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Australian company has a plan to mine sands

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Mannar Island is a bird paradise that survived Sri Lanka’s civil war

Two thousand flamingos and a war-torn island: controversy over Australian mine proposal

Have you heard of Sri Lanka’s Mannar Island?

Up to a million migrating birds seek sanctuary here each year on their gruelling journeys South, and thousands of flamingos call the island home too.

It’s also home to the survivors of a 26-year civil war, who are still rebuilding their lives and rely on the island for their subsistence livelihoods.

An Australian ASX-listed company wants to mine on the island for mineral sands – a booming global industry extracting vital minerals for a multitude of uses.

But Sri Lankan scientists, environmentalists, and human rights activists are concerned about the impact a mine could have, and dismayed about the lack of information on what’s proposed.

Science Friction investigates.

 

by environment reporter Nick Kilvert and Jane Lee for Science Friction

As a small child, Shreen Abdul Saroor remembers getting up before dawn with her father to spy on the masses of migratory birds that would visit her island.

The birds were on their way down the Central Asian flyway — a migration path that crosses 30 countries from Siberia to the Indian Ocean.

“We would hide somewhere and … we don’t make any noise,” Ms Saroor recalls.

“[Then we’d watch] them coming and landing in the causeway areas and then catching fish and taking off as a huge group covering the entire sky.”

Up to a million birds stop at Mannar Island, off the north-west coast of Sri Lanka, to feed during the winter.

The Vankalai Bird Sanctuary on the southern tip of the island is protected by the Sri Lankan government and has been internationally recognised under the Ramsar Convention for its importance to both local and migratory birds.

Ms Saroor also remembers climbing the swollen trunks and gnarled branches of the baobab trees — trees synonymous with Africa, Madagascar and Australia’s Kimberley, but also found incongruously on her tiny island.

“Even though I fondly remember these baobab trees, one thing that I really remember is how … [members of the militant separatist group the Tamil Tigers] put the mutilated heads of the Indian peacekeeping forces on those trees.”

The Liberation Tigers of Tamil Eelam fought a 30-year civil war with majority Sinhalese Sri Lankan military, in an attempt to create an independent Tamil homeland in the north and east of the country.

Ms Saroor had already left the island to study in Colombo in 1990 when the Tamil Tigers forced her remaining family off Mannar Island, along with all the other Muslim residents.

“Everybody overnight became refugees,” she says.

Since the war ended in 2009, many displaced Mannar Islanders have returned to re-establish themselves in fishing and farming communities. But the trauma still lingers and there are tensions over land.

Against this backdrop, an Australian company has a plan to mine Mannar’s sands.

There are fears for the island’s fragile ecology, agriculture and fishing areas — and islanders are worried they could be displaced all over again.

Company’s drilling triples estimate of island’s minerals

Mannar is the biggest island at the base of a narrow chain of limestone shoals known as Rama Setu or Adam’s Bridge, which stretches 48 kilometres north-west to join India.

The island is 26km long by 8km wide and has rich deposits of the mineral ilmenite in its sand.

Ilmenite is the main source of titanium dioxide, a valuable white pigment used in things like paints, ink, plastics and cosmetics.

In 2018, Perth-based company Titanium Sands advised the Australian Securities Exchange (ASX) it entered an agreement with Srinel Holdings Ltd to explore the extent of the island’s ilmenite reserves.

In May this year, the company announced their exploratory drilling had tripled the previous estimate — to a total of just under 265 million tonnes.

Managing director of Titanium Sands, James Searle, says the company is looking to mine an area of the island that is 2km wide and about 8km long.

“That’s probably over a 30-plus year lifespan,” he told ABC RN’s Science Friction.

“On an annualised basis that’s probably … in the region of between 10 and 16 hectares.”

But some Sri Lankan scientists and environmentalists say they have been inadequately informed about the project.

‘The machines are moving in’

Ms Saroor’s younger brother is one of those who have made it back to the island, where he has a coconut estate.

“The first time I heard about this Titanium Sands mining is from him,” Ms Saroor says.

“He called me frantically and said there are machines moving in and out of those areas.”

Companies that Titanium Sands acquired started preliminary assessment with small-scale drilling on the island in 2015.

Throughout the totality of their study, which included a scoping study completed this year, the company drilled more than 3,000 exploratory holes with the deepest going down to 12 metres. The majority were between 1 and 3 metres.

According to Dr Searle, there has been no drilling in built-up areas of the island.

“The population on the island is largely concentrated in a town down the landward end of the island, called Mannar Town. There are other coastal villages, other settlements around the island,” he says.

“Our exploration work is only being undertaken on areas where there is no habitation and where there is no active agriculture.”

It’s some of those undeveloped areas of Mannar Island that concern ecologist Sampath Seneviratne, who studies Mannar’s birds.

