By Emeritus Professor
The media is full of information about the dangers of aflatoxins, increasing fear in the minds of public. Exposure to extremely small doses of aflatoxins of the order of micrograms per kilogram for long periods leads to liver cancer in humans and animals. Aflatoxins can also cause deaths within a few days if people are exposed to extremely high doses of it. In the world, there has been only one such recorded incident due to toxicity; 105 people died after consuming aflatoxin contaminated maize, during a famine in a neighbouring country. The toxic dose was around 20 mg per kilogram. That was in 1975.
In addressing a sensitive issue such as toxicity of human foods, the background scientific information needs to be understood in its correct perspectives to discuss and explore benefits of science to mankind. Aflatoxins are present in most foods in minute quantities. Unfortunately, none of the common food processing and preparation methods including heat processing or cooking could remove the aflatoxins significantly. In case of edible oils, aflatoxins could be removed industrially, only by chemical (alkali) refining. The treatment removes 98% aflatoxins in oils, bringing down aflatoxin concentrations in edible oils to levels safe for consumption. Other methods of ‘refining’ cannot remove aflatoxins. There is a patented process in Sri Lanka to remove aflatoxins in coconut oil using solar radiation. It needs to be scaled up for industrial use.
Humans do not live in an ideal world. We survive in a world of toxins, whether it is aflatoxin, other mycotoxins (mould toxins), heavy metals, like cadmium, mercury, lead or arsenic, or histamine in tuna fish, which causes allergic reactions, familiar to some of us. The list is much longer. We have learned to consume manioc containing cyanide by boiling in open pots to remove toxicity. Manioc is the staple diet in some of the African countries, but they live with it. Sri Lankans have learned to use goraka as a means of checking histamine producing bacteria in tuna fish. Panic should be avoided when it comes to understanding and handling the problems associated with foods.
Science has developed mechanisms to understand the amount of toxins that could be metabolized by the human body safely. Based on this information, risk level for each of the toxic entities in foods is worked out. The risk level is finally established at a concentration a few 1000 times less than concentrations experimentally established to be safe to humans. This simply means world possess regulatory systems, and dependable accredited testing systems, to make food consumption safe, avoiding naturally occurring undesirable constituents. It applies to aflatoxins as well. The volume of a food consumed by a human is also considered in deciding acceptable or tolerable levels, expressed based on per kilogram body weight of the consumer. Weight of the human body and the concentrations of deleterious entities that could be consumed without harmful effects are combined in establishing no-risk levels. Human health is primary in the efforts of sound science to make us live longer. That is food safety.
Ever increasing human populations against available lands and other resources to produce foods require new mechanisms to ensure food security. This is where strict application of ‘good practices’ in agriculture, food processing, and hygiene contributes to the well-being of humans through safe foods. There is the need for striking the best balance between protection of human health and possible application of good practices in food production to enable humans leade healthy lives without becoming a burden to the public health systems.
The food regulations meant to trike this balance continue to change with increasing scientific knowledge of human health as well as fast developing food processing technology. In the developed countries, food regulations are revised frequently to strike the above balance beneficially for humans. The same cannot be said of most developing countries. Sri Lanka is no exception. However, there are ample opportunities for countries, without adequate resources, to develop their own regulations adopting scientifically designed international “Codex” food standards, without reinventing the wheel.
“Codex” stands are developed by the Codex Alimentarius Commission, which is a joint committee of the FAO and WHO.
The international system gives the opportunity for every country to improve its knowledge, taking into consideration the developments in the scientifically advanced countries, and practices of food handling. Codex knowledge helps all countries to develop food standards in line with world trade, which is also an important aspect in our export trade. Sri Lanka needs to be more tuned to get these benefits.
