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First do no harm, Primum non nocere

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Sudarshana syrup:

These are famous lines of high ethical and moral value which all physicians of allopathic system are expected to respect and adhere to.

Regardless of the system of medicine, all health workers’ final objective must be to care for the patients; for their betterment. In a broad sense, it goes beyond human, where all living beings, environment, etc.’ should be considered as in ONE Health Concept.

The earliest health systems were based on magic, witchcraft, superstitious beliefs, etc. With time, more refined systems, such as Ayurveda, and later allopathic, gradually replaced such early systems. At present, the allopathic system, based on empirical science, has been established throughout the world, in favour of other systems of health, over the past few centuries. However, it was the Ayurveda system, based mainly on herbs, which helped people look after their health needs, successfully, particularly in eastern cultures. 

In Sri Lanka, even at present, quite a significant population (10 – 15%) is heavily dependent on Ayurveda for their day-to-day health needs. Almost all people have taken medicines of herbal origin (e.g. coriander/Kottamalli, etc.) at some stage of their lives. Hence, the place for Ayurveda medicine is well established and never a doubt in Sri Lankan society. In fact, it is part of the Ministry of Health as the Indigenous Medicine Division.

The current COVID–19 pandemic is sweeping the entire world, in various proportions. With the initial successful containment of the epidemic, Sri Lanka is now suddenly confronted with a painful ground reality. Our country, and all concerned, were used to low numbers in terms of number of patients, and deaths, due to COVID–19, when compared to almost all developed countries. Therefore, the initial euphoria, enjoyed by all, is disappearing fast.

Under these chaotic circumstances, the integration of indigenous/Ayurveda system to local healthcare delivery system, needs to be recognized. Such integration is recommended by the WHO in 2014 (WHO Traditional Medicine Strategy 2014 – 2023, which is an ongoing activity).

As a government, it cannot ignore this need but has to work on a strategy to accommodate the integration. Under this context, Minister Channa Jayasumana’s attempt to introduce Sudarshana syrup to our system is justified and appropriate. In this endeavour, he has to be considered as a Minister, and not as a pharmacologist.  Hence, the unfair attack on Minister Jayasumana, on this matter, is not acceptable. The assault is beyond Minister Jayasumana and in fact the traditional Ayurveda system which has been trusted by many.

Also important to note is that the assessment tools used to assess allopathic drugs may not be suitable to assess the efficacy of Ayurveda medicines, due to two different bases of origin. I am certain that all pharmacologists are well aware of the ancient association between numerous allopathic drugs and herbs. A classic example would be the usage of Cinchona bark for fever for many centuries. Quinine, a drug which was used to combat malaria is extracted from Cinchona bark.

At this critical juncture, one has to be careful about our heeds and deeds; as such actions can undermine and discourage those who are tirelessly fighting hard the battle against COVID–19. If such deeds are responsible for breakdown of the system, the adverse consequences are not only to them but to all of us in the country, regardless of political parties, wealth, social class, ethnicities, etc. The ones who are unfairly critical could well and truly be the victims of the breakdown.

Therefore, all must be very genuine in their behaviour as the infection does not differentiate, based on the type of people in the country. The need of the hour is to stop all unfair attempts, which could hinder the preventive measures, and unite as one force to face this unprecedented challenge.  

Sri Lanka is now potentially facing a chaotic situation as our health sector and skilled human resources are struggling to cope up with the situation. It is very important to protect healthcare workers, particularly those who are involved in public health services (as the number is limited), security forces,   including the police, administrators and all others involved. Therefore, all precautions ought to be taken in order to minimize their exposure to the virus, as depletion in such human resources is not an option for our country. Under this circumstance, fresh thinking is essential with regard to the level of contact tracing as large numbers are reported on daily basis.  

 We have no time to go through all these time consuming and labour-intensive steps, during a crisis period of this nature, as human catastrophe is lurking. Edward Jenner, in 1796, would not have been able to vaccinate a child against Smallpox if he had to go through all steps for approval, before vaccination. It means the world would not have been able to eradicate Smallpox, in 1977. Another example would be the story of the Anti-Rabies Vaccination.  Louis Pasteur, in 1885, decided on his own, in good faith, and vaccinated a boy who was bitten severely by a rabid dog. The boy would have faced a certain death if not for the vaccination. He survived the episode to tell the story and work for Pasteur Institute later.