“Flamingos must be the most charismatic and sought-after in terms of beauty,” he says. “[But] spoon-billed sand piper, one of the rarest birds in the world and one of the most iconic species that are on the verge of extinction right now, has been recorded in Mannar.

“These birds require highly productive places to feed during their migration and during their winter stopover. So if the productivity drops, they can’t use Mannar, they have to go [to] other places.”

According to Dr Seneviratne, a public notice is usually issued when companies are given permission for mining exploration in Sri Lanka.

But he and his colleague at the Wildlife Protection Society only found out from a friend in Australia about the drilling, and they were surprised that local environmental groups knew nothing of the project.

“It was a big shocker, because how did people like us working in [Mannar] not know

Company accused of illegal conduct by Mines Bureau

Earlier this year in June, Titanium Sands was accused of illegal conduct in local Sri Lankan media reports.

The Sri Lankan Geological Surveys and Mines Bureau (GSMB) — the government body responsible for issuing mining and exploration licenses in Sri Lanka — reportedly said the company’s exploration was unlawful.

The GSMB told local media that under Sri Lankan law, Titanium Sands couldn’t legally acquire the rights to explore Mannar by purchasing the company (Srinel Holdings Ltd) that previously held the licenses.

But Dr Searles says the GSMB was “incorrect” and was responding to misleading social media posts.

“The legal advice and the legal structures are in total compliance with the Sri Lankan regulations,” he says.

The ABC contacted the GSMB but did not receive a response.

In November, a committee was put together by the Sri Lankan Ministry of Industry to look into the claims of illegal drilling.

Titanium Sands presented its case to the Ministry of Industry, but Dr Searle says he hasn’t heard anything further.

“I reiterate again that the licenses are held in a fashion which is in total compliance with the legal requirements in Sri Lanka

At the time Science Friction went to air there was no information on the company website about the committee’s enquiries into the project.

Asked why, Dr Searle responded: “We received enquiries on all manner of things and we don’t consider it to be significant.”

The company has since added a statement that says it “is not being investigated” although they have “provided information to the committee” which they say confirms the validity of their licences.

It also stated that the company has “no intention of pursuing a project that potentially impacts a Ramsar-designated area”.

Mannar ‘promoted as a promising resource’

Environmental scientist and senior director of the Centre for Environmental Justice, Hemantha Withanage, says he is concerned he hasn’t heard anything about the committee’s enquiries since the Sri Lankan federal election in August.

But, he says, the picture Titanium Sands is painting for their shareholders is not all it seems to be.

“On their website, they’re promoting Mannar Titanium Sands as a promising resource,” Mr Withanage says.

“How can somebody promote like that, without going through the environmental impact assessment process and getting the government approval?”

“We are very, very concerned about what this company is going to do in Sri Lanka,” he says.

But an environmental impact assessment and public consultation are the next steps in the process, according to Dr Searle.

“That would eventually [lead to], we hope, granting of mining licences and ultimately development of the project,” he says.

Mining would ‘dramatically transform’ the ecosystem

Mineral sands mining is considered to have a fairly low impact on the environment compared to some other forms of mining.

The process doesn’t involve chemical separation of minerals such as in gold mining, or digging vast open-cut pits such as with coal.

Titanium Sands published material online showing the location of their resources including exploratory drill holes near the coast.

Daniel Franks, program leader of the development minerals strategic program at the University of Queensland, says Titanium Sands’ scoping study, released 

to the ASX in June this year, reveals the size of the planned mine is extensive and includes areas just a few metres from the beach.

If the operation was based in Australia, the company would be unlikely to be granted permission to mine those areas, says Professor Franks, who is not involved in the project.

“Mining to such a wide extent would dramatically transform the ecosystem. It would also limit the land uses that the community already has for the island,” he says.

“If it was in Australia, which is the home company of the project partners, it would face some pretty steep obstacles to regulatory approval.”

Mining near active beaches can disturb coastal morphology and removing vegetation can leave sand dunes vulnerable to erosion.

Managing director Dr Searle stresses that his company may not end up being able to mine all the resources they’ve identified, should the mine go ahead.

He says the company doesn’t intend to mine near beaches on Mannar, and that there is no economic incentive for the company to do this.

“Those areas along the shoreline are of no interest to us whatsoever because we consider them to be environmentally sensitive. We are much more interested in the interior, one to three kilometres away from the nearest coastline.”

But Professor Franks says the company’s assertion that it has no plans to mine near the beach “appears contrary to the scoping study released to the ASX” and that an update to the ASX might be in order.

Ms Saroor is also afraid the mine could damage the island’s groundwater.

“Mannar gets the smallest amount of the rain in the whole of Sri Lanka. So we totally depend on groundwater,” she says.

Professor Franks says the extent to which a sand mine could disturb the groundwater on Mannar depends on how deep Titanium Sands digs into the ground.

“I think there is a potential to impact groundwater systems. We’ve seen that in Australia where there’s indurated layers in the sand, that are impermeable and that can hold water,” he says.

