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Giving life to days

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UHKDU Palliative Care Services Unit

By Sajitha Prematunge

Fifty six year-old Somalatha was diagnosed with end stage cancer and was already bedridden by the time she was admitted to hospital. With proper care she was able to walk again and was looking forward to making a secure future for her children. But tragedy struck Somalatha’s family again. After her husband suddenly died of a stroke, she was forced to fend for herself. Soon after her condition worsened. Unfortunately Somalatha didn’t live to see her kids receive scholarships with the help of the dedicated University Hospital, Kotelawala Defence University staff, who cared for her.

Although her name is fictitious her predicament is all too real and thousands like her die annually without vital palliative care they are denied just because they couldn’t afford it. It is true that the Sri Lankan healthcare system is one of the best in the world, in that it is almost exclusively free of charge. But no system is infallible. It is patients like Somalatha who have to bear the brunt of its shortcomings, falling through the cracks of the Sri Lankan healthcare system.

In this light, University Hospital, General Sir John Kotelawala Defence University Palliative Care Services Unit, inaugurate on February 3 should be lauded as a timely intervention, although they had been practising palliative care long before. The UHKDU Palliative Care Services Unit was initiated at a time when repeated attempts to establish such services by various institutions had failed.

 

Palliative care

 

“The simple definition of palliative care is to optimise the quality of life of patients and care givers or loved ones, from the moment the patient is diagnosed with a chronic illness. The definition of ‘chronic’ here has wide implications, ranging from terminal cancer, schizophrenia, chronic neurological diseases, motor neuron disease, stroke to multiple fractures. Any of these conditions require palliative care,” said Consultant Oncologist Dr. Sachini Rasnayake.

It is difficult to believe that this personage of slight build heads Palliative Care Services at UHKDU, deftly fielding inquiries of changes to medication, pain management, financial issues and fears of patients, while breaking bad news to patients as gently as possible on an all too regular basis. “The responsibility of the palliative care giver is to uplift lives of the patients physically, psychosocially and spiritually,” said Rasnayake.

 

Goals

 

UHKDU Palliative Care Services was established with four main goals in mind. The first of which was to appoint a palliative care team. Rasnayake said that having so many expert consultants from different fields within the UHKDU was an added advantage. “A number of consultants volunteered to provide their services,” said a grateful Rasnayake. She opined that this team spirit was vital in establishing palliative care services. “A team of consultant anaesthetists volunteered to conduct a pain management clinic,” said Rasnayake, who pointed out that pain management is key priority when dealing with any chronic illness. “A group of physicians volunteered to attend to medical issues of palliative care patients. Onco-surgeons and the surgical team looks into the surgical aspect of palliative care.” For example, a Percutaneous Endoscopic Gastrostomy (PEG) tube is surgically inserted into a patient’s stomach through the abdominal wall for feeding purposes. “This is much more desirable than the nasogastric (NG) tube. An NG, inserted through the nose, past the throat, and into the stomach, is very uncomfortable for the patient.”

The team at UHKDU has performed the procedure on multiple long term paralysed patients and patients with throat cancers. “Long term bedridden patients require catheter care and may suffer from urinary incontinence, accidental or involuntary loss of urine; or faecal incontinence, accidental or involuntary loss of faeces or flatus.” Rasnayake explained that indwelling catheters could cause a host of other problems such as urinary track infections. “Genitourinary (GU) surgeons are tasked with addressing such issues.” Rasnayake appreciated the fact that the few oncologists at KDU were able to volunteer for palliative care despite their heavy workload. “Palliative care at UHKDU has no designated Medical Officers. But with much difficulty we were able to secure one nurse. The whole oncology team along with the pharmacists are all experts at palliative care and are wholeheartedly supportive of this initiative.” The rest of the palliative care team consists of a dedicated group of psychiatrists, psychologists and ENT surgeons.

Their second goal is to conduct ongoing medical education programmes. She explained that the team, including the supporting staff had undergone training. “By 2022 we hope that the whole hospital staff would be trained in palliative care,” said Rasnayake hopefully. “It’s vital that everyone undergoes training, since every service accompanies a component of palliative care.” Rasnayake informed that virtual teaching clips were used to train and online assessments used to ascertain the success of candidates, validated through a certification process. “If there is one thing we learned from the COVID-19 pandemic, it’s how pragmatic and applicable virtual training is. For example training a whole staff at the same time would mean that they would have to expend vital work hours. But with virtual training clips the potential care-givers can learn at their own pace.” UHKDU, Executive Director and Senior Consultant Psychiatrist, Dr Jayan Mendis was the first to identify the crying need for a palliative care facility within the University Hospital. Mendis reiterated the significance of such an initiative, pointing out that the training students receive at the facility will be crucial.