Taking the current global thinking and Sri Lanka’s needs into consideration, the table for aflatoxin regulatory limits was computed with the field experience of the author on food safety issues in more than 25 countries. It was made available to the health authorities in Sri Lanka a few months ago and Institutions interested in standards a week ago. It addresses the levels of acceptance or tolerance (ML = meaning maximum limit that could be tolerated in a food) for aflatoxins in common foods and feeds in Sri Lanka. The proposal also considered the test results generated in local accredited laboratories.
It focuses on the direction to be followed by Sri Lanka to address aflatoxicity problem. The responsible administrators and policy makers may use it. The scientific reasoning to keep the balance between health and food processing is summarised as notes in the table against each recommendation.
This information would be useful to the public, and those who are interested in understanding regulations in relation to presence of aflatoxins in foods in Sri Lanka. The proposed regulations would not contradict any of the globally used regulations in food trade.
Establishing standards is one thing. Applying it through testing only is the proof of the pudding. The interpretation of the generated test results is even more vital. The writer has tested more than 1,000 samples of foods including large number of coconut oil samples for aflatoxins in Sri Lanka and the US, working at the bench, and interpreting results for internationally recognised publications. The aflatoxins tend to adhere to laboratory glassware, and give a positive reaction for the next sample tested unless special cleaning techniques are used. This adherence can happen with any storage surface including container and bowser surfaces. The surfaces of bulk storage systems are never cleaned to get rid of the aflatoxins. Cleaning to remove storage tanks is practically impossible.
The interpretation of test results should be done with deep knowledge of background information. In interpreting test results for field samples, we need to be mindful that local coconut oil contains small concentrations (of the order of 5 -15 parts per billion) of aflatoxins and the imported oil (100 – 300 parts per billion, if what we hear in the press is correct). Skills of the scientist must go far beyond analyst, and the digits generated by instruments through the testing step. Interpretation of results is not a job for the layman. The testing requires demonstrated competency of analysts through continuous practice. Therefore, we need to resort to a laboratory accredited for the purpose. Gazetting a laboratory as public analyst or use of laboratories which holds accreditation for other tests, but not for aflatoxins, particularly oils, are not the best scientific approaches. Let us be mindful that we are discussing handling of human health through assessing an invisible toxin.
I sincerely believe that the decision makers take the above aspects into consideration in data interpretation responsibly, without leaving it to the newsmakers.
Foreign policy dilemmas increase for the big and small
‘No responsible American President can remain silent when basic human rights are violated.’ This pronouncement by US President Joe Biden should be interpreted as meaning that the supporting of human rights everywhere will be a fundamental focus of US foreign policy. Accordingly, not only the cause of the Armenians of old but the situation of the Muslim Uyghurs of China will be principal concerns for the Biden administration.
However, the challenge before the US would be take this policy stance to its logical conclusion. For example, the murder of Saudi journalist Jamal Khashoggi was one of the most heinous crimes to be committed by a state in recent times but what does the Biden administration intend to do by way of ensuring that the criminals and collaborators of the crime are brought to justice? In other words, how tough will the US get with the Saudi rulers?
Likewise, what course of action would the US take to alleviate the alleged repression being meted out to the Uyghurs of China? How does it intend to take the Chinese state to task? Equally importantly, what will the US do to make light the lot of Russian opposition leader Alexei Navalny? These are among the most urgent posers facing the US in the global human rights context.
Worse dilemmas await the US in Africa. Reports indicate that that the IS and the Taliban have begun to infiltrate West Africa in a major way, since they have been compelled to vacate the Middle East, specially Syria and Iraq. West African countries, such as, Mali, Burkina Faso, Nigeria and Mauritania are already facing the IS/Taliban blight. The latter or their proxies are in the process heaping horrendous suffering on the civilian populations concerned. How is the US intending to alleviate the cruelties being visited on these population groups. Their rights are of the first importance. If the US intends to project itself as a defender of rights everywhere, what policy program does it have in store for Africa in this connection?