“But I think the bigger impact is just the surface disturbance that’s going to happen across the island.”

Dr Searle, however, says the project will not affect groundwater or disturb beach areas.

“If it was to affect the groundwater, we wouldn’t be doing it,” he says.

“How you can make a statement that [this type of operation] would not be permitted in Australia is farcical.

“This sort of operation … has occurred over the last 50 to 60 years [in Australia] with an excellent environmental record.”

‘The people on the ground have the right to say no’

Rather than displacing people, Dr Searle says the mine will create between 200 and 600 jobs and that 95 per cent of those employed would be Sri Lankan people.

But Ms Saroor, who is now an award-winning human rights activist, is concerned about the impact on a community recovering from war.

She believes Titanium Sands should not add to the trauma of a community that is still rebuilding.

“At the end of the day, they are investing in Sri Lanka to make profit,” she says.

“So, my message would be to them to make sure not to profit out of a community that has been suffering in the last 30 years of the war.

“Think about the impact not only on the environment, but also on the people, and [then] make their decision.”

Mr Withanage of the Environmental Justice Centre says he could support the project, if it can be proven to be done in a way that benefits the local community and earns its social licence.

He says the final decision on whether the mine goes ahead needs to rest with the Mannar people.

“It’s not the Australian citizens who are going to make that decision.

“It is the Sri Lankan citizens going to that place, Sri Lankan government agencies, Sri Lankan courts… So they have to make that information available to Sri Lankans first.

“Australians are just going to buy the shares. The people on the ground have the right to say no.” –ABC



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Life style

Dr. Shama inspires hope in battle against breast cancer

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Dr. Sharma Goonatillake Consultant Clinical Oncologist

Breast cancer is the most common cancer among women in Sri Lanka. Annually, out of approximately 37,000 newly diagnosed cancer patients nearly 27% are attributed to female breast cancer. In contrast male breast cancer is significantly rarer, observed at a ratio of about 1:100 compared to female cases.

On a daily basis, the statistics translate to approximately 15 new female breast cancer patients being detected with sadly three fatalities due to this disease. An excerpt from an interview with Dr Shama

Goonatilleke, Consultant Oncologist at Asiri Surgical Hospital

Breast cancer remains one of the most common cancers among women. What trends are you seeing locally in terms of age, risk and incidence?

Breast cancer is the most common cancer among women in Sri Lanka. Annually, out of approximately 37 000 newly diagnosed cancer patients, nearly 27% are attributed to female breast cancer. In contrast, male breast cancer is significantly rarer, observed at a ratio of about 1:100 compared to female cases.

On a daily basis, the statistics translate to approximately 15 new breast cancer patients being detected, with sadly, three fatalities due to this disease.

In Sri Lanka, the key trends for breast cancer show a significant increase in incidence, particularly affecting older, post-menopausal women, and a growing prevalence of lifestyle-related risk factors.

The age-standardized incidence rate for female breast cancer in Sri Lanka has shown a steady and significant increase over the years, rising from 18.4 per 100,000 in 2005 to 34.4 per 100,000 in 2019. A gradual increase of approximately 4% per year was observed between 2001 and 2010, with the trend expected to continue.

The highest incidence of breast cancer is observed in women aged 50 to 59 years, with the mean age of diagnosis around 56 years. The increase in incidence has been substantially greater among women older than 50 years compared to younger women. While the incidence is lower in younger age groups, cases are reported from the 20-24 age group onwards, and nearly one-third of cases are reported before the age of 50. A significant proportion of patients are diagnosed at advanced stages (Stage III and IV), which contributes to lower survival rates compared to developed countries.

Why are we witnessing more breast cancer cases in younger women today?

Unfortunately, breast cancer is not a preventable cancer. The rise in breast cancer cases among younger women today is attributed to a complex interplay of lifestyle changes, environmental exposures, hormonal/reproductive shifts, and genetic factors. No single cause fully explains the trend, and research is ongoing.

Lifestyle and Hormonal Factors: Reproductive Changes:

Women are having their first child later in life or not having children at all, and are less likely to breastfeed. Pregnancy and breastfeeding, especially at a younger age, have a protective effect against breast cancer later in life, and the loss of this protection increases risk.

Increased Lifetime Estrogen Exposure:

Girls are starting menstruation earlier and women are entering menopause later, increasing the number of menstrual cycles and the body’s lifetime exposure to estrogen and progesterone, which can fuel the growth of hormone-receptor-positive breast cancers.

Obesity and Weight Gain:

Higher rates of obesity and weight gain during childhood and adulthood are associated with increased inflammation and hormonal imbalances, raising the risk of breast cancer in premenopausal young women.

Alcohol Consumption:

Alcohol intake is clearly linked to an increased risk of breast cancer, and the risk increases with the amount consumed. Alcohol consumption among young Sri Lankan females have increased during recent past.