The third goal is to provide palliative care home visits. Rasnayake explained that such a service would be beneficial to bedridden patients who experience financial constraints. “Unfortunately we still don’t have a free a

mbulance service.” Rasnayake said that while serving in Polonnaruwa the Cyril Dharmawardana Foundation provided an ambulance service free of charge, which facilitated Rasnayake’s travel to distant parts of the country so she could provide palliative care services to patients who could not afford to travel. “With home visits we can address issues such as constipation, administer IV drips, train care givers and optimise the condition of the patient’s accommodation, including lighting and ventilation.”

The fourth goal is to establish a palliative care hospice. “Palliative Care Unit, Karapitiya Teaching Hospital, Onco Sergeon Dr. Krishantha Perera has achieved just this,” said Rasnayake. “There isn’t such a hospital in Colombo.” She explained that a hospice would see to the psychosocial well being of a patient, in a homely environment, providing symptomatic support. Towards achieving their last goal KDU Vice Chancellor Major General Milinda Peiris has announced his agreement to allocate 10 such rooms from the KDU hotel, to extend this facility to short term palliative care patients. “For the first time in Sri Lankan health tourism, UHKDU has introduced the hospital hotel concept,” said Peiris. “Moreover, in an emergency the patient can be transferred to the hospital in less than five minutes.”

Rasnayake informed that a host of other services concerning palliative care is provided in-house by physiotherapists, psychologists and social workers. Providing radiation therapy at the palliative care facility is also in the works. “But to establish such services and facilities we must have the man power and resources,” Rasnayake pointed out. Rasnayake said that manpower, resources and understanding are integral to palliative care, aspects Sri Lanka is lagging behind in, compared to developed countries. “Unfortunately this has not been well communicated to the community. Most don’t know how they can provide such services,” said Rasnayake. She explained that this is the greatest difference between a hospital and a hospice. “At a hospice you can offer your services, clean and wash patients, subject to supervision, and even entertain them. In a hospital there are rules and regulations that prevents this.”

“One doesn’t have to be medically proficient to practise palliative care. Many who’ve had fallen on hard times in their lives later want to help others through such times,” said Oncology Department, Research Assistant, Dr. Sandini Liyanage. Liyanage and her ilk are stuck between a rock and a hard place. “We want to help, but there’s only so much we can do. We can only treat the patient, with chemotherapy or radiotherapy. But a lot more goes on in the patients’ lives. A terminal illness entails a host of psychosocial issues.” For example, Liyanage explained that, from the moment someone is diagnose with stage four cancer, they’ll invariably start to worry about everything from money, treatment to how to educate their children. “They will mentally fall apart.” Liyanage who is volunteering for palliative care service said that the services are available to any patient, although most who currently receive services are oncology patients. “It’s not just about treating the cancer. The families are also devastated. Cancer takes not only lives but a lot of other things from the family the patient leaves behind.”

 

Socio-economic constraints

 

As medical officers of palliative care those like Liyanage are able to build a complete picture about the socio-economic background of a patient by studying their history. She pointed out that most of the patients who require palliative care services are of lower socio-economic backgrounds, who were struggling to make ends meet when the illness in question exacerbated the situation.

“That’s why communication is vital. Palliative care strives to provide a patient-friendly environment,” said nurse Yashmi Kaushalya. Oncology Department nurse, the only such working full time for the Palliative Care unit, Kaushalya is a far cry from the average nurse. With a temperament befitting palliative care, Kaushalya’s calm and measured speech will no doubt assuage her patients. “As nurses we are required to communicate with patients and family members.” Palliative care nurses must be privy to psychological, physical, socio-economic problems of patients. She opined that palliative care is instrumental in caring for patients who have little family backing.

As a nurse new to palliative care, Kaushalya has not broken bad news to a patient’s family yet, for which she would accompany Rasnayake tomorrow. “It can’t be easy breaking bad news,” admitted Kaushalya. “In fact, our services have a lot more to do with caring for patients psychologically than physically,” said Kaushalya. “This is what makes palliative care nurses different from the average nurse.”