It does not follow from the foregoing that issues of a kindred kind would not be confronting the US in other continents. For example, not all is well in Asia in the rights context. With the possible exception of India, very serious problems relating to democratic development bedevil most Asian states, including, of course, Sri Lanka. The task before any country laying claims to democratic credentials is to further the rights of its citizens while ensuring that they are recipients of equitable growth. As a foremost champion of fundamental rights globally, it would be up to the US to help foster democratic development in the countries concerned. And it would need to do so with an even hand. It cannot be selective in this undertaking of the first importance.
The US would also from now on need to think long and deep before involving itself militarily in a conflict-ridden Southern country. Right now it is up against a policy dilemma in Afghanistan. It is in the process of pulling out of the country after 20 years but it is leaving behind a country with veritably no future. It is leaving Afghanistan at the mercy of the Taliban once again and the commentator is right in saying that the US did not achieve much by way of bringing relief to the Afghan people.
However, the Biden administration has done somewhat well in other areas of state concern by launching a $1.9 trillion national economic and social resuscitation program, which, if effectively implemented could help the US people in a major way. The administration is also living up to the people’s hopes by getting under way an anti-Covid-19 vaccination program for senior US citizens. These ventures smack of social democracy to a degree.
The smaller countries of South Asia in particular ought to be facing their fair share of foreign policy quandaries in the wake of some of these developments. India, the number one power of the region, is in the throes of a major health crisis deriving from the pandemic but it is expected to rebound economically in an exceptional way and dominate the regional economic landscape sooner rather than later.
For example, the ADB predicts India will recover from an 8% contraction in fiscal 2020 and grow by 11% and 7% this year and next year. South Asia is expected to experience a 9.5% overall economic expansion this year but it is India that will be the chief contributor to this growth. A major factor in India’s economic fortunes will be the US’ stimulus package that will make available to India a major export market.
For the smaller states of South Asia, such as Sri Lanka, the above situation poses major foreign policy implications. While conducting cordial and fruitful relations with China is of major importance for them, they would need to ensure that their relations with India remain unruffled. This is on account of their dependence on India in a number of areas of national importance. Since India is the predominant economic power in the region, these smaller states would do well to ensure that their economic links with India continue without interruption. In fact, they may need to upgrade their economic ties with India, considering the huge economic presence of the latter. A pragmatic foreign policy is called for since our biggest neighbour’s presence just cannot be ignored.
The Sri Lankan state has reiterated its commitment to an ‘independent foreign policy’ and this is the way to go but Sri Lanka would be committing a major policy mistake by tying itself to China too closely in the military field. This would send ‘the wrong signal’ to India which is likely to be highly sensitive to the goings-on in its neighbourhood which, for it, have major security implications. A pragmatic course is best.
In terms of pragmatism, the Maldives are forging ahead, may be, in a more exceptional manner than her neighbours. Recently, she forged closer security cooperation with the US and for the Maldives this was the right way to go because the move served her national interest. And for any state, the national interest ought to be of supreme importance.
A Sri Lankan centre for infective disease control and prevention
The need of the hour:
BY 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.
On 01st July 1946, the Communicable Disease Center (CDC) of the United States of America opened its doors and occupied one floor of a small building in Atlanta, Georgia. Its primary mission was simple, yet highly challenging. It was to prevent malaria from spreading across the nation. Armed with a budget of only 10 million US dollars, and fewer than 400 employees, the agency’s early tasks included obtaining enough trucks, sprayers, and shovels necessary to wage war on mosquitoes.
It later advanced, slightly changed its name, and transformed itself into the much-acclaimed and reputed Centres for Disease Control and Prevention (CDC). It became a unique agency with an exceptional mission. They work 24/7 to protect the safety, health and security of America from threats there and around the world. Highest standards of science are maintained in this institution. CDC is the nation’s leading science-based, data-driven, service organization that protects the public’s health. For more than 70 years, they have put science into action to help children stay healthy so they can grow and learn, to help families, businesses, and communities fight disease and stay strong and to protect the health of the general public. Their are a bold promise to the nation, and even the world. With this strategic framework, CDC commits to save American lives by securing global health and America’s preparedness, eliminating disease, and ending epidemics. In a landmark move, the CDC even established a Central Asia regional office at the U.S. Consulate in Kazakhstan in 1995 and have been involved in public health initiatives in that region.