Physical Inactivity and Diet:

A lack of physical activity and diets high in red meat and processed foods, which are common in “Western-style” diets, are linked to an increased cancer risk.

Environmental Exposures:

Endocrine-Disrupting Chemicals:

The current generation of young women has grown up exposed to a wider array of chemicals than ever before, including endocrine disruptors in plastics (like BPA and phthalates), cosmetics, pesticides, and food packaging. These chemicals can mimic hormones and interfere with hormonal regulation, increasing susceptibility to cancer.

Air Pollution:

Exposure to air pollutants can be absorbed into breast tissue and contribute to cancer development.

Other Potential Factors:

Genetics: Younger women getting breast cancer are more likely to have a genetic predisposition, such as BRCA1 and BRCA2 gene mutations, some may be direcDr. Shama inspires hope in

battle against breast cancertly getting from their parents,are associated with higher cancer risk and more aggressive forms of the disease.

Increased Awareness and Screening:

While not a cause of the disease itself, recent changes to screening guidelines (such as the recommendation to start mammograms at age 40) lead to earlier detection of existing cancers, which may contribute to the uptick in reported cases in this age group.

Researchers emphasize that these factors likely interact with one another, and exposures during critical windows of susceptibility, such as puberty and pregnancy, may be particularly impactful.

What early warning signs should women be paying attention to?

Women should pay attention to any new or unusual changes in the look or feel of their breasts, chest, or armpit areas. The most common early warning sign of breast cancer is a new lump or thickening, but other symptoms can occur even without a lump.

A new lump or thickening in the breast or armpit area, which may be painless and have irregular edges (though some can be soft, round, or tender).

Changes in the size or shape of one or both breasts.

Skin changes on the breast, such as dimpling, puckering, redness, scaling, or irritation (sometimes described as resembling an orange peel texture).

Nipple changes, including a nipple that pulls inward (inverts), changes direction, or has a rash or scaling.

Nipple discharge (other than breast milk), especially if it is clear or bloody and happens spontaneously (without squeezing).

Persistent pain in the breast or nipple area that is new and does not go away after a menstrual cycle.

Swelling or a lump in the armpit or around the collarbone, as cancer can spread to nearby lymph nodes.

It is important to become familiar with the normal look and feel of your breasts through regular self-exams so that any changes can be spotted promptly. While many of these symptoms can be caused by benign (non-cancerous) conditions, any new and persistent changes should be evaluated by a healthcare professional as soon as possible for an accurate diagnosis. Early detection significantly improves the chances for effective treatment and positive outcomes.

Many women are still hesitant about breast screening. What misconceptions prevent early detection?

Misconceptions and fears that prevent women from attending breast screening and receiving an early diagnosis include false beliefs about personal risk, the screening procedure’s safety and comfort, and the outcomes of a cancer diagnosis

Key misconceptions preventing early detection are:

“I am not at risk because I am healthy/have no family history.” This is a very common myth. The truth is that most breast cancers occur in women with no family history, and healthy habits only reduce the risk, not eliminate it. A woman’s primary risk factors are simply being a woman and getting older.

“Mammograms are painful or dangerous.” Many women avoid screening due to fear of pain or concerns about radiation exposure. In reality, the procedure may cause brief, manageable discomfort, and the radiation dose is very low and considered safe by medical guidelines. The benefits of early detection far outweigh the minimal risks.

“Only women with symptoms or lumps need screening.” Mammograms are designed to find cancer years before physical symptoms, such as a lump, can be felt. Waiting for symptoms often means the cancer is more advanced and potentially less treatable.

“A painless lump is harmless.” Most breast cancers do not cause pain. Any new lump or unusual change should be checked by a healthcare provider regardless of whether it is painful.

“Breast cancer is a death sentence.” This fatalistic view can lead women to avoid screening or delay treatment. With early detection, the 5-year relative survival rate for localized breast cancer is an impressive 99%.

“Breast self-exams are enough.” While self-awareness of breast changes is important, self-exams alone are not a substitute for regular professional screenings like mammograms, which can detect much smaller cancers.

“Newer tests make mammograms obsolete.” While other tools like ultrasound and MRI are used for high-risk cases, mammography remains the gold standard and most effective tool for average-risk screening and early detection.

Other Barriers:

Fear and Anxiety:

Many women avoid screening due to fear of the results (receiving a cancer diagnosis) or the procedure itself.

Socio-cultural factors:

Taboos, stigma, or a preference for traditional medicine can lead to significant delays in seeking conventional care.

Logistical and financial issues

: Cost, lack of health insurance, difficulty accessing healthcare facilities (e.g., transportation issues), or an inability to take time off work or find childcare can all prevent women from attending appointments.

Lack of knowledge:

Low awareness of the benefits of screening, the risk factors, and the signs and symptoms of breast cancer contributes to hesitation and delay

Addressing these misconceptions through better education and communication from healthcare providers is essential to encouraging regular screening and improving outcomes.

