By Uditha Devapriya

This is the second of a two-part article that was published in The Diplomat.

Today, in terms of bilateral trade, Sri Lanka enjoys modest relations with the region. Between 2011 and 2020, exports to Central Asia exceeded USD 10 million in just one year and with just one country: 2014, with Uzbekistan. On the other hand, in 2015, Sri Lanka imported USD 21 million worth of goods from there.

This underlies a basic feature of the island’s economy: even after 75 years of independence, Sri Lanka imports large-scale manufactures but has only been able to export commodities such as tea, paper products, and coconut oil. As Shiran Illanperuma, an economic analyst, points out, Central Asia’s bilateral relations have been strongest with countries like China, Russia, and India, which have industrialised or are industrialising at a rapid pace. Sri Lanka, on the other hand, “is still using traditional avenues like tea.”

It is also unclear what Central Asia can bring to Sri Lanka. Ravinatha Aryasinha, Executive Director of the Lakshman Kadirgamar Institute, noted at the Forum that Sri Lanka should have reached out more to the region after the end of the 30-year war in 2009. Aryasinha served as Sri Lanka’s Foreign Secretary back then, when the country was controversially engaged in a diplomatic battle at the UN Human Rights Council over allegations of human rights abuses and war crimes in the last stages of the conflict.

On the other hand, P. K. Balachandran, an Indian foreign policy analyst based in Colombo, contends that Sri Lanka needs to stabilise its relations with neighbouring South Asian countries, particularly Delhi, before it can think of Central Asia. Rathindra Kuruwita, a Sri Lankan foreign policy commentator and a regular contributor to The Diplomat, largely agrees. “India is engaging more constructively with the region. Whether Sri Lanka can match Delhi’s clout and influence is a big question and at best highly debatable.”

That raises the question of what avenues the island can try in bolstering relations with the region. Bilateral trade and diplomatic relations are obviously paramount, but these will need to be supplemented by other strategies. Cultural cooperation is one possible method – Sri Lanka and Central Asia enjoy historical and cultural ties going back to the third century BC – but all too often, as pointed out at the August 21 conclave, such ties tend to be parroted out like a mantra. These now need to be updated.

One potential way would be sport. For instance, Central Asia and Sri Lanka share a platform for volleyball, Sri Lanka’s national sport. In February 2022, before protests erupted, the country hosted the Central Asian Volleyball Association (CAVA). While cultural engagement is hardly a substitute for economic ties, volleyball and other non-elite sports like elle – Sri Lanka’s equivalent of baseball – garner a lot of interest and galvanise the youth. They have proved less expensive, at a grassroots level, than cricket, the nation’s most popular sport. According to Pasindu Nimsara Thennakoon, a school volleyball player from Ratnapura (a village in the country’s Sabaragamuwa Province) now studying for his A Levels, these sports provide easy, cost-effective ways of reaching out to other regions.

Then there is the issue of how Sri Lanka can get closer to the region. The most obvious way would be through Central Asia’s outreach in South Asia in general and India in particular. Multilateral platforms like the SCO represent another way. Yet the SCO is dominated by a troika – China, Russia, India – while Sri Lanka’s ties with India, which entered a new phase after the 2022 crisis, has been rife with many controversies. Central Asia is pondering energy connectivity with Delhi. But given the blowback against such forms of cooperation, as the lawsuit against Adani Group’s wind power plant project in the country shows, the Sri Lankan government may not be too keen on pursuing this line.

The future: A question mark

Direct connectivity seems to be the preferred option. As a result of last year’s consultations, for instance, Air Astana began direct charter flights to Colombo. This came about seven months after Türkiye launched direct flights as well. Such developments suggest that the Sri Lankan government and the Foreign Ministry are sincere and keen on extending outward while prioritising relations with major powers. Yet is sincerity alone enough in ensuring that these efforts are carried forward?

