This is a personal accolade and a bouquet to that premier medical institution, the Lady Ridgeway Hospital (LRH) for Children, in Borella.
They were kind enough to administer the first dose of the Oxford-AstraZeneca vaccine to me on the 3rd of February 2021, as I was deemed to be a frontline health worker. I was due for the second dose, as they commenced the second round of the vaccination on 29th April 2021. I reported to that hospital on 30th April 2021 and they promptly gave me the second dose of the vaccine.
In my professional life, I have spent a total of around 17 years at this hospital, in all possible positions, such as Intern House Physician, Medical Officer OPD, Paediatric Registrar, Resident Paediatrician, Visiting Paediatrician of the OPD and, finally, as the Visiting Paediatrician in charge of Unit No.9 for 12 years, before my retirement. For me, that hospital was a home away from home, in a career spanning 37 years.
When I reported there for my jabs, I was treated extremely well – in fact, virtually like a VVIP. Although I was more than willing to wait in a queue, they would not even hear of it; an unsolicited privilege. The nurses and the Sisters were most kind, younger medical colleagues made sure that I was attended to immediately, and two of my younger consultant colleagues stayed there on standby, just in case anything went even slightly wrong. I was observed after the injection for about half an hour and was then released. A young consultant came with me even to my car, across the Maradana Road, to ensure that all was well.
With me, there were several other retired consultants of similar vintage who came for the vaccine, who were also treated in the very same manner. To say the least, it was ever so lovely to have been treated that way, in that very same hospital where my heart really lies.
I also saw many other healthcare workers of all kinds, of different grades of the hospital, getting their shots. They, too, were treated extremely well and really the same way as we were treated. It was not only us, perhaps the privileged, who were treated so very well.
So, take a bow, the administration and all staff at the Lady Ridgeway Hospital for Children; you are, indeed, the best of the very best.
Thank you so much, from the bottom of my heart.
Dr. B. J. C. PERERA
Specialist Consultant Paediatrician
Beating the virus
The inevitable has happened. In January this year,, I warned about the possibility of the UK variant B 1.1.7. arriving in the country. Some blamed an English cricket player, who was in a protective bubble, for this, but there could be others infected with the virus who had arrived in the country from the UK. After all, the PCR tests show only 70 % of infected persons as being positive for the disease! So, many could escape being detected with Covid-19 and be symptomless carriers. What has happened, has happened.
It is interesting that the virus has spread to a lot of areas, before it was found, but details are sketchy. So maybe it was here for a few months. The lowering of the number of PCR or antigen tests may be the reason why this was not detected earlier. Maybe, the lower infection rates that were shown since February this year, were not factually correct. Let’s stop the blame game now and take urgent informed action to control the present outbreak. Otherwise, it would be catastrophic for the country.
There are six strains in the country at present and all are detectable now, and the areas where each is located are mapped. When patients are found, mainly Grama Sevaka Divisions are brought under lockdown to control the spread. Some are opened after a few days, or weeks. Is this enough to stop this epidemic spreading? There seems to be no coordinated efforts by the stakeholders, and a blame game is on. While politicians have to listen to the people’s woes, the health authorities have to impose conditions laid out in the Quarantine and Prevention of Diseases Ordinance. The Mayor or the Medical Officer of Health is the Authority to implement the conditions in this Ordinance, at local level, and therefore it is seen that the Municipal Councils or Town Councils have a role to play during this period too.
While local lockdowns may work in the peripheral areas, in the short term, such small lockdowns will be ineffective and dangerous in areas where large crowds live, such as towns and cities where a large number of slum and shanty areas and middle-class housing complexes are situated, side by side, allowing the disease to spread like wildfire. The solution for such areas is vaccination of all people at least over the age of 30. Although mutations take place all over the world and will continue until Covid-19 goes away, most of the vaccines seem to be holding well against them. The infected people, or vaccinated persons, will create herd immunity, but only vaccinations can prevent massive infections and mutations quickly, so that there isn’t much of a damage to the society. The toll of this traumatic experience for many cannot be measured individually or as a society. Families have suffered socially, economically and some have already lost their beloved ones. The death of a pregnant woman yesterday, shows how traumatic the experience could be, not only to the family but also to the health staff. It is appreciated that Colombo’s Municipal Commissioner took a decision to allow pregnant staff members to keep away from work, even before the government made such a decision.
Lockdowns themselves will not stop the spread among the people unless they are properly policed. This is what happened in the recent past in poorer settlements, where people had to face 60-day lockdowns which are not acceptable. This is so as now the scientists have identified that the virus stays alive in the body only for 6-7 days, and if so a quarantine period with a proper lockdown of 14 days would suffice to clear an area of the virus. The law enforcement agents should build positive relationships with their community, respect civil rights and not impose unnecessary hard and fast rules, which may be counterproductive. With the threat looming due to the UK variant, we have to prevent the disease spreading, but at the same time see that socially and economically people are not that affected, as for more than a year they have undergone immense hardships.