How has modern technology improved breast cancer treatment outcome at Asiri AOI (American Oncology Centre) cancer centre?

Modern technology has improved breast cancer treatment outcomes at Asiri AOI Cancer Centre by enabling more accurate, personalized, and less invasive care, which enhances efficacy while minimizing side effects and recovery times.

Key technological advancements and their impact include:

Diagnosis and Staging

Advanced Imaging (PET-CT, MRI, 3D Mammography): These technologies allow for the detection of tumors at earlier stages and provide detailed information on their location, size, and extent. This precision in staging is crucial for developing the most effective treatment plans, which directly improves survival rates.

Genetic and Histopathology Labs: Asiri AOI uses advanced labs for genetic testing and biomarker analysis to understand cancer at a molecular level. This allows for the classification of breast cancer into specific subtypes (e.g., hormone receptor-positive, HER2-positive) and the development of personalized treatment plans tailored to the patient’s unique cancer profile, improving treatment efficacy and reducing unnecessary therapies.

Treatment Modalities Surgical Techniques

Sentinel Lymph Node Biopsy (SLNB): This minimally invasive procedure has largely replaced the traditional, more extensive axillary lymph node dissection. SLNB accurately stages the cancer while significantly reducing the risk of lymphedema and other post-surgical complications, leading to better recovery and quality of life.

Intraoperative Guidance:

Techniques such as image-guided surgery and the potential future use of cancer-targeted dyes or molecular probes during operations help surgeons ensure complete tumor removal while preserving maximum normal breast tissue, reducing the need for re-operations and improving cosmetic results.

Systemic Therapies

Targeted Therapy and Immunotherapy:

By using insights from advanced diagnostics, in addition to traditional chemotherapy clinicians can employ targeted therapies and immunotherapies that focus on specific cancer-driving molecules or leverage the body’s own immune system to fight cancer. These treatments are often more effective and have fewer side effects than traditional chemotherapy.

Precision Radiotherapy (TrueBeam STx)

Asiri AOI utilizes the TrueBeam STx radiotherapy system, which delivers high doses of radiation with sub-millimeter accuracy.

Improved outcomes:

This system targets cancer cells while sparing healthy surrounding tissues and organs (like the heart and lungs), which reduces side effects and long-term complications.

Efficiency:

It allows for faster treatment sessions and fewer visits (e.g., reducing multi-week radiation courses to a few sessions or even intraoperative radiotherapy options), which improves patient comfort and quality of life.

Overall, the integration of these modern technologies, combined with a multidisciplinary approach and adherence to international protocols (via collaboration with UPMC), enables Asiri AOI Cancer Centre to provide world-class, individualized care that has significantly improved breast cancer treatment outcomes.

Is radiotherapy recommended for every breast cancer patient? When is it more beneficial?

No, radiotherapy is not recommended for every breast cancer patient. The decision to use radiotherapy is personalized and based on a variety of factors related to the cancer’s characteristics, the type of surgery performed, and the patient’s overall health.

Radiotherapy is primarily used to destroy any remaining cancer cells after surgery and reduce the risk of the cancer coming back in the breast area or nearby lymph nodes. It is generally more beneficial, and often standard, in the following situations:

After Breast-Conserving Surgery (Lumpectomy): Radiotherapy to the remaining breast tissue is a standard part of treatment to lower the risk of local recurrence. Some very low-risk, older patients (e.g., age 70 or older with a small, hormone receptor-positive tumor) who are receiving hormone therapy may be able to skip it, but this is an exception.

After a Mastectomy:

It is often recommended if there is a high risk of the cancer returning to the chest wall or nearby lymph nodes. This includes cases where:

The tumor was large (larger than 5 cm).

Cancer has spread to the lymph nodes (especially four or more, but potentially even one to three).

Surgical margins have cancer cells (positive or very close margins).

The cancer has grown into the skin or muscles.

For Certain Aggressive Cancers: Radiotherapy is a key part of the treatment plan for inflammatory breast cancer.

For Advanced or Metastatic Cancer: It can be used as a palliative treatment to shrink tumors, relieve pain, and control symptoms when cancer has spread to other parts of the body, such as the bones or brain.

Before Surgery (Neoadjuvant therapy): In some cases, it can be used to shrink a large tumor to make it easier to remove with surgery.

A patient may not be an ideal candidate for radiotherapy in certain situations:

Very Early Stage, Low-Risk Breast Cancer: Some patients with early-stage, small, hormone receptor-positive tumors that have not spread to the lymph nodes may not require radiotherapy, especially if they are older and receiving hormone therapy.

Prior Radiation Exposure: Patients who have previously had radiation therapy to the same area (chest/breast) cannot typically receive a second course due to the risk of damage to healthy tissues.

Certain Medical Conditions:

Individuals with connective tissue diseases (like lupus or scleroderma) or severe heart/lung problems may face higher risks of complications.