I fully agree that before carrying out research and giving drugs, present standard protocols, e.g. ethical clearance, etc., should be adhered to. But, at times of crisis or disaster, what is done in good faith is acceptable.   

 

Prof Ananda Jayasinghe

Professor in Community Medicine

Faculty of Medicine

University of Peradeniya

 



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Opinion

A Cabinet reshuffle needed

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By Dr Upul Wijayawardhana

It looks as if the government did not realise the need to take drastic action to stem the tide of public disapproval. Even the most optimistic, who were overjoyed at the election of a non-politician President, followed by that of a government with an unexpected thumping majority, are sighing in despair! Although part of it is due to avoidable own-goals, there seems to be an extremely effective anti-government campaign directed by an unseen hand. Even when toxins are detected in imported coconut oil, rather than laying the blame on errant importers, attempts are made to tarnish the image of the government. All this is possible because the government seems to lack an effective communication strategy. One wonders whether the government has a lax attitude because the Opposition is blundering.

The fracas in the Parliament on the issue of Ranjan Ramanayaka losing his seat was the best illustration of a misguided Opposition not fit for purpose. Critics may argue that RR was given an unfairly harsh punishment but their criticism lacks moral authority because they opted to be silent when a Buddhist priest was given a much harsher punishment for the same offence: in fact, they were delighted! RR stated publicly that most judges were corrupt and defended his stance at every possible turn. He also refused all opportunities afforded for clarification. In spite of the Attorney General informing a while ago that RR’s seat should be declared vacant, to his credit the Speaker waited till RR’s petition for appeal was dealt with. Even though the facts were obvious, the Leader of the Opposition accused the Speaker of removing RR on the basis of non-attendance for three months, which he had to correct the following day! Those who blamed the SLPP for staging unruly protests in Parliament in October 2018, did the same on behalf of RR. Is this not laughable?

Once and for all, the question of the authority of the President was settled with the passage of the 20th Amendment and it is high time the President made use of his new powers. The most important thing he can and should do is a cabinet reshuffle, a mechanism often adopted by British Prime Ministers by way of a course correction. It need not be a major reshuffle but a minor one involving some ministers who are obviously underperforming. I have written in the past about the Minister of Health who demonstrated gross irresponsibility by partaking of an untested and unlicensed medicinal product. She is also responsible for not implementing the Jennifer Perera committee report on the disposal of bodies of unfortunate victims of Covid-19? Had this been implemented in December, much of the adverse publicity the country received could have been avoided. Perhaps, the voting during the UNHRC resolution also may have been very different. The Minister of Public Security talking of banning some face coverings did not help either. Pity he did not realize he was talking of this at the wrong time; during an epidemic when face coverings may be useful.

The Minister of Trade, who was an effective critic in the Opposition, has turned out to be totally ineffective. Even the government gazette has become a joke due to his actions. Perhaps, it is time for him to take a back-seat and allow someone else to have a go at the rice-mafia. etc. Perhaps, ex-president Sirisena may be given a chance to see whether brotherly love is more effective than the gazette in controlling the prices of rice.

The biggest failure of this government is on the diplomatic front. What most diplomats consider to be the most important diplomatic assignment, the post of High Commissioner to India remains unfilled for almost a year. Whether we like it or not, India is fast gaining the status of a world power, and not having our representative to deal with officials acknowledged to be of top calibre is a shame.

The way the UNHRC resolution was handled showed total incompetence of the highest order. We withdrew but the Ambassador decided to take part; we lost and claimed victory! To cap it all, the Foreign Minister announced in Parliament that the resolution was illegal. All the time sinister forces are at work, relentlessly, to undermine the country and force the separatist agenda on us and if we are not sharp, we may end up in disaster. For reasons best known to themselves, the government failed to utilize fully the good offices of Lord Naseby. Statements made by the Foreign Secretary no doubt irked the Indian and US governments.

For all these reasons, the need of the day is a complete overhaul of our Foreign Affairs set up, starting with the Minister. It is high time we made use of our career diplomats, who are well trained for the job and stop sending political ambassadors. The practice of utilizing ambassadorial posts as parking lots for retired service chiefs is abhorrent, as it gives the false impression that Sri Lanka has a military government in all but name.

There is still a chance for reversal of fortunes, if the President decides to act swiftly after returning from Sinhala and Tamil New Year celebrations. If not, unfortunately, there may not be much left to celebrate!