As always, the verdict is out there. There is no denying that Sri Lanka faced major issues and sticking points in its foreign policy between 2020 and 2022. That is not to say there were no problems before. But it was during this period that these issues were thrown into sharp relief. More than anything, there was a sense of policy incoherence, an inability to define the country’s foreign policy and a breathtaking ability to anger multiple partners at the same time. Coming out of a crisis, Sri Lanka has only begun to admit to these failures. Central Asia clearly has become a crucial part of the damage-control.

Central Asia (Courtesy of Wikpedia)

It should be noted, however, that such efforts predate the crisis as well. In 2020, the Sri Lankan government drew up a paper on Africa. Ravinatha Aryasinha, who served as Foreign Secretary then, observes that this was part of a strategy to diversify Sri Lanka’s external relations. However, Aryasinha was replaced soon afterwards, and moved as Ambassador to Washington, from where he retired in 2021. The government did hold consultations with Kazakhstan and Uzbekistan that year. But these were never fully followed up.

Certainly, whether or not these strategies bear fruit, the crisis has spurred Sri Lanka to keep its options as open as possible. As it reaches out to new regions and new countries, it will have to prioritise economic recovery. As Sashikala Premawardhane observed at the Central Asia Forum, moreover, the private sector will need to play a major role. She went on to add that a Sri Lankan conglomerate is already operating in the region.

Sri Lanka’s Central Asia gambit may or may not work. Without necessarily parading it as a turnaround in the country’s foreign policy, it must be said that it provides a broader insight into what vulnerable states seeped in crisis are doing to navigate themselves amidst a sea of geopolitical complexities. It is clear that Sri Lanka will need to be innovative and responsive. The question, however, is whether the country can continue these engagements, or whether they will peter out – as they have, all too often, in the past.

Uditha Devapriya is the Chief International Relations Analyst at Factum, an Asia-Pacific focused foreign policy think-tank based in Colombo, Sri Lanka. He studied at the Bandaranaike Centre for International Studies (BCIS), from where he graduated in 2023. His thesis, supervised by Dr Chulanee Attanayake, was on Sri Lanka Central Asia relations. It won the Prize for the Best Dissertation that year.

I capitalise or upper case my title because it is The Debate I write about, thousands of miles away in Philadelphia in the State of Pennsylvania between US contestants for the presidency. It was on September 10 at 9.00 pm and Cassandra listened to it on BBC News on 11^th morning starting around 6.30. She is sure many of her readers did the same but dissecting it and expressing opinions cannot be boring.

The debate was conducted superbly by ABC News, facilitated by moderators David Muir and Linsey Davis. To Cassandra it was completely fair and unbiased. But the immediate war cry of the Republicans, denounced by Trump’s son, was that it was a ‘three on one’ debate. Their contention was that the hosts were biased and questioned Trump while Harris was given plenty of time to express her views. This I felt was a case of the carpenter blaming his tools for a shoddy job done. Trump’s people have to blame and malign unless he is treated with kid gloves and respect bordering on reverence given him

Issues

The main subjects debated on were the American economy, abortion, migration, global warming, international relations, war in Gaza and Ukraine, Afghanistan, and of course the respective policies of Trump and Harris.

The American economy was never so stable according to what Trump proclaimed when he was president. He said he fired any officer who was inefficient in his job, whatever position he held. Harris pointed out the jobs created within the four years of Biden’s presidency and the advancement of technology and mass green manufactures such as electric cars. Trump derided the development of solar power etc., as too expensive. Harris said people had better medicare and social benefits and schooling and housing would be improved vastly when she became president. She said Trump had done away with Obama’s Medicare legislation to which Trump replied he improved it.

Abortion

was hotly debated with Harris presenting facts such as Trump appointing three judges to the Supreme Court who rescinded Roe vs Wade judgment which allowed women to seek abortion within the first trimester with valid reasons for the request. Harris spoke so well on this topic justifying a woman’s right over her own body and pregnancy. Trump went haywire. “So, you will allow abortion in the eighth, ninth month, seventh month?” Harris mentioned that IVF treatment for childless couples was denied during Trump’s tenure and to obtain a necessary abortion a woman had to go to other States until abortion was made illegal. She showed her humanity here and the humane policies of a Democratic government.