Genetic Predisposition:

Patients with certain genetic mutations, such as Li-Fraumeni syndrome or some ATM mutations, may be advised against radiotherapy due to a higher risk of developing a second cancer later.

Pregnancy:

Radiotherapy is generally avoided during pregnancy.

Ultimately, the decision to use radiotherapy is made through a discussion between the patient and their healthcare team (including a radiation oncologist), weighing the benefits of reducing recurrence risk against potential side effects and the individual’s specific health factors.

Many patients initially fear diagnosis more than the disease. How do you help them cope emotionally?

Helping patients cope with the fear of a potential diagnosis involves compassionate communication, providing clear information, offering emotional support, and empowering them with a sense of control.

Compassionate and Empathetic Communication

Active Listening: Give the patient your undivided attention and allow them to express their fears, worries, and anxieties without interruption. Acknowledging their feelings with phrases like, “I understand why you’re feeling this way” or “It’s okay to feel scared,” helps them feel heard and validated.

Acknowledge and Normalize Feelings: Reassure patients that denial, fear, anxiety, and anger are normal responses to the stress and uncertainty of a potential serious diagnosis.

Be Aware of Non-Verbal Cues:

Use calm body language, maintain appropriate eye contact, and use a warm, comforting tone of voice to convey support and sincerity. A reassuring touch on the arm, when appropriate and consensual, can also make a difference.

Honesty and Transparency:

Be honest about what is known and what is unknown, as this builds trust. Avoid giving false reassurance or minimizing their concerns, as this can break trust and make them feel misunderstood.

Information and Education

Provide Clear, Simple Information: Explain medical conditions, tests, and procedures in clear, non-medical language to reduce the “fear of the unknown”. Use visual aids if helpful.

Encourage Questions: Create an open, non-judgmental environment where patients feel comfortable asking questions. Offer your contact details or a specific point of contact for follow-up questions they may have later.

Guide Information Seeking: Advise patients on reliable sources for information and gently discourage unhelpful internet searches, which can increase anxiety with misinformation.

Empowerment and Control

Involve Patients in Decision-Making: Discuss options and allow patients to be active participants in their care plans. This gives them a sense of control, which is often lost during a health crisis.

Focus on the Next Steps: Collaboratively formulate a plan for immediate next steps and contingencies. A clear action plan helps shift focus from worry to proactive management.

Set Realistic Goals: Help patients focus on manageable, day-to-day goals and activities, rather than overwhelming long-term expectations, to prevent feelings of frustration and failure.

Support Networks and Coping Strategies

Involve Family and Friends: With patient consent, involve loved ones in the conversation. They can offer emotional support and help remember information and instructions.

Suggest Coping Techniques: Introduce relaxation strategies such as deep breathing exercises, mindfulness, meditation, music therapy, art therapy, aroma therapy, or guided imagery.

Recommend Support Groups: Connect patients with peer support groups or online communities where they can talk to others who have similar diagnoses and experiences. Hearing personal stories can provide valuable perspective and coping strategies.

Refer to Mental Health Professionals: Encourage patients to seek professional help from a counselor or psychologist who specializes in health anxiety if their feelings become overwhelming or interfere with daily life and treatment adherence.

What lifestyle factors contribute to increased breast cancer risk – especially in urban areas?

Can diet exercise or hormone regulation reduce risk?

How can survivors, ensure long term health and reduce recurrence risk?

Breast cancer survivors can ensure long-term health and reduce recurrence risk through a combination of consistent medical follow-up, healthy lifestyle choices (diet, exercise, weight management), avoiding harmful habits, and managing emotional well-being.

Medical Follow-Up and Adherence to Treatment

Regular Check-ups and Screenings: Adhere strictly to your follow-up schedule with your oncology team or primary care physician. These visits, typically every few months initially and then annually after five years, are crucial for monitoring signs of recurrence or new cancers.

Annual Mammograms: Continue annual mammograms on the remaining breast tissue (or both if you had breast-conserving surgery).

Adherence to Therapies: If prescribed, complete the full course of hormone therapy (e.g., tamoxifen, aromatase inhibitors) or other maintenance therapies, as early discontinuation increases the risk of recurrence.

Discuss Advanced Therapies: Talk to your doctor about advanced therapy options, as modern targeted treatments can significantly reduce long-term risk for specific cancer types.

Know Your Body and Report Changes: Be vigilant for new or persistent symptoms, such as new lumps, unexplained pain, chronic cough, or sudden weight loss, and report them to your doctor immediately.

Healthy Lifestyle Choices

Maintain a Healthy Weight: Obesity is a significant risk factor for recurrence. Aim to achieve and maintain a healthy weight through diet and exercise.

Be Physically Active: Regular physical activity can reduce breast cancer mortality and recurrence risk by a significant percentage (up to 40%). Aim for at least 150-300 minutes of moderate-intensity aerobic exercise (like brisk walking) or 75-150 minutes of vigorous activity per week, plus two strength-training sessions per week.

