WHO among Ministries of Health across many countries, focusing on the service delivery for NCDs during the COVID-19 pandemic, revealed deepening concerns that many people living with NCDs are no longer receiving appropriate treatment or access to medicines during the COVID-19 pandemic. The more severe the transmission phase of the COVID-19 pandemic, the more NCD care services were disrupted.

With our country currently in the cluster transmission phase and heading towards the community transmission phase due to the large and distant spread of the first-line contacts, the threat to NCD care and especially routine and emergency care of diabetes patients worries us physicians. As healthcare providers, we too are torn between the dilemma of not wanting to expose our patients to unnecessary hospital visits and the need to ensure that all our patients have continued access to their healthcare team along with a steady supply of medicines and other diabetes care products such as glucometer strips and insulin. Unfortunately, the delay in visiting their healthcare provider when they have symptoms of complications has caused many people to present late to the hospital with heart attacks or infections. A delayed presentation, weakens the patient further.

This disruption to healthcare services is foreseen to be a huge dilemma for patients and healthcare providers alike, especially when it comes to the care of patients with diabetes and other non-communicable diseases. In Sri Lanka, the Ministry of Health, is currently providing a number of telemedicine services and has opened avenues to deliver medicines to houses without diabetic persons having to visit crowded settings

How do we counter this?

At Healthy Life Clinic, we adhere strictly to COVID-19 safety operational health protocols established according to Ministry of Health (MOH), Epidemiology Unit. All incoming patients are screened by our nurses as soon as appointments are made over the phone, to understand the nature of their illness. If there is a worry that they could have contracted COVID-19 or have been in contact with such patients, they are given the opportunity to speak to the doctor first over the phone for a detailed history. Every patient will be consulted and no one is turned away from our care.

In order to help patients overcome barriers such as curfews or even the fear of entering communal healthcare settings, our experienced, highly-regarded team of consultants conducts telehealth consultations via established, trusted telemedicine partners such as oDoc and Mydoctor.lk to maintain continuity of care throughout this pandemic. We have also moved many of our long-standing diabetes care and weight management programs online, which have proven to be effective even in the absence of a physical meeting and examination. Additionally, our social media platforms and website are constantly updated to increase awareness about this condition, along with content that informs people about the proper management and prevention of diabetes – particularly when it is thus connected to COVID-19.

(Dr. Kayathri Periasamy is a consultant physician MBBS (UK), MRCP (UK), Board Certified in Int. Medicine (U.S.A). She is the founder of Healthy Life Clinic, Colombo 07.)