More recently, the European Centre for Disease Prevention and Control (ECDC), was established. It is an agency of the European Union, aimed at strengthening Europe’s defences against infectious diseases. The core functions cover a wide spectrum of activities such as surveillance, epidemic intelligence, response, scientific advice, microbiology, preparedness, public health training, international relations, health communication, and the scientific journal Eurosurveillance.
Still later on, the African CDC (ACDC) was born. It strengthens the capacity and capability of Africa’s public health institutions, as well as partnerships, to detect and respond quickly and effectively to disease threats and outbreaks, based on data-driven interventions and programmes.
All these organisations are autonomous, independent, and are confidently dedicated to hold science to be sacred. They play a major role in advocacy and work in a committed advisory capacity. With the cataclysmic effects of the current coronavirus pandemic COVID-19, the contributions made by these institutions are priceless. What is quite important is that they are able to provide specific recommendations based on the latest scientific information available for countries and nations in their regions, even taking into account the many considerations that are explicit and even unique to their regions. All these organisations have been provided with optimal facilities and human resources. The real value of their contribution is related to just one phenomenon: AUTONOMY.
Well…, isn’t it the time for us to start a Sri Lankan Centre for Infective Disease Control and Prevention (SLCIDC)? It should be formulated as an agency constantly striving, day in and day out, to safeguard the health of the public. Science and unbending commitment to evaluation of research on a given topic should be their operating mantra. It would work as a completely apolitical organisation and what we can recommend is that it would be directly under the President of the Democratic Socialist Republic of Sri Lanka, unswervingly reporting to and accountable to the President. It would consist of medical doctors, scientists and researchers but no politicians of any sort, no non-medical or non-scientist persons, no hangers on and no business persons. All appointments to the SLCIDC will be made by the President of the country, perhaps in consultation with medical professional organisations.
The prime duty of the SLCIDC would be to assess the on-going situation of any infective issue that has any effect on the health of the public. The organisation will undertake in-depth examination and assessment of a given situation caused by an infective organism. They need to have all relevant data from within the country as well as from outside the country. There will not be any vacillation of the opinions expressed by them and their considered views should not be coloured by any consideration apart from science and research done locally and worldwide. Their considered opinion would be conveyed directly to the President of the country. They are free to issue statements to keep the public informed about the results of their deliberations.
We believe that it would be a step in the right direction; perhaps even a giant step for our nation, not only during the current coronavirus pandemic but also on any major problems of an infective nature that might occur in the future.
This writer wishes to acknowledge a colleague, a Consultant Physician, who first mooted this idea during a friendly conversation.
Kudurai Madiri Pona
The big jumbo has come from the French land and as the French themselves say it is ‘annus mirabillis’ the miracle year, finally, and finally the wait is over. The world will now see the Big- Bus that we all waited for so long to see. As the years roll by, none would talk of delays regarding the delays on delivery dates and how late the bird flew in. These would be like words written on a blackboard, erased forever. But the aeroplane will grace the sky and, perhaps rewrite all the records of commercial aviation when the mega-miracle A380 dominates the international air-routes.
Singapore Airlines went into the record books as the launch customer. Some of my old friends from SIA would fly the A380. Perhaps, Luke would, too, and this story is about him. Luke of yesteryear and how he first flew as a cadet and how young Luke and I went romping the skies in our own special way, writing a few new lines in the flight training manual.
Luke was from Johor Baru, in Malaysia. His roots were in South India where years ago his grandfather had done a Robinson Crusoe and ended up in the Malayan Peninsula. Luke was named after one of the four Gospel scribes. Luke really isn’t his name. It is a pseudonym, I use just to give him some anonymity. Not much protection, but one is to three are playable odds. Like in Rumple stiltskin the manikin, you are welcome to guess the name.
