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Ivermectin – A possible win-win situation

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BY Dr. Sumedha S. Amarasekara

Ivermectin is a drug that has been increasingly occupying medical attention, following its possible role in the treatment and prevention of SARS-CoV-2 (Covid-19). A news item in the The Sunday Times of 05.09.2021 says, ‘Ivermectin divides doctors while NMRA gives waiver to import drug to stop black market sales’.

Ivermectin:

Ivermectin was discovered in 1975 and had come into medical use by 1981. It is an antiparasitic drug that has antiviral and anti-inflammatory properties. It is a well-known drug, approved as an antiparasitic agent by both the FDA (U.S. Food and Drug Administration) and the WHO (World Health Organization). It is on the list of the WHO’s Essential medicines. It is considered to be extremely safe in the recommended dose (0.2 to 0.4 mg/kg). Over the last 20 to 30 years the medical/scientific community has begun to investigate /appreciate its antiviral and anti-inflammatory properties (Kircik LH, Del Rosso JQ, Layton AM, Schauber J. Over 25 Years of Clinical Experience with Ivermectin: An Overview of Safety for an Increasing Number of Indications. J Drugs Dermatol. 2016 Mar;15(3):325-32. PMID: 26954318)

Ivermectin is also an extremely cheap drug. A 12mg tablet –the normal recommended dose for a 60 kg adult- is around US $ 0.03 -3 cents. The manufacturing cost is estimated at US $ 168 for 1 kilogram. Therefore, as one can work out, to manufacture 12 mg will cost: 168 divided by 1,000,000 and multiplied by 12 = US $ 0.002. Hence the bulk of the cost of the drug is in fact in converting the drug into tablets, packaging and distribution!

Evidence of the use of Ivermectin :

There is an increasing number of news items and journal publications showing the efficacy of Ivermectin’s role in reducing the mortality of Covid-19 and reducing the spread (prophylaxis) of Covid-19 among the population. A case-control study done at the All India Institute of Medical Sciences concluded that two-doses of Ivermectin prophylaxis at a dose of 300μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 (Covid-19) infection among health care workers for the following month (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886121/). A meta-analysis published in June this year shows a probable reduction of mortality (i.e. deaths) by 62%, when Ivermectin was used as a therapeutic agent and a possible reduction of spread by 86% when Ivermectin was used as a prophylactic agent(American Journal of Therapeutics 28, e434–e460 (2021).

In fact the control of Coivd-19 in the Northern states of India and across a number of other countries has been attributed to the use of Ivermectin. An increasing number of countries has stated that they are adding Ivermectin on to their arsenal in combating Covid-19 (https://www.youtube.com/c/WhiteboardDoctor/playlists- Ivermectin and Covid-19).

However, the NIH (National Institute of Health) maintains that there isn’t sufficient data to recommend Ivermectin for or against, in the treatment of Covid-19, which is the same stance that has been taken up by the National Medicines Regulatory Authority (NMRA) of this country as well. The WHO’s stand is still that, Ivermectin should not be used outside a clinical trial.

Conducting clinical trials:

To understand this apparent discrepancy between the results of the clinical trials and the stance of the NIH, WHO, etc., requires an insight into the interpretation of clinical trials. In today’s world conducting and interpreting clinical trials is almost a separate discipline on its own and is well beyond the scope of this article (and mine as well!).