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Opinion

Alleviating poverty, the Chinese way

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China has released a white paper on poverty alleviation which outlines the success of policies implemented, the methods employed and her desire to share the unique social experiment with other developing countries. Sri Lanka being a friendly international partner of China should make use of this opportunity to study the programme and plan a scheme and send a team to China to learn the activities conducted under the scheme so that Sri Lanka will be able to handle the fight against poverty, successfully.

“China achieved the largest scale battle against extreme poverty, worldwide, as 98.99 million people had been lifted out of absolute poverty, creating a miracle in human history.” These people were living in 128 ,000 villages all over in China. China through a sustained program was able to achieve its poverty reduction targets set out in UN 2030 agenda, 10 years ahead of its schedule.

A quote from a report released by the BBC outlines the success achieved by China.

:” In 1990, there were more than 750 million people in China, living below the international poverty line – about two-thirds of the population. By 2012, that had fallen to fewer than 90 million, and by 2016 – the most recent year for which World Bank figures are available – it had fallen to 7.2 million people (0.5% of the population). So clearly, even in 2016 China was well on the way to reaching its target This suggests that overall, 745 million fewer people were living in extreme poverty in China than were 30 years ago. World Bank figures do not take us to the present day, but the trend is certainly in line with the Chinese government’s announcement. (“Another large country, India, had 22% of its population living below the international poverty line in 2011 (the most recent data available) …:”}

The people living in extreme poverty suffer from the lack of extremely basic amenities, such as food. safe drinking water, sanitation, health, shelter, and education. It is a fact that those who come under this category are trapped in a vicious circle and for generations they cannot escape the deprivations.

Some of the policies followed by China in achieving the enviable outcome are discussed in the White paper. The most important condition to be fulfilled is the acceptance of the fact that governance of a country starts with the needs of the people and their prosperity is the responsibility of the government. “To achieve success, it is of utmost importance that the leadership have devotion. strong will and determination. and the ruling party and the government assumes their responsibilities to the people. play a leading role, mobilize forces from all quarters and ensure policies are consistent and stable’.

China has provided the poor with the guidance, direction and tools while educating them to have the ambition to emerge from poverty, Through farmers’ night schools, workshops and technical schools create the improvement of skills. The government identifies the economic opportunities in consultation with the people, then provides finances, loans for the selected projects, and strengthens the infra-structure facilities, including the marketing outlets.

While the macro aspects for the poverty alleviation is planned centrally, the activities are executed provincially and locally.

Sri Lankans living under the national poverty line was 4.1% of the population in 2016 (World Data Atlas). The impact of Covid-19 in 2020-21 has dealt a severe blow to the living standards in Sri Lanka and it is assumed that the people living under the poverty line would have reached approximately 8% of the population by 2021.

President Gotabaya Rajapakasa has realised this gloomy truth in his interaction with the poor in the villages on his visits to the remote areas in Sri Lanka. I would request him to study the success story of China and to work out a similar NATIONAL programme in consultation with China. In the White Paper, China says that she is ready to share her experience with other countries who desire to reduce the poverty levels. The President should appoint a TASK FORCE of capable and nationalist-minded individuals to steer the program with given targets as PRIORITY VENTURE. If Sri Lanka can plan a comprehensive programme for poverty alleviation and implement with determination under the capable, dedicated and willing leadership of the President, nearly two million Sri Lankans who live below the poverty line will benefit and would start contributing to the growth of the nation productively.

RANJITH SOYSA

 

 

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Opinion

Need in New Year is to heal the divides

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By Jehan Perera

One of the definitions of reconciliation is to move from a divided past to a shared future.  The arrest of the Jaffna Mayor Visvalingam Manivannan came as a reminder that unhealed issues from the past continue to threaten peace in the present and the future.  According to people I spoke to in Jaffna, this arrest has revived memories that were no longer in the people’s consciousness.  Nearly 11 years after the end of the war, the people were no longer thinking of the LTTE police and the uniform they once wore. The bailing out of the mayor de-escalated the crisis that was brewing in Jaffna following his arrest.  There were reports that a hartal, or shutdown of the city, had been planned to protest against the arrest.

Jaffna Mayor Manivannan was taken into custody by the Jaffna police for allegedly promoting uniforms and iconography of the LTTE, according to the police.  They had found that the Mayor had recruited five individuals to perform traffic duties in Jaffna town in uniforms that resembled those worn by the LTTE’s police during the time when they ran a parallel administration in parts of the north and east. Photos published in the media show a similarity.  Promoting symbols associated with the LTTE, including uniforms is an offence under provisions of the Prevention of Terrorism Act (PTA).