“When the patient does not have money to buy drugs, palliative care ends then and there. Although palliative care has been practised for ages, when social and financial capability is curtailed the quality of service drops. This is why social and economical support is vital,” admitted Rasnayake, who had bought drugs for patients out of her own pocket on several occasions. She reiterated that trust and continuous social care services and above all financial support is imperative for maintaining sustainable palliative care.

Rasnayake is positive that money will not be an obstacle for the continuity of the programme. Cancer Care Association founder and Chairman of the National Authority on Tobacco and Alcohol, Dr. Samadhi Rajapaksa provides much needed support, while Indira Caner Trust Director Dr. Lanka Dissanayake and Cancer Society President Anuja Karunaratne have pledged support for the programme. Rasnayake emphasised the significance of establishing a palliative care trust and a governing body to coordinate funds and all stakeholders, to ensure continued support for patients. Rasnayake appreciated the support of senior journalist and former diplomat late Bandula Jayasekara in making the programme a success.

Rasnayake readily admits that Oncology Department Head, Senior Oncologist Dr. Jayantha Balawardhane is the driving force behind the programme. Balawardhane explained that the main objectives of palliative care is to relieve and comfort patients. He pointed out that palliative care can be conducted in the ward, acute care hospital, palliative care unit or hospice, hostel, nursing home, elders home or one’s own home. “Place is immaterial when it comes to palliative care.” Balawardhane emphasized that pain relief is an integral part of palliative care. “Relieving pain is half the battle in palliative care.” Other discomforts such as bedsores, loss of bladder and bowel control adds insult to injury.

 

Psychosocial issues

 

Psychosocial issues such as sense of abandonment, anger, frustration and resentment exacerbate the psychological condition of the patient. “Patients maybe embittered, therefore we must address such psychosocial issues with care,” reiterated Balawardhane. Social abandonment, resulting from stigma, due to myths such as cancer is contagious or associating those undergoing chemo or radiation therapy could adversely affect others, and busy schedules that prevent loved ones from visiting are among the major social issues faced by palliative care patients. “Cosmetic mutilation is also a major issue,” pointed out Balawardhane. Treatment results in hair loss, palloring of skin and weight loss and this contributes to patients becoming social outcasts.

“Palliative care must also respect cultural differences and religious inclinations. For example, one who may believe in reincarnation may attempt to weigh one’s merits and demerits, contemplating on where he or she would be reborn. All this contribute to the suffering of the patient,” said Balawardhane. Quoting from American neurosurgeon, pathologist and writer, Harvey Cushing, Balawardhane said that, “‘A physician is obligated to consider more than a diseased organ, more even than the whole man – he must view the man in his world’, meaning that palliative care is holistic care. Most importantly it should be patient centred, family centred.” Palliative care should be comprehensive, leaving no stone unturned, continuous and proactive, delivered by a coordinated team and subject to regular review.”

The palliative care team consists of nurse, dietician, pharmacist, occupational therapist, paramedical aid, General Practitioner, bereavement support worker, social worker, councillor, domestic care provider and even the funeral director plays a vital role in the team. Palliative care is a support system that facilitates an active lifestyle for as long as medically possible. “This requires a lot of distractions such as games like carom, card or scrabble, listening to music or watching TV.” Palliative care practitioners use their clinical expertise and judgement to anticipate problems and treat them proactively before they manifest. “Integration of psychological, emotional, social and spiritual aspects of care between patient, family and caregivers is imperative to the functioning of the palliative care process,” emphasised Balawardhane.

Palliative care trains the patient to regard dying as a normal process, by improving the quality of life for the remainder, explained Balawardhane. “Quality is subjective, it differs from person to person.” he explained that the care provider must not enforce what he or she assumes as ‘quality’ on the patient and in stead must cater to patient demand. Palliative care promotes a degree of acceptance by the patient and immediate family, regarding the final outcome and assists the patient in the decision-making process that would result in a peaceful and dignified demise. Bereavement support helps loved ones to accept loss and does not abruptly stop with the demise of patient under palliative care. “The objective is to give life to days, whatever the remaining number of days, and not give days to life.”



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Rise of Dual Power amidst Covid 

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We had so many kings in our Sinhala Balaya of many centuries. There were many questionable deals on succession by members of this royalty, and others who came to those realms. But we have yet to hear of any brother of a ruling monarch rushing abroad in the midst of what may have been a national crisis, moving to a disaster.This is the stuff of Sinhala Power in the 21st Century. It is a show of the Raja Keliya – the power game, where dual citizenship is the dominant factor. The Sri Lanka, Mawbima home, is of lesser importance than the Videsha mawbima, especially if one’s health has to be handled by foreign medical sources; even if the Videsha Mawbima is the biggest affected by the Covid pandemic.