However, an understanding of clinical trials and their interpretation is necessary to understand the clinical trials themselves and the decision-making process of these authorities. There is a variety of trials that could be done. The basis of all these trials is that one group of patients is given Ivermectin and the other group is not given Ivermectin. Following the trial, by comparing the mortality rates and spread of Covid-19 (the results) between the two groups, scientists would be able to say what effect Ivermectin has on the mortality and spread of Coivid-19. For the results to be valid, apart from the Ivermectin, everything else between these two groups needs to be the ‘same’, such as the male to female ratio of patients, other illnesses they have, other medication they take, smoking habits, alcohol consumption, etc. As one can see it is not easy to get two comparable groups. Thereafter, if one is treating for Covid -19, both groups need to have the same degree of sickness i.e. the average number of mild to moderate to severe cases should match up. If one is checking for prevention (prophylaxis) then their exposure to ‘known Covid-19 cases’ and ‘potential cases’ needs to match up as well. For example starting from, do they wear one or two masks, what type of masks, do they wear a face shield, do they maintain social distancing; all the time or some of the times, have they been exposed to any known Covid-19 patients, have they attended any weddings, funerals, parties, ‘get togethers’, do they live in apartments or individual houses, do they travel to work using public transport, do they shop on line or in person, etc… etc… As one can see this is even more complex than trying to match groups for treatment. This is what leads to the term Controlled. Thereafter, scientists need to make sure that every patient has an equal chance of either receiving the Ivermectin or not. In other words, there is no bias in who receives and who does not receive the drug. Because inadvertently one might be influenced by whom one gives the drug to i.e. the drug may be given to someone considered sick who needs the drug and not given to one with a milder disease. This process of randomly allocating the treatment leads to the term Randomised. From a patient’s point of view, they may feel psychologically let down by not having received the drug or psychologically boosted by receiving the drug. This can affect their response to the treatment. The doctors monitoring the patient can be influenced as well, if they know whether a patient is taking the drug or not. To eliminate this phenomenon everybody receives ‘the drug’- either the drug or the placebo –originating from the Latin phrase ‘I shall please’. Therefore only those who actually run the trial know, who gets what. So the person/s who gives the ‘drug’ and monitors the patients do not know what they are giving and neither do the patients know what they are receiving which is called a double blind. If all these elements are combined then we arrive at a randomised, double blind, controlled study which is considered as the golden standard.

Interpretation of clinical trials:

So the trial is done and the results are out. Now a complex issue remains as to how certain the scientists are that these results are due to Ivermectin and not due to a natural variation of events. To illustrate this we can look at a hypothetical situation of 10,000 Covid -19 patients that have an overall mortality of 2% i.e. 200 deaths. If we were to divide these patients into lots of 1000, it is extremely unlikely that these deaths would be distributed equally for every lot of 1000 patients. Some lots would have had more deaths, other lots would have had less, averaging out at 20 per group of 1000 i.e. 2%. Now let us assume that the two groups of patients selected of a 1000 each for the study, were to have 10 deaths in one group and 30 deaths in the other –averaging out at 2%. The critical issue to grasp is that, which group is which is not known. Assume Ivermectin was given to the group that was to have 30 deaths and as a result of Ivermectin the death rate was halved and ended up being 15 –a 50% reduction- this is 50% (5) more than that of the control group, so it could be erroneously concluded that Ivermectin does not work, when it actually does work. On the other hand Ivermectin may not actually work, but in this instance it was given to the group that was to have 10 deaths, so erroneously the conclusion is that Ivermectin does work, when in fact it doesn’t. If things were not as complex as it were, it is worthwhile to remember that this natural variation exists for all of the characteristics mentioned above between the two groups as well. This needs to be taken in to account.

So when scientists interpret data, these variations are taken into consideration and there are three main aspects that they consider. The first is the power of the study. That basically means, are there sufficient numbers of patients in the study for the scientists to be able to pick up a true difference that goes beyond the natural variation. The hypothetical study shown above, has very little power; as one could see that the results could not be interpreted due to the natural variation. Next is significance. That is a measure of allowing for chance to be involved in the result. For most studies the significance level, known commonly as a P value is set below 0.05 (P< 0.05). In this context it would mean that, there is less than a 5% chance that the decrease in mortality is, not due to Ivermectin i.e. the chance of Ivermectin causing the decrease in mortality is more than 95%. Thirdly, there is the concept of ‘a confidence interval’. Broadly speaking the narrower the confidence interval the more valid the results are.

Clinical interpretation and Ivermectin:

It is a deficiency of some of the above factors in the clinical trials so far conducted and their subsequent interpretation that have resulted in this stance of the various authorities. Therefore the vital aspect to understand in going forward is that the issue is not primarily to do with the results from all these trials (and other evidence) that have been conducted across the world; that have shown that Ivermectin does work. But, it is to do with the validity of these results. Therefore the view put forward by those who are guarded in their recommendation in the use of Ivermectin, is that the validity (certainty) of these trials is not strong enough for the use of Ivermectin to be recommended. Which of course is not the same as saying that Ivermectin does not work.