We first flew to Seoul. He, straight out of flying College, and yours truly, as old as the hills, driving the ‘Jumbo’ classic, the lovable 747. The first thing I noticed about him was his socks, black and white diamond shapes, a mini version of the flags they swing at Grand Prix finals – if Luke swung his feet, a Ferrari would pass underneath. That we sorted out the first day itself. In Seoul,he went shopping and the next day he was Zorro, waist to toe, black as a crow.
His flying credentials were all there, somewhat mixed up between what they teach in modern flying schools and how to apply the ‘ivory tower’ jargon to cope with the big 747. As for raw handling of the aeroplane, all his skills were intact, only they were in bits and pieces and spread in places like an Irida Pola (Sunday Fair). They had to be streamlined, the wet market needed to be modified to a ‘Seven-Eleven’ – that was my job.
The next round we went flying to Europe, his first run to the unknown, like Gagarin in his Sputnik, young Luke flew to Rome. The flying was same as before, a bit mixed up amidst the hundreds of aero dynamical paraphernalia that spelled out from the encyclopaedic collection of books that he had to study.
That’s when I decided to change the tide.
‘Luke my friend,” I said to him in a fatherly fashion.
‘You and I are from similar fields, you from Kerala and me from Sri Lanka. These Min Drag Curves and VFEs and WAT limits and VLEs are too much for us. Just remember when you pull the stick back, the houses will become smaller and when you push the stick down, the houses will become bigger, that’s climbing and descending this monster,” I explained the simple theory of flight.
“As for landing my friend, Kudurai Madiri Pona, just ride it like a horse.”
That was it. We flew, over Europe and he flew like a Trojan, bravely battling the weather and the overcrowded skies. Every time he came in to land it was pure and simple Kudurai Madiri Pona and the big jumbo responded and touched down on the concrete as smooth as a honeymoon lover.
On the way back, we flew via Colombo, that’s my home ground. I requested the radar controller to give Luke a very short ‘four-mile’ final. They know me well here and the controller said “No problem, Captain.”
I was depicting what we did in the Old Hong Kong Airport or what we do in the Canarsi Approach in New York; both, most demanding. A ‘four-mile’ final is a challenge for anyone. I was throwing him in at the deep end and I had no doubt Luke could manage. He came in tight and right, like Hopalong Cassidy and rode the horse straight and beautiful to do a perfect landing. Gone was the Kampong kid and his ‘Irida Pola’ flying, this was Takashimaya and Robinsons rolled into one, everything was in place, nice and shining and professional to the tee.
That was our little story, Luke the ‘jockey’ and me. Sometimes in the field of training, the script needs a little changing. New acts to be introduced to suit the stage. That is the essence of teaching, different hurdles for different horses. It wasn’t for Luke to learn what I knew, more so, it was for me to know who he was and what he could cope with. That part was difficult to find in the flying training manual, and so was Kudurai Madiri Pona.
The world has gotten older and young Luke now wears four stripes and flies in command of Boeing Triple Sevens, fly-by-wire and multiple computers. I met him a few times, flew as his passenger, too, with great pride. “Captain Luke is in command,” the stewardess announced, and silently and gratefully I said, ‘Amen’.
I saw him walking down the aisle, looking for me. Same old Luke in his flat and uncombed Julius Ceaser hairstyle. He came to my seat and grinned and shook my hand and lightly lifted his trouser leg and said,
“Captain, the socks are black and it is still Kudurai Madiri Pona.“
I am sure Luke will fly in command of the gigantic A380 one day. That’s a certainty. It would be the zenith for any pilot. Luke is ready, that I know. He is competent, polished and professional and will wear socks as black as midnight. It’s nice that he remembers his beginnings. That’s what flying is all about, that’s what life is all about.
Kudurai Madiri Pona
– ride it like a horse. Some flying lesson.
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