This is so, especially with the farmers and middle level traders, who are unable to trade or sell their crops due to sudden closures and lockdowns. Living with the virus should be the slogan for these days. TV footages show vendors with perishable items such as vegetables and fruits, told all of a sudden to pack up and go from the road side or from the fairs.
I understand the police have been given orders, but then these people should be handled more humanely. Perhaps they should be allowed to sell and maintain health conditions. Consumers should be told that only one person is allowed near a street vendor at a time and they should stand in queues waiting for their turn.
Unfortunately, the communication between the government agencies and the people at large has broken down. The people are apprehensive about the actions of the law enforcement officers and the Public Health Inspectors. Usually, Health Educators and Instructors communicate with the people well, spreading out the health messages in an appropriate manner. Concern is about disorganized communities in the cities, especially in the urban slums and marginalised apartment complexes. Prevention and control of disease spread have become impossible as there is no community participation. More informal health education actions should be carried out, visiting the probable high risk areas; and action should be taken to look into various needs of the people in locked down areas whether it is the rice, fruits and vegetables, dry rations, curry powder, cooking oil, gas or whatever they need or simply the need to sell their wares.
So, what should be done to rein in the virus and stop this menace? First, have proper communications with people in the area, and the health staff comprising the field officers, are the best to do this. Secondly, lockdowns must cover larger land areas than at present. For example, if patients are found in a certain Grama Sevaka (GS) Division, then lock down the surrounding GS areas, too, as obviously people don’t contain themselves to their own areas, but would have gone into other close-by areas also even before the virus was detected by PCR testing. If there are tens of GS divisions affected, then the MOH areas or even Districts should be locked down. However, the essential staff should be allowed to go to work and trading of essential items should be allowed. Every household should be issued with a card where only one person at a time is allowed outside to go to buy needed items. If these measures still don’t work out, then curfew should be declared in such areas for at least two weeks and see the progress.
What will stop the epidemic is natural decline or vaccination of the population, as Israel did for their citizens. The latter should be our priority. People should as early as possible get their doses of the Covid-19 vaccine, whether it is the AstraZeneca, Sputnik V, Sinopharm or Pfizer vaccine that is available in their area. If we want to stop large scale deaths, as in India, this should be done immediately. We don’t want this to happen in Colombo. Yesterday, the Ven. Muruththettuwe Ananda Thera alleged that vaccines are hoarded and only the VIPs are given them in Colombo. Such situations should not be allowed to arise at any cost. Hope the government will take action to see that all are safe in this country.
Dr. PRADEEP KARIYAWASAM
Work with people to defeat Covid-19
by Jehan Perera
The sudden resurgence of the Covid pandemic in Sri Lanka was totally unexpected by the people at large though it was expected and predicted by those in the scientific and medical communities. The people had been reassured by the political leaders and sections of the media that Sri Lanka was a success story unlike other countries, including more developed ones that had been devastated by the pandemic. However, the country had received an early warning in the second wave which had commenced in October last year with the spread that was believed to have originated in the garment industry. But much before this the country’s top medical associations had been warning that community spread of the coronavirus had already commenced. These warnings were neither heard nor acted upon by the vast majority of the population. The mainstream view, until the shock of the third wave in April, was that Sri Lanka was a success in Covid management.
Sri Lanka enjoyed undoubted success in combatting the first wave of the coronavirus, with the participation of the security forces in implementing the lockdown and tracing of persons infected by the coronavirus. This success seems to have given rise to the misperception that the country was secure enough in terms of Covid control to give priority to the revival of the economy. But there was a big information gap between the appearance and the reality that swayed the governmental decision-makers. There can be no other explanation for their failure to heed the warnings that came from the medical and scientific community in the week, prior to the New Year shopping and holiday season.
Scholars, who have studied disasters that have afflicted human beings over the millennia, have noted that lack of proper information was often at the centre of those tragedies that might have been averted. Famines have taken place in many parts of the world and have led to millions of deaths that need not have happened. There was sufficient food stocks in other parts of the world, sometimes in the country itself, that could have been sent to the areas that did not have food. The Bengal famine of 1943 in British India is an example. The policy failures began with the provincial government’s denial that a famine existed. There was a breakdown in the lines of communication that could have led to food supplies from areas, where food stocks existed, being sent to the areas with short supply. (https://en.wikipedia.org/wiki/Bengal_famine_of_1943)
Since the successful containment of the first wave of Covid by the strict policy of lockdown and curfew adopted by the government, the restoration of the economy has been its first priority. The economy and people’s livelihoods received a severe battering during the two-month long lockdown. The Covid spread was contained but the economy shrank by more than it ever has in the post-independence period. The government gained the appreciation of the general population and the international community for its success in containing Covid. But the downturn in the economy needed to be restored which is what the business advisors of the government set out to do.