This view needs to be counterbalanced by the following facts. Firstly, there have been no significant adverse effects reported in any of the trials conducted using Ivermectin. Secondly, there is only an extremely limited number of drugs that have been recommended in the treatment of Covid-19 and none of these is ‘curative’ in the strictest sense of the word. Thirdly, though vaccination makes a significant difference to the outcome if one were to get Covid-19, it has not been as successful in preventing its spread.

Available options:

The WHO apart from the vaccines, has only recommended a few drugs to be used in the treatment of Covid-19. Remdesivir is one such drug. This is however, only to be used in the treatment of Covid-19 patients, essentially in a hospital environment. A vial of this drug costs over US $ 500. Not exactly a practical solution for us! Besides there are no clinical trials scheduled by the major pharmaceutical companies comparing Remdesivir (US $ 500) with Ivermectin (US $0.03) to be seen in the near horizon. Countries that have already used Ivermectin and are satisfied with its outcomes are not going to be conducting trials to assess a drug that they already find works.

One option is to evaluate all the existing evidence and start using Ivermectin. Prof. Saroj Jayasinghe (Faculty of Medicine, University of Colombo) a highly respected clinician has already written to the Ministry of Health recommending that Ivermectin should be used in the treatment of Covid-19.

However, to take a national stance on a drug not approved by the WHO could be considered ‘irresponsible’ and may jeopardise our future with regard to health and safety issues on an international forum.

Therefore, another option would be to follow the guidelines of the WHO and conduct a clinical trial. The issue that would now cross one’s mind is given in this discussion; conducting a trial that would give valid results would be an extremely complex and arduous undertaking. How does one organise these matching groups etc..?

The solution:

An islandwide clinical trial with the use of Ivermectin.

With regard to an islandwide clinical trial, the numbers will be huge running into millions. This leads to an enormous power and thereby an incredible validity of the study. It also ironically means that the amount of extra data that one needs to record, to make sure that one has matching groups, etc., becomes minimal as well. As a point of illustration, if we were to have a randomised clinical trial–blind or not-across the 14,022 Grama Niladhari Wasams involving around 22 million adults and children, where half are given Ivermectin; the outcome would be dependent on the use of Ivermectin, as the chance of another confounding factor or natural variation affecting one group-of roughly 11 million- and not the other would be almost nonexistent!

Let us not forget that we are probably one of the few countries in the world where countrywide elections are held and the results are given within a day or so.

The WHO will/should give its blessing and if need be, provide help with the necessary expertise (and resources?) to conduct this trial.

This is essentially a win, win

and win situation

An acceptable clinical trial is required to provide the definitive answers-what the WHO, the NIH and our NMRA need. The medical sector would be happy to get the findings they require with a ‘controlled opening of the country’. The country needs to be opened in some manner to assess the prophylactic role of Ivermectin and the ‘government’ would find it feasible and more than willing to do so for economic reasons. The people would be happy to get ‘a drug that would/could work’ and more importantly an easily affordable one in their hour of need.

The advantage of an island wide clinical trial:

There are a number of important points that are extremely favourable in terms of conducting an islandwide clinical trial with Ivermectin.

1. Ivermectin is an extremely safe drug at the prescribed doses. It can be given to children as well, leading to a comprehensive island\wide clinical trial. This is particularly important as we still do not have a proper handle on vaccination when it comes to children.

Given that Ivermectin is already used as an antiparasitic agent and given to children, it can be used separately in an islandwide clinical trial to re-open the schools.

2. Ivermectin is an extremely cheap drug. This is most relevant to us in our current economic predicament. The cost of treating an adult with Covid-19 and /or using Ivermectin as a prophylactic drug (the loading dose and the required tablets for three months) on average will be less than Rs. 500 per person. As the dose is based on body weight, the cost will be less for children.

3. When used as a prophylactic drug, it has an extremely simple dosing schedule – a loading dose administered a couple of days apart then a maintenance dose once a week or at a prescribed interval.