Migration was hotly spoken on by Trump not only when the subject was under discussion but in answer to many questions on other issues asked him. He accused Biden and Harris for destroying the country by allowing thousands of migrants to enter the US with most of them being terrorists and murderers. He even said: “In Springfield people are complaining of the loss of their pets, and migrants are eating cats and dogs.” Muir is said to have fact checked and challenged Trump to substantiate his statement with figures. Of course, he evaded that.

One of the hosts asked Trump: “About the march on the Capitol, do you regret anything connected with January 6^th?” He did not reply that question even when repeated and lied preposterously that it was a peaceful march and he did not incite violence. He denied culpability. “Only one was shot that day and by the police. I had nothing to do with it. The police who defended the Capitol were on the other side.” He blamed Nancy Pelosi and the Major of Washington for the incident. Harris pitched into him but without any show of anger. She said he incited a violent mob. She said her government would “turn a page and stand for law and order. He has said there will be a bloodbath if he loses the election.”

Which led one of the moderators to ask Trump whether and why he said he won the 2021 election and then concede he lost by a whisker. Trump replied: “There is proof I won. Elections are bad, allowing everyone and anyone to vote. The problem is the nation is dying.”

When debating foreign policy and the ongoing wars, Trump boasted that if he was in power there would have been no wars. He would have negotiated with Putin, Netanyahu and Hamas and no wars would have occurred. To which Harris scathingly said he wrote love letters to Kim Jong Un and would favour any dictator if that person praised him. She recounted the many visits she had made to Ukraine as VP; and heard many, even officers of the American armed forces, who spoke of Trump’s pride and self-esteem and that anyone who praised him was his friend. Trump said Harris hated Israel, hated the Arabs too. Also, that she was worse than Biden and he was the weakest of all presidents of the US of all time. “She is a horrible negotiator.” In this segment of the debate Harris did not shine like she did all through. She should have mentioned her husband is a Jew.

One of the hosts addressing Trump said: “You said you can stop the war in Ukraine. How will you do it? What is your opinion?” Trump replied: “I will settle matters before becoming president.”

Trump was very critical of how Biden handled the situation in Afghanistan allowing American soldiers to die there. Harris countered this by saying Trump when he was Prez negotiated directly with the then and now Taliban leader – Hibatullah Akhundzad and even invited him to stay over in Camp David which is a resort where respected, notable world leaders are invited to.

Climate change was discussed briefly. Harris reminded her audience that Trump had said global warming was a hoax. She commented the young particularly were concerned about the environment and dangers inherent. Her policy was clean energy.

The racial issue came up when one of the moderators asked why Trump often brought up the issue of a person’s race like Obama being Black and showing surprise on discovering Harris claimed to be Black. “I don’t care” he lied. She spoke of her parentage and growing up in a middleclass milieu with a very determined and disciplined mother, implying the contrast between Trump’s background and hers.

The issue of gun possession had Trump saying that Harris and Biden would confiscate everyone’s gun. She countered this by saying she and her VP – if she were elected – both possessed guns. It is known that one policy issue in her future plans is about schools and schooling with free meals and safety.

The 90-minute debate ended with the final statements of each. Harris said she would take the country forward charted by a new plan: children would be protected; COL would be brought down; American peace policy would be sustained worldwide; human rights, particularly women’s, would be protected.

Trump had no definite statement. He said Harris promises much and questioned what she had done in 3 ½ years. (The notes I took down gave me nothing from him. He rambled on).

Analysis/opinions

You can Google or read in the foreign press myriads of comments. Cassandra says the debate was excellently conducted and so were the moderators. Kamala Harris out debated her contestant and “landed repeated blows on former President Trump”. She was focused, gave clear definite answers to questions posed to her and was charismatic, emanating vibes of vibrancy, charm, firmness. She will make an excellent Prez. However, she faces two negatives with white conservative Americans: her being a woman and of mixed races – Jamaican and Indian.