Eat a Balanced Diet: Focus on a diet rich in a variety of colorful fruits, vegetables, whole grains, and lean proteins (fish, chicken, legumes). Limit red and processed meats, highly processed foods, and sugary drinks.

Avoid Alcohol: Avoid alcohol, as alcohol intake is linked to an increased risk of a second primary breast cancer.

Quit Smoking: Smoking increases the risk of recurrence and overall mortality. Seek support to quit immediately.

Consider Vitamin D: Low levels of vitamin D may be associated with a higher risk of recurrence. Discuss monitoring your levels and appropriate supplementation with your healthcare team, especially for bone health.

Emotional and Mental Well-Being

Manage Stress: Chronic stress can impact immune function. Utilize stress-reduction activities like yoga, meditation, gardening, or counseling to manage anxiety and the fear of recurrence.

Seek Support: Connect with friends, family, or support groups of other survivors. Sharing experiences and building a strong support network can improve quality of life and emotional health.

Prioritize Sleep: Aim for at least seven hours of quality sleep per night to aid physical and mental recovery.

By Zanita Careem

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When hearts sing together

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The rhythm of compassion,Chandimal and his talented band

It was an evening of meaningful moments as the Heart to Heart volunteers gathered for a joyful sing-along at the elegant Raffles Hotel led by the even charismatic Chandimal Fernando and his talented band. The night resonated with old favourites and golden hits that had everyone singing along in harmony, guests gathered in a spirit of friendship and celebrations honouring those who continue to make a difference through compassion and service.

From the very first song the crowd joined in enthusiastically, voices blending in harmony, smiles lighting up faces and hearts beating as one. For many it was a vision to support a mission of Heart to Heart, founded by compassionate and brilliant doctors. Dr. Ruwan Ekanayake and Dr. Rajitha. Dr Rajitha is a young cardiac surgeon whose work has touched continous lives. This Heart to Heart Sing along is an event that perfectly blended music, camaraderie and purpose true to the spirit of the Heart to Heart.

A doctor of quiet strength and deep compassion Dr. Rajitha’s vision has turned Heart to Heart into more than a social initiative, it is a moment of empathy. His belief that every heart matters continues to inspire countless volunteers.

The evening carried an emotional touch as Heart to Heart took a moment to honour Mr.Wimalaratne and his wife Chandra Wimalaratne – long time volunteers. The gesture was met with heartful applaud, a moving tribute to two individuals who embody the true essence of service.

They were pillars of kindness whose quiet generosity and hard work and continued support have touched countless lives. Adding warmth to the evening was a joyful celebration of birthday of Shanti Fernando, Executive Coordinator of the Heart to Heart Trust Fund, an occasion joyfully acknowledged by members of the Volunteer Society.

Behind every successful event is a team of tireless volunteers and this evening was no exception. The meticulous organisation and attention to detail bore testimony to the evening’s proceedings. The dedication of volunteers like Indrajith and his wife Oshadie, and Commander Bohoron whose planning , co-ordination and personal touch ensured everything ran seamlessly. From managing guest arrivals to the seating plan and programme flow, their quiet leadership kept the evening smooth and stress free. Alongside them were other volunteers who contributed their time and energy, working in harmony to create an atmosphere of warmth, volunteers Lakshmi,Kalhari,Nelka to name a few The young compere for the evening, Aqueela Bashir, impressed all with charm, confidence and stage presence was over the audience. She guided the evening flow with ease introducing performances, engaging the crowd and keeping spirits high. The guests were treated to an exquisite buffet from Raffles restaurant Mirihana that reflected the hotel’s reputation for fine dining. From delicate starters and flavourful mains to decadent desserts, every dish was a celebration of taste and presentation.

As the final song faded and guests lingered with smiles, it as clear that the Heart to Heart sing along was for more than a musical evening – it was a testament to love, gratitude and the joy of giving.A big thank you for the generous sponsors, whose unwavering support made this event a great success. We deeply appreciate your trust,encouragement and believe in our cause and partnership truly makes a difference

By Zanita Careem ✍️

Pix by Thushara Attapathu

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Guardians of the Night: The Secret Life of Sri Lanka’s Frogmouth

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When dusk falls across the rain-soaked forests of Sinharaja, a low, rasping call echoes through the canopy — neither frog nor owl, but something eerily in between. It belongs to the Sri Lanka Frogmouth (Batrachostomus moniliger), one of the most secretive birds ever to inhabit the island’s forests. Its strange croak seems to rise from the mist itself — an ancient whisper from the treetops.

For Suranjan Karunaratne, an ecologist with the Nature Explorations and Education Team, this haunting sound became a lifelong fascination.

Speaking to The Island, he said: “It was like finding a ghost in the forest,” he recalls. “The bird was perched motionless, its feathers blending so perfectly with the bark that even my camera couldn’t distinguish it from a branch.”