4. The existing trials show a considerable impact from this drug. Based on the existing trials, if Ivermectin were to work, we should be expecting at least a 50% reduction of mortality and at least the same reduction in the spread of the disease, or there about. Therefore the effects of using this drug would be extremely easy to monitor.

5. A very important point, the prevention (i.e. prophylactic) aspect of Ivermectin, starts once the drug has got absorbed into the system – pretty much immediately. When one considers the vaccine, the first dose needs to be given, then a period of at least four weeks has to pass for the body to generate a sufficient immune response for the second dose to be given. Thereafter, a further two to three weeks need to elapse before one is considered to be immune i. e. close upon almost two months. With Ivermectin, if one takes the tablet at night, by morning one is ‘good to go’.

6. Finally, another significant and interesting aspect is that we would be able to evaluate the relative efficacy and interactions between Ivermectin and our vaccines. How does Ivermectin impact on those who have completed both vaccine doses or only had one or have not been vaccinated at all? Looking to the future, how does Ivermectin-given that it has therapeutic as well as prophylactic properties- compare with Vaccination?

The country still faces a dilemma of opening the country vs having an uncontrolled spread of Covid-19. The reality is that we will need to ‘reopen the country’. This is the best time while the country is in a lock down to organise an islandwide clinical trial. Plan what type of trial/trials we want to execute, formulate the primary and secondary questions that need to be answered, identify the significant sub groups, determine what monitoring processes are required, etc. Make necessary plans to reopen the country systematically with an islandwide clinical trial in place.

Hopefully, we shall see the light at the end of the tunnel.



Features

Another Christmas, Another Disaster, Another Recovery Mountain to Climb

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In line with its overall response to Cyclone Ditwah that devastated many parts of Sri Lanka, India has undertaken to set up temporary Bailey Bridges at selected locations. Work on the first such bridge has begun in Kilinochchi on the Paranthan–Karaichi–Mullaitivu A35 road. Indian Army engineers are working with their counterparts. The Indian HC said that 185 tonnes of Bailey Bridge units were airlifted to restore critical connectivity, along with 44 engineers (Pic courtesy IHC)

The 2004 Asian Tsunami erupted the day after Christmas. Like the Boxing Day Test Match in Brisbane, it was a boxing day bolt for Indonesia, Thailand, Sri Lanka, India and Maldives. Twenty one years later, in 2025, multiple Asian cyclones hit almost all the old victims and added a few more, including Malayasia, Vietnam and Cambodia. Indonesia and Sri Lanka were hit hard both times. Unlike the 2004 Tsunami, the 2025 cyclones made landfalls weeks before Christmas, during the Christian Season of Advent, the four-week period before Christmas preparing for the arrival of the Messiah. An ominously adventus manifestation of the nature’s fury.

Yet it was not the “day of wrath and doom impending … heaven and earth in ashes ending” – heavenly punishment for government lying, as an opposition politician ignorantly asserted. By that token, the gods must have opted to punish half a dozen other Asian countries for the NPP government’s lying in Sri Lanka. Or all those governments have been caught lying. Everyone is caught and punished for lying, except the world’s Commander in Chief for lying – Donald J. Trump. But as of late and none too sooner, President Trump is getting his punishment in spades. Who would have thought?

In fairness, even the Catholic Church has banished its old hymn of wrath (Dies irae, dies illa) that used to be sung at funerals from its current Missals; and it has on offer, many other hymns of peace and joy, especially befitting the Christmas season. Although this year’s Christmas comes after weeks of havoc caused by cyclonic storms and torrential rains, the spirit of the season, both in its religious and secular senses, will hopefully provide some solace for those still suffering and some optimism to everyone who is trying to uplift the country from its overflowing waterways and sliding slopes.

As the scale of devastation goes, no natural disaster likely will surpass the human fatalities that the 2004 Tsunami caused. But the spread and scale of this year’s cyclone destruction, especially the destruction of the island’s land-forms and its infrastructure assets, are, in my view, quite unprecedented. The scale of the disaster would finally seem to have sunk into the nation’s political skulls after a few weeks of cacophonic howlers – asking who knew and did what and when. The quest for instant solutions and the insistence that the government should somehow find them immediately are no longer as vehement and voluble as they were when they first emerged.