Donald Trump was a failure in the debate: rambling and vituperative with insults. He was brought many pegs down after being judged better in the debate he had with Biden.

Locally, many debates were spoken about, challenges thrown by party leaders to their opponents, but none have been forthcoming.

By Dr Anjalee De Silva,
Dr Thusitha Jayathilake, Dr Abdus Sukoor,
Dr Vijayashakthy Sivasankar, Dr Nandika Wanigasinghe

College of Anaesthesiologists and Intensivists of Sri Lanka

Sepsis is a serious and potentially life-threatening condition that affects millions of people each year.The Global Sepsis Alliance (GSA) has designated September 13th as “World Sepsis Day” and the entire month of September to enhance awareness about sepsis. This day serves as a crucial opportunity to educate the public, healthcare professionals, and policymakers about sepsis, its symptoms, and the importance of prompt medical intervention.

The College of Anaesthesiologists and Intensivists of Sri Lanka conducts educational programs to raise awareness about sepsis among healthcare providers and the public.

The Critical Importance of Awareness: Why Understanding Sepsis Matters

Understanding sepsis is critically important due to its severe impact on global health. According to the Global Sepsis Alliance (GSA), sepsis affects 47 to 50 million people worldwide each year, leading to the deaths of at least 11 million individuals. This translates to a staggering death rate of one person every 2.8 seconds. Moreover, sepsis is linked to one in every five deaths globally.

The consequences of sepsis extend beyond mortality; survivors frequently face long-term health challenges and complications. Recognising the signs of sepsis and ensuring timely medical intervention can be life-saving and help to reduce both the death toll and the enduring impacts on survivors.

What is Sepsis?

Sepsis is a life-threatening medical emergency that begins with an infection.

The body’s immune system works to fight against microorganisms and protect us from illness. However, in sepsis, the immune system becomes dysregulated and begins attacking not only the microorganisms, but also the body’s own organs, including vital ones like the heart, lungs, brain, kidneys, and liver. This overreaction can lead to a critical condition known as septic shock, where there is a dangerous drop in blood pressure, resulting in inadequate blood supply to the organs and causing them to malfunction. Immediate recognition and treatment are crucial for survival. Unfortunately, 40% of individuals with septic shock do not survive this severe condition.

Identifying Culprits: Microorganisms and Infections That Can Lead to Sepsis

Sepsis is triggered by a wide range of organisms and infections, which can originate from various sources in the body. Bacteria are the most common cause, but viruses, fungi, and parasites can also lead to sepsis.

Common bacterial infections that can cause sepsis include pneumonia, abdominal infections such as appendicitis, urinary tract infections (UTIs), meningitis, skin and soft tissue infections from wounds.

Fungal infections, particularly in individuals with weakened immune systems and severe viral infections, such as influenza, can also result in sepsis.

The infection triggers an overwhelming immune response, leading to systemic inflammation and potentially life-threatening complications if not addressed early and promptly.

Recognising the Symptoms

Early detection is crucial for survival. Symptoms can sometimes be mistaken for other illnesses, so it’s important to be vigilant, especially if you or a loved one has an infection.

Key signs to watch for;

S– Slurred speech or confusion

E– Extreme shivering or muscle pain/fever

P– Passing no urine all day

S– Severe breathlessness

I– It feels like you are going to die

S– Skin mottled or discoloured

Sepsis can escalate quickly, making early treatment vital. Quick intervention with antibiotics and supportive care can significantly improve outcomes. The earlier sepsis is recognised and managed, the better the chance of recovery and survival.

Who is at Risk?

Sepsis is indiscriminate; it can strike anyone, regardless of age or background. However, certain groups are at higher risk, including those with long-term illnesses (such as lung, liver, heart, and kidney diseases), those with weakened immune systems (e.g., AIDS, diabetes, cancer patients, individuals without spleens), pregnant mothers, infants under one year, and the elderly (over 60 years old). People with recent infections or surgeries are at high risk since infections from surgical wounds or other injuries can lead to sepsis.