The appointment of Task Forces to deal with important issues facing the country and the people is the substance of the current Saubhagyaye Dekma – Vision of Prosperity and Splendour. Appointing a brother to head task forces of key importance is the show of dominant family power that prevails in this country today. But brotherly feelings are certainly not important when a dual citizen thinks of the greater importance of the Videsha Mawbima. The tasks of Economic Growth, Eradicating Poverty and Assuring Food Supply, as well as the more recent Green Socio-Economy must all be pushed aside, when the call of the Videsha Mawbima for healthcare is the stuff that matters.

This is the brotherly Vision of Prosperity and Splendour, or the Sahodara Saubhabyaye Dekma.

The Covid pandemic has certainly brought much contradictory thinking, especially in the government, on how the health of the people in this country, non-dual citizens, could be assured. Minister Udaya Gammanpila, a Cabinet spokesman too, is certain that mixed vaccinations of different brands and qualities, is the means to protect the people. 

Dr. Sudarshani Fernandopulle, State Minister on the subject, thinks differently, on the lines of the WHO specialists, who have stressed there is no evidence so far to authorize mixed vaccinations. The other minister of health and vaccination issues is somewhat silent on this confusion in official thinking. Is a new pandemic syrup to be promoted by the power handlers?

Thank heavens that the Cabinet Minister of Health, Pavithra Wanniarachchi, is so far silent on this matter. She could come up with a new Sri Lankan Deshamanya scientific solution, such as throwing some of the Sinopharm and Sputnik (Chinese and Russian) into the nearby river, and using the mixed and river blended vaccine for people of the related province. She is sure to obtain the support of Ministers Udaya Gammanpila and Prasanna Ranatunga for such a crafty thinking of science, just as they shared her belief in the Charmed Pot Game or Mantara Kala Keliya to fight the Covid-19.

  We are now in the midst of what is known as a Lockdown. It is not a “Vasaa thabeema” in Sinhala, but a limit on travel – a ‘Sancharana Seemava’. The Police are very clear that anyone who breaks the lockdown rules will be arrested and brought to justice. We have seen the great joy that policemen showed in carrying non-mask wearers and other violaters of Covid safety guidelines, to be shoved into buses. How much more of such delights would follow when Covid increases its hold on Sri Lanka? What was the related Task Force, and its ceremonial uniformed head doing, when Indians were brought to Sri Lankan hotels for quarantine before travel to some Middle Easter countries? What foreigner from the Covid battered India was carried or courteously conducted to a place where lawbreakers are detained?

As we keep wearing our masks and distancing ourselves from others, there is much cause for concern, even beyond the Covid pandemic, on how persons arrested and detained by the police are killed by or in the presence of the  police. Two suspected and arrested persons have been killed while in police custody this week.  They are Melon Mabula or ‘Uru Juva’ and Tharaka Perera Wijesekera or ‘Kosgoda Tharaka’ These are persons with records of major crimes, possibly with much strong evidence, but not presented in court and any punishment order through the judicial process.

The police spokesperson, a person with a legal background, too, tells the people the details of all the terrible crimes these persons are supposed to be guilty of. It is a contemptible move to get public support for the killings. The Bar Association has raised concerns about these departures from justice. There must be much more protests, even with the Covid dangers.

One gets the impression that the prevailing dangerous situation due to Covid, is being used to carry out increasing violations of the law and the judicial process. This is certainly a major step back to the earlier years of Rajapaksa Power, when many such suspects were killed in Colombo and elsewhere, showing off police escape power. It also brings back memories of the killing and attacks on journalists by similar police and official forces of crooked power.

Are we moving to a new sense of Dual Power — where the judiciary is ignored and official power is the Rule of the Day? Is the power of Dual Citizenry to be the dominant force once Covid puts down the people’s power?

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Should ASEAN Free Trade Area be considered model for SAFTA?

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By Dr. Srimal Fernando

Economic integration is more important today than it has ever been for South Asia’s development. When comparing the impact of South Asian Association for Regional Cooperation (SAARC)s South Asian Free Trade Area (SAFTA) and the Association of Southeast Asian Nations (ASEAN ) Free Trade Area (AFTA) in promoting trade amongst its member states, AFTA has been more effective in integrating the economies of its member states. SAFTA , on the other hand, has yet to make significant contributions to the integration of the economies of SAARC member states. The Success of ASEAN’s economic integration can be attributed to the willingness of Southeast Asian countries to embrace the tenets of regional integration. In contrast, SAARC’s model has failed to create a secure regional environment that is conducive for economic growth since its formation.