NBRO and Landslides

But there is understandable frustration and even fear all around, including among government ministers. To wit, the reported frustration of Agriculture Minister K.D. Lalkantha at the alleged inability of the National Building Research Organization (NBRO) to provide more specific directions in landslide warnings instead of issuing blanket ‘Level 3 Red Alerts’ covering whole administrative divisions in the Central Province, especially in the Kandy District. “We can’t relocate all 20 divisional secretariats” in the Kandy District, the Minister told the media a few weeks ago. His frustration is understandable, but expecting NBRO to provide political leaders with precise locations and certainty of landslides or no landslides is a tall ask and the task is fraught with many challenges.

In fairness to NBRO and its Engineers, their competence and their responses to the current calamity have been very impressive. It is not the fault of the NBRO that local disasters could not be prevented, and people could not be warned sufficiently in advance to evacuate and avoid being at the epicentre of landslides. The intensity of landslides this year is really a function of the intensity and persistence of rainfall this season, for the occurrence of landslides in Sri Lanka is very directly co-related to the amount of rainfall. The rainfall during this disaster season has been simply relentless.

Evacuation, the ready remedy, is easier said than socially and politically done. Minister Lal Kantha was exasperated at the prospect of evacuating whole divisional secretariats. This was after multiple landslides and the tragedies and disasters they caused. Imagine anybody seriously listening to NBRO’s pleas or warnings to evacuate before any drop of rainwater has fallen, not to mention a single landslide. Ignoring weather warnings is not peculiar to Sri Lanka, but a universal trait of social inertia.

I just lauded NBRO’s competence and expertise. That is because of the excellent database the NBRO professionals have compiled, delineating landslide zones and demarcating them based on their vulnerability for slope failure. They have also identified the main factors causing landslides, undertaken slope stabilization measures where feasible, and developed preventative and mitigative measures to deal with landslide occurrences.

The NBRO has been around since the 1980s, when its pioneers supplemented the work of Prof. Thurairajah at Peradeniya E’Fac in studying the Hantana hill slopes where the NHDA was undertaking a large housing scheme. As someone who was involved in the Hantana project, I have often thought that the initiation of the NBRO could be deemed one of the positive legacies of then Housing Ministry Secretary R. Paskaralingam.

Be that as it may, the NBRO it has been tracking and analyzing landslides in Sri Lanka for nearly three decades, and would seem to have come of age in landslides expertise with its work following 2016 Aranayake Landslide Disaster in the Kegalle District. Technically, the Aranayake disaster is a remarkable phenomenon and it is known as a “rain-induced rapid long-travelling landslide” (RRLL). In Kegalle the 2016 RRLL carried “a fluidized landslide mass over a distance of 2 km” and caused the death of 125 people. International technical collaboration following the disaster produced significant research work and the start of a five-year research project (from 2020) in partnership with the International Consortium on Landslides (ICL). The main purpose of the project is to improve on the early warning systems that NBRO has been developing and using since 2007.

Sri Lankan landslides are rain induced and occur in hilly and mountainous areas where there is rapid weathering of rock into surface soil deposits. Landslide locations are invariably in the wet zone of the country, in 13 districts, in six provinces (viz., the Central, Sabaragamuwa, Uva, Northwestern, Western and Southern, provinces). The Figure below (from NBRO’s literature) shows the number of landslides and fatalities every year between 2003 and 2021.

Based on the graphics shown, there would have been about 5,000 landslides and slope failures with nearly 1,000 deaths over 19 years between 2003 and 2021. Every year there was some landslide or slope failure activity. One notable feature is that there have been more deaths with fewer landslides and vice-versa in particular years. In 2018, there were no deaths when the highest number (1,250) of landslides and slope failures occurred that year. Although the largest number in an year, the landslides in 2018 could have been minor and occurred in unpopulated areas. The reasons for more deaths in, say, 2016 (150) or 2017 (250+), could be their location, population density and the severity of specific landslides.