In retrospect,some of the government’s decisions, taken to revive the economy appear to have been unnecessarily risky in terms of containing the Covid spread. One was the partial reopening of tourism industry which led to an influx of tourists from countries that had poor track records of containing the pandemic, most notably Ukraine and India. These tourists were meant to arrive in a “bubble” and depart having toured the country in a “bubble” but even with these most stringent precautions it seems to have paved the way for new Covid variants to have taken root in the country. More recently there was media exposure given to a variety of “quarantine tourism” from badly affected countries from which the wealthier people wished to temporarily take a respite. The actions of government ministers in pouring “sacred water” into rivers to forestall the pandemic and their imbibing of a special “Covid herbal concoction” to protect against the virus was not based on science, professional advice and rationality that the country needs its decisionmakers to follow.
In these circumstances, it seems unfair that the blame for the resurgence of the Covid pandemic should be put on the people themselves who are charged with being negligent in their duties to take care of themselves and of others. Shock and awe treatment of ordinary citizens who were not taking the Covid pandemic seriously was witnessed on a video clip that were released of the police apprehending people who did not wear masks in commando-style. The videoing of the operations was done with precision and widely circulated on the media for maximum impact. The videos show police personnel in Covid protective clothing going into crowded urban areas, apprehending offenders who are not using masks properly, carrying them physically and bundling them inside parked buses to be taken to be charged. Such governmental actions can breed resentments that grow with the passage of time. The danger is also that the security forces may be induced to act similarly in other situations, too.
For the past year, after the success of the government in controlling the first wave of coronavirus, the people at large have been made to believe that the government has everything under control and that Sri Lanka has certain unique conditions that will spare it the fate of other countries. The recent police operations in different parts of the country to apprehend members of the general public who were either not wearing their face masks at all, or improperly by not covering their noses, suggests an intention to instill the importance of following health guidelines in the people. It would have been better if these police actions had been done consistently throughout the period, and by police in the course of their regular duties, such as during the Sinhala and Tamil New Year festivities in different parts of the country.
It needs to be kept in mind that these are very fraught times in which the majority of people are struggling to make ends meet. Due to the economic downturn many of them have lost their jobs or are getting only a part of their salaries. According to the World Bank, “With jobs lost and earnings reduced, especially in urban areas and among private sector employees and informal workers, the $3.20 poverty rate is projected to have increased from 9.2 percent in 2019 to 11.7 percent in 2020.” (https://www.worldbank.org/en/news/press-release/2021/04/09/sri-lankan-economy-recovers) Daily wage labourers find it harder to get daily work as potential employers do not wish to give them work and hire them for fear of Covid infection. Those who are fortunate enough to have their children attending schools with online teaching have all to meet extra expenses such as phone data charges for their children’s education.
At the same time as there is public resistance to a lockdown there is fear and apprehension about contracting Covid and the health consequences in a situation where the hospitals are full and not able to accept more patients. In these circumstances there can be pent up anger within society that can suddenly come to the fore. The government needs to take these tensions within people into account when it designs its responses to the unfolding crisis. Instead of demonstrating the punitive powers of the state machinery there could be an emphasis on messages of care from the government to the people. The government could take the people into its confidence and educate them about the true situation with regard to Covid spread and what can be done in partnership to mitigate it. It needs to come up with economic support schemes, such as the Rs 5000 dole or food coupons for the poor, that will make the people ready for a lockdown. A democratic polity will seek to inform, educate and work with the people to overcome any crisis the country faces.
‘Preaching to SL on internal unity’
Please allow me some space to make a brief response to S A R’s comments, published in The Island on the 5th May 2021. There was a time when initials were so well known, that it was possible to identify the person from his/her initials. JR and DS come to mind.
1″ From the content and tone of the article I can easily guess on whose behalf he wrote it”
Let me assure S A R that I am not a foreign agent or spy or whatever. I am proudly Sri Lankan. I was born here. My parents were born here. My children were born here.
Is the spirit of altruism so dead that one must be doing something, as an agent for another party, presumably with a financial or other reward in view? No, my dear S A R, I was moved to write because I, like many others in this country, am distressed with the way things are being done in the seats of power, and elsewhere, and feel duty bound to voice my views.
2 “Too many innocent people are being convicted of crimes which they never committed
I heartily agree. This should never happen.
However, I wonder whether this is more heinous than convicted criminals, even on death row, being set free, to say nothing of the criminals in high places who never seem to be brought to justice.
3 “We know this country is certainly not without sin to claim the right to throw the first stone”
I am not sure which country is meant by the description “this country”. No country is without sin or an abundance of sinners.
If my house is in need of a good clean up, it is pretty futile for me to point to my neighbours’ houses and say they are much worse than mine Let the cleanup start with me. It was indeed the same person who questioned whether anyone was sinless enough to cast first stone, who also said, “You hypocrite, first take the plank out of your own eye, and then you will see clearly to remove the speck from your brother’s eye”
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