The Association of Southeast Asian Nations (ASEAN ) member states signed the AFTA agreement on 28 January 1992. After the establishment of AFTA, the member states of ASEAN succeeded in signing trading protocols within the organization. The ASEAN model succeeded in creating one of the most successful free trade areas in Asia as well as globally. The establishment of AFTA has been an important milestone in Southeast Asia as a factor that facilitated the economic integration of ASEAN member states.

In the case of the SAARC, the signing of free trade protocols under the SAFTA agreement has been faced with several tariff and non-tariff barriers. Although both SASRC and ASEAN member states face unique challenges that affect trading within these organizations, it can be said that, unlike the SAARC, the ASEAN economic integration model has been far successful in promoting trade amongst its member states. For the SAARC, the liberalization of the economies of SAFTA signatories has been a crucial challenge. On the other hand, ASEAN has made notable progress with regards to trade liberalization, policy alignments, and intra-regional trade among Southeast Asian nations.

The specific trade liberalization challenges faced by the SAARC member states include concerns over SAFTA revenue allocation from member states, restrictive rules of origin, and negative sensitive lists. The sensitive lists adopted by SAARC member states have proven to be a significant hurdle to exportation amongst SAARC member states. This has particularly made it difficult for exports from small member states of the SAARC to enter into large markets such as India and Pakistan. Having failed to grant the application of  most favored nation (MFN) status that would have seen a significant reduction in the sensitive lists maintained by both countries, trade between these two regional powers has been problematic over the years. Notably, the trading commodities that are in the sensitive lists of a majority of the SAFTA member states have high export potential. Despite the various commitments made by SAFTA member states, countries continue to maintain long sensitive lists hence the dismal performance of SAFTA. 

In the case of ASEAN, the establishment of the AFTA agreement has provided ASEAN member states with a platform to exploit their export potential. The AFTA agreement has boosted the economies of ASEAN countries through its trade liberalization policies. AFTA has also entered into several free trade agreements with regional powers such as Australia, China, South Korea, India, and Japan. The ASEAN countries are now focused on creating an Economic Community for their member states. Notably, several countries have shown interest in being a part of the proposed ASEAN Economic Community.

It should however be noted that the massive success achieved by ASEAN’S AFTA as opposed to SAARC’s SAFTA is not flawless. For example, although ASEAN has made significant steps in eliminating tariff barriers amongst AFTA member states, Non-tariff barriers are still a key challenge to the AFTA agreement. However, when analyzing the progress made by ASEAN’s AFTA since its formation, the achievements and evolution are undeniable. ASEAN was formed in an era when interstate relations amongst Southeast Asian countries were characterized by political mistrust and strained interstate relations. Years later, the organization has succeeded in unifying its member states for a common course, an aspect that the SAARC still struggles with. 

Way Forward

If SAFTA is to become more effective and emulate AFTA’s success, the myriad of issues mentioned above needs to be addressed. First, downsizing the sensitive lists of countries in a time-bound manner will be necessary. Secondly, the issue of para tariffs needs to be squarely addressed. A starting point could be to reduce and accelerate the elimination of para tariffs on items not on sensitive lists and include para tariffs in SAFTA negotiations. Also, the non-tariff barriers to trade facing SAFTA member states need to be equally addressed like the tariff barriers. Finally, strengthening economic relations can be used to reinforce improving political relations in the region, particularly between India and Pakistan. To an extent, the success of ASEAN in achieving effective economic integration and its experience can be used as an external driver of SAARC and its SAFTA agreement.

About the author:

Dr. Srimal Fernando received his PhD in the area of International Affairs. He was the recipient of the prestigious O.P. Jindal Doctoral Fellowship and SAU Scholarship under the SAARC umbrella. He is also an Advisor/Global Editor of Diplomatic Society for South Africa in partnership with Diplomatic World Institute (Brussels). He has received accolades such as 2018/2019 ‘Best Journalist of the Year’ in South Africa, (GCA) Media Award for 2016 and the Indian Council of World Affairs (ICWA) accolade. He is the author of ‘Politics, Economics and Connectivity: In Search of South Asian Union’

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Ramazan spirit endures amid pandemic

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This will be a sombre Ramazan, indeed, with the country under a lockdown. But the spirit of Ramazan lives on in all Muslims. Ramadan, also referred to as Ramazan, Ramzan, or Ramadhan, in some countries, is the ninth month of the Islamic calendar, and Muslims the world over dedicate this holy month for fasting, prayer, reflection and community.