NBRO’s landslide early warning system is based on three components: (1) Predicting rainfall intensity and monitoring water pressure build up in landslide areas; (2) Monitoring and observing signs of soil movement and slope instability in vulnerable areas; and (3) Communicating landslide risk level and appropriate warning to civil authorities and the local public. The general warnings to Watch (Yellow), be Alert (Brown), or Evacuate (Red) are respectively based on the anticipated rainfall intensities, viz., 75 mm/day, 100 mm/day; and 150 mm/day or 100 mm/hr. My understanding is that over the years, NBRO has established its local presence in vulnerable areas to better communicate with the local population the risk levels and timely action.

Besides Landslides

This year, the rain has been relentless with short-term intensities often exceeding the once per 100-year rainfall. This is now a fact of life in the era of climate change. Added to this was cyclone Ditwah and its unique meteorology and trajectory – from south to north rather than northeast to southwest. The cyclone started with a disturbance southwest of Sri Lanka in the Arabian Sea, traversed around the southern coast from west to east to southeast in the Bay of Bengal, and then cut a wide swath from south to north through the entire easterly half of the island. The origin and the trajectory of the cyclone are also attributed to climate change and changes in the Arabian Sea. The upshot again is unpredictability.

Besides landslides, the rainfall this season has inundated and impacted practically every watershed in the country, literally sweeping away roads, bridges, tanks, canals, and small dams in their hundreds or several hundreds. The longitudinal sinking of the Colombo-Kandy Road in the Kadugannawa area seems quite unparalleled and this may not be the only location that such a shearing may have occurred. The damages are so extensive and it is beyond Sri Lanka’s capacity, and the single-term capacity of any government, to undertake systematic rebuilding of the damaged and washed-off infrastructure.

The government has its work cutout at least in three areas of immediate restoration and long term prevention. On landslides warning, it would seem NBRO has the technical capacity to do what it needs to do, and what seems to be missing is a system of multi-pronged and continuous engagement between the technical experts, on the one hand, and the political and administrative powers as well as local population and institutions, on the other. Such an arrangement is warranted because the landslide problem is severe, significant and it not going to go away now or ever.

Such an engagement will also provide for the technical awareness of the problem, its mitigation and the prevention of serious fallouts. A restructuring could start from the assignment of ministerial responsibilities, and giving NBRO experts constant presence at the highest level of decision making. The engagement should extend down the pyramid to involve every level of administration, including schools and civil society organizations at the local level.

As for external resources, several Asian countries, with India being the closest, are already engaged in multiple ways. It is up to the government to co-ordinate and deploy these friendly resources for maximum results. Sri Lanka is already teamed with India for meteorological monitoring and forecasting, and with Japan for landslide research and studies. These collaborations will obviously continue but they should be focused to fill gaps in climate predictions, and to enhance local level monitoring and prevention of landslides.

To deal with the restoration of the damaged infrastructure in multiple watershed areas, the government may want to revisit the Accelerated Mahaweli Scheme for an approach to deal with the current crisis. The genesis and implementation of that scheme involved as many flaws as it produced benefits, but what might be relevant here is to approach the different countries who were involved in funding and building the different Mahaweli headworks and downstream projects. Australia, Britain, Canada, China, Italy, Japan, Sweden and Germany are some of the countries that were involved in the old Mahaweli projects. They could be approached for technical and financial assistance to restore the damaged infrastructure pieces in the respective watershed areas where these countries were involved.

by Rajan Philips ✍️

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Feeling sad and blue?

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Rowan Atkinson

Here is what you can do!

Comedy and the ability to have a good laugh are what keep us sane. The good news to announce is that there are many British and American comedy shows posted up and available on the internet.

They will bring a few hours of welcome relief from our present doldrums.

Firstly, and in a class of its own, are the many Benny Hill shows. Benny is a British comedian who comes from a circus family, and was brought up in an atmosphere of circus clowning. Each show is carefully polished and rehearsed to get the comedy across and understood successfully. These clips have the most beautiful stage props and settings with suitable, amusing costumes. This is really good comedy for the mature, older viewer.

Benny Hill has produced shows that are “Master-Class” in quality adult entertainment. All his shows are good.

Then comes the “Not the Nine o’clock news” with Rowan Atkinson