Steps to Take if You Suspect Sepsis

If you experience symptoms of sepsis, seek medical advice immediately by going to the nearest hospital or medical centre. Health care professionals will evaluate your condition by checking vital signs such as heart rate, blood pressure, oxygen levels, and breathing rate. If sepsis is confirmed or suspected, you will likely be advised to be admitted to the hospital. Adhere to prescribed treatments, which may include antibiotics, fluids and other supportive measures. Early treatment is crucial, as the first hour is critical for effective intervention and a favourable outcome.

What Happens in the Hospital?

Once admitted to the hospital with sepsis, patients typically receive immediate treatment to stabilise their condition. This includes;

· Blood and Specimen Collection: Various specimens, including blood, urine, and sputum, are collected to identify the infectious organisms, severity of infection and your vital organ functions. This helps guide the appropriate treatment.

· Strong antibiotics to fight the infection

· Fluids such as saline given directly to your blood to maintain blood pressure and hydration

· Other medications to support your blood pressure and other organ functions.

· If your condition is severe, medical professionals may determine that you need admission to intensive care.

Complications of Sepsis

Sepsis can lead to severe complications if not treated quickly, including septic shock, which causes a dangerous drop in blood pressure and multi-organ failure. It can damage almost every organ in the body, resulting in conditions like kidney or liver failure, brain dysfunction and breathing problems. Survivors may face long-term effects such as physical disabilities, cognitive impairments, and chronic health issues. In severe cases, sepsis can progress to septic shock and ultimately result in death. Prompt treatment is crucial to reduce these risks and improve recovery outcomes.

Post-Sepsis Syndrome: Life After the Hospital

Survivors of sepsis may face long-term effects known as “Post-Sepsis Syndrome”.

They can experience; persistent psychological issues such as anxiety and depression which can affect mental health, ongoing weakness and tiredness may hinder daily activities, problems with concentration, memory and thinking can linger.

These physical and mental health issues can lead to a lower quality of life, even after the initial recovery.

Preventing sepsis involves several key practices:

Prevention starts with reducing the risk of infections:

– Practice Good Hygiene: Regular handwashing is one of the simplest ways to prevent infections.

– Stay Vaccinated: Vaccines for flu, pneumonia, and other preventable diseases can lower your risk.

– Manage Chronic Conditions: Keeping chronic conditions under control can help prevent infections.

– Care for Wounds Properly: Clean cuts and wounds promptly and seek medical care for severe injuries.

How You Can Make a Difference

On World Sepsis Day, take the opportunity to learn more about sepsis and share information with friends, family, and community members. Awareness can lead to quicker recognition and treatment. By increasing knowledge and encouraging swift action, you can help save lives and reduce the impact of this global health challenge.

Engage with organisations and campaigns dedicated to sepsis awareness and research. Support their efforts through donations, volunteering, or spreading their message.

Conclusion

World Sepsis Day serves as a powerful reminder of the importance of sepsis awareness.

The Global Sepsis Alliance (GSA) provides extensive information about sepsis. In Sri Lanka, the Sri Lanka Sepsis Alliance which was launched in 2023, in partnership with the College of Anaesthesiologists and Intensivists of Sri Lanka (COAISL) and the Sri Lanka College of Microbiologists (SLCM) , marking this day with a significant event: “Sepsis mini-congress”. This congress will bring together experts from various fields to discuss and promote strategies for combating sepsis.

On September 13th and beyond, let us commit to educating others and ourselves, supporting sepsis initiatives, and fostering a proactive approach to combating this critical health issue. Your awareness and actions can play a crucial role in fighting sepsis and improving health outcomes worldwide.

Together, let’s Recognise early… Act Swiftly and Save Lives…(Pictures – Global Sepsis Alliance)