That “ghost” became the subject of Sri Lanka’s first comprehensive, 20-year study on the species — research that has redefined what we know about one of Asia’s most enigmatic nocturnal birds.

A Two-Decade Search for Shadows

Between 1998 and 2018, Karunaratne and his collaborators traversed the length and breadth of the island — from the misty lowlands of Sinharaja to the scrublands of Yala and the arid forests of Hambantota. Their work, recently published in Ardeola, the journal of the Spanish Ornithological Society, mapped the distribution, habitat associations, and conservation status of the Sri Lanka Frogmouth with unprecedented precision.

The project brought together a powerhouse team of Sri Lankan and international researchers, including Salindra K. Dayananda, Dinesh Gabadage, Madhava Botejue, Majintha Madawala, Indika Peabotuwage, Buddhika Madurapperuma, Manjula Ranagalage, Asanka Udayakumara, and Prof. Thilina Surasinghe, who led the modelling work from Bridgewater State University, USA.

“This was no short-term study,” Karunaratne says proudly. “It took years of patient night work — sometimes returning from the field at 2 a.m., drenched, bitten by leeches, but exhilarated by a single call.”

A Forest Specialist

The team’s findings confirmed the frogmouth’s status as a true forest specialist. The species was found in 18 percent of the 249 survey sites, spread across all of Sri Lanka’s major bioclimatic zones — wet, intermediate, dry, and arid. Yet 90 percent of sightings were in forested areas, highlighting its extreme dependence on intact ecosystems.

“It simply cannot survive in heavily degraded habitats,” Karunaratne notes. “That makes it a perfect indicator of forest health.”

The frogmouth’s range extended from 11 metres above sea level to about 767 metres, confirming its preference for low-elevation rainforests and evergreen forests. Its camouflaged plumage, nocturnal habits, and motionless roosting posture make it nearly impossible to detect — a natural master of disguise.

Listening to the Forest

To locate these secretive birds, the researchers used a combination of visual surveys and call recognition, often navigating rough terrain at night. Over two decades, they documented the frogmouth’s calls, nesting sites, and habitat preferences, revealing patterns that were previously unknown.

The team employed cutting-edge geospatial analysis using Google Earth Engine and Landsat imagery to map land-cover changes around the frogmouth’s habitats. The results were sobering: 535.9 square kilometres of forest were lost between 1998 and 2018, with an annual loss of nearly 27 km².

Suranjan Karunaratne

“Forest loss is the single biggest threat,” warns Karunaratne. “The frogmouth depends on large tracts of undisturbed forest. When those are fragmented, its populations collapse silently.”

An Evolving Range

Perhaps the most striking discovery was that the frogmouth’s range is far wider than previously thought. Traditionally believed to be confined to the southwestern rainforests, it was also recorded in the dry and arid zones — from Maduru Oya to Yala and even the southeast plains.

“We were surprised to find it calling in unexpected places,” Karunaratne admits. “This suggests that older, mature secondary forests may now serve as refuges, especially where primary forests have vanished.”

The team’s Habitat Suitability Model (HSM) predicts that the southwestern lowlands will remain the stronghold of the species, while climate change could make mid-elevation forests more suitable by 2050.

A Fragile Sentinel

In ecology, the frogmouth is what scientists call a sentinel species — its presence signals the health of an ecosystem.

“If the frogmouth disappears, it means the forest has crossed a threshold of damage,” Karunaratne says. “It is nature’s quiet warning.”

The bird’s behaviour underscores its fragility. It avoids human settlements, tourist trails, and even faint noise pollution. Its nesting success depends on complete stillness; both male and female share incubation duties, each guarding the nest in total silence.

Conservation and Hope

Currently, the Sri Lanka Frogmouth is listed as ‘Least Concern’ by both the global IUCN Red List and the National Red List. But the study’s authors believe this underestimates the risks.

“We recommend that its status be upgraded to ‘Near Threatened’,” says Karunaratne. “It may be regionally common, but it’s locally rare — found in small, isolated pockets that are vanishing fast.”

The team urges conservation planners to protect mature secondary forests — often dismissed as “degraded” — because these areas now harbour viable frogmouth populations.

“Sri Lanka’s secondary forests are hundreds of years old,” Karunaratne adds. “They’ve regained enough complexity to support wildlife. Protecting them could make the difference between survival and extinction for species like the frogmouth.”

The Whispering Forest

In the stillness of the rainforest night, when the moonlight filters through lianas and mist, the frogmouth’s hoarse croak carries far — a sound that few have heard, yet one that defines the mystery of Sri Lanka’s wilderness.

For Suranjan Karunaratne, that sound is both a warning and a gift.

“It reminds us that there’s another world in our forests — one that wakes when we sleep. Protecting it means protecting our own future.”

As he and his colleagues continue to monitor these spectral birds, one message echoes through their research: listen to the night, before it falls silent.

By Ifham Nizam ✍️

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