However, the position of the Municipality was that the five individuals had been recruited to a Jaffna Municipal Council task force on a temporary basis to enforce penalties against environmental violations such as littering the streets.  According to Mayor Manivannan, the uniforms were, in fact, the same as those worn by a similar task force run by the Colombo Municipal Council (CMC). Media reported a striking resemblance between the task force uniform and the uniforms worn by the LTTE police but also that a parking meter initiative run by the Colombo Municipal Council has employed staffers who also wear a light blue shirt and pants of a darker shade, vaguely similar to the offending Jaffna outfit. 

 

JAFFNA VISIT

Ironically, a few days prior to this incident, I visited Jaffna to take part in the last rites for Fr Nicholapillai Maria Saveri who had headed the Centre for Performing Arts, in Jaffna, for over four decades.  Under Fr Saveri’s leadership the centre produced an entire generation of artistes who reached out across all barriers of ethnicity and religion and touched the lives of people everywhere.  Through his artistic and cultural productions, Fr Saveri tried to show the interdependence of those who live in the country and need to share it bringing to the fore their different talents, connections and capacities.   He sought to turn the diversity and pluralism in the country away from being a source of conflict into one of strength and mutual enrichment. 

The normalcy I saw in Jaffna, during the short period I was there, made me feel that the ethnic conflict was a thing of the past.  At the hotel I stayed I saw young people come and enjoy a drink at the bar and talking with each other with animation and laughter as young people do.  When I went to the District Secretariat, I was struck by the fact that they played the national anthem at sharp 8.30 am and all work stopped while the anthem played all three verses in the Tamil language and all stood to attention, even inside their rooms.  The Lessons Learnt and Reconciliation Commission (LLRC) appointed by President Mahinda Rajapaksa, in 2011, had recommended that the national anthem be sung in both languages and I was happy to see that in Jaffna this was being implemented a decade later.

At the funeral service for Fr Saveri I met many people and none of them spoke of war and conflict but like people in other parts of the country they spoke of the economy and cost of living.  An administrator from the University of Jaffna spoke about his satisfaction at the large number of Sinhala students at the University and the mixing that was taking place as a result, between the communities.  He said that as the University did not have adequate hostel facilities many of the students from outside of Jaffna, including the Sinhala students, lived with local families.  He said that during the recent graduation ceremony, hundreds of their family members came from the southern parts of the country and joined their children in their places of accommodation which contributed to the inter community mixing.

 

UNIFYING THEME

The situation in Jaffna was so normal to my eyes as a visitor that one of the questions I had and to which I sought answers from those I met, was whether there was a common theme that bound the people together.  Despite my inquiries I could not discern such a common theme that was openly visible or explained to me as such.  It was much like the rest of the country.  At the last general election the people of the north voted for a multiplicity of parties including ones that are part of the present government.  The candidate who got the largest number of votes was one who was affiliated with the government.  At the same time nationalist parties got votes too that saw them enter Parliament and the more moderate parties emerged the largest. 

The arrest of Mayor Visvalingam Manivannan has now supplied a common unifying theme to the politics of the north.  There is distress that the popularly elected Mayor has been treated in such a manner.  If the uniforms that the Municipal workers were wearing too closely resembled those of the LTTE, he could have been informed that this was not appropriate.  It would have been possible to ensure that the uniforms were immediately removed and replaced with ones that were more appropriate while taking into consideration the sensitivities that three decades of war would bring.  As the Mayor is most closely associated with government Minister Douglas Devananda such a request would most certainly have been complied with.  As leader of the EPDP, Minister Devananda was at the forefront of militarily fighting against the LTTE.

The government’s determination to thwart any possible attempt to revive the LTTE can be understood.  The war with the LTTE cost the country enormously in terms of human suffering and economic devastation.  The government won the last election on the promise that it would give priority to national security and also develop the country on that basis.  However, sections of the Tamil Diaspora continue to be openly pro-LTTE and espouse a separatist agenda.  The loss of the vote at the UN Human Rights Council, in which the Tamil Diaspora played a role, would make the government more determined to suppress any attempt to revive the LTTE.  Now that the immediate crisis has been defused due to the release of the Mayor on bail, it would be timely for the government to mitigate the political damage by a multiplicity of means, including by reaching out to the Jaffna Municipal Council about its Municipal law enforcement mechanism.

 

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