Although most non-Muslims associate Ramazan, solely with fasting, it is believed to bring Muslims closer to God and inculcate in them qualities such as patience, spirituality, and humility. Those of the Islamic faith believe that fasting redirects one away from worldly activities, cleanses the inner soul and free it from harm. It also teaches self-discipline, self-control, sacrifice, and empathy for those who are less fortunate and encourage actions of generosity and charity. It is a time of self-examination and increased religious devotion.

Ramazan is a commemoration of Prophet Muhammad’s first revelation, and the annual observance of Ramazan is regarded as one of the Five Pillars of Islam. The Five Pillars are basic acts, considered mandatory by Muslims, namely Muslim life, prayer, concern for the needy, self-purification, and the pilgrimage. Prophet Muhammad’s first revelation is believed to have taken place in 610 AD, in a cave called Hira, located near Mecca, where Muhammad was visited by the angel Jibrīl, who revealed to him the beginnings of what would later become the Qur’an. The visitation occurred on Ramazan.

Ramazan lasts from one sighting of the crescent moon to the next and the local religious authority is tasked with announcing the date. The Colombo Grand Mosque announced on Wednesday (12) that Sri Lankan Muslims will celebrate Ramazan on Friday (14). Because the Muslims follow a lunar calendar, the start of Ramazan moves backwards by about 11 days, each year, in the Gregorian calendar. Fasting from dawn to sunset is considered fard (obligatory) for all adult Muslims who are not acutely, or chronically, ill, travelling, elderly, breastfeeding, diabetic, or menstruating.

During this month, Muslims refrain not only from partaking of meals, but also tobacco products, sexual relations, and sinful behaviour, devoting themselves to prayer or salat and recitation of the Quran. The pre-dawn meal is referred to as suhur, and the nightly feast that breaks fast is referred to as iftar. During Ramazan, Muslims wake up well before dawn to eat the pre-dawn meal. This is considered the most important meal, during Ramazan, since it has to sustain one until sunset. This means eating lots of high-protein food and drinking as much water as possible, right up until dawn, after which one cannot eat or drink anything. The day of fasting ends at sunset, the exact minute of which is signalled by the fourth call to prayer, at dusk.

It is believed that spiritual rewards, or thawab, of fasting multiply during Ramazan. Muslims do not Fast on Eid, but Sri Lankan Muslims believe that observing the six days of optional fasting, that follows Eid, multiplies spiritual rewards.

Eid-Ul-Fitr is the Festival of Breaking the Fast, also simply referred to as Eid, and marks the end of the month-long dawn-to-sunset fasting of Ramadan, as well as the return to a more natural disposition of eating, drinking, and marital intimacy. In Sri Lanka, this Festival of Breaking the Fast is also referred to, colloquially, as Ramazan. Eid begins at sunset, on the night of the first sighting of the crescent moon. Muslims hand out money, to the poor and needy, as an obligatory act of charity, before performing the Eid prayer.

Globally, the Eid prayer is generally performed in open areas, like fields, community centres, or mosques in congregation. In Sri Lanka, the prayer is performed annually in Galle Face Green and mosques. The Eid prayer is followed by the sermon and then a supplication asking for Allah’s forgiveness, mercy, peace and blessings for all living beings across the world. The sermon encourages Muslims to engage in the rituals of Eid, such as zakat, almsgiving to other fellow Muslims. After the prayers, Muslims visit relatives, friends, and acquaintances, or hold large communal celebrations.

After prayer, Muslims celebrate Eid, with food being the central theme. Sri Lankans celebrate Ramazan with watalappam, falooda, samosa, gulab jamun and other national and regional dishes. The festivals were said to have initiated in Medina, after the migration of Muhammad from Mecca.

This year, as well as last year, Sri Lankan Muslims will have to forgo the custom of communal prayers, and celebrations, due to the ongoing pandemic, and will have to settle for private prayers and celebrations of Ramazan during this period of curfew. While these preventive measures are in place, during this year’s Ramazan, the principles of this holy month remain the same. Devout Muslims all over the world, will still be honouring this pillar of Islam, albeit from the security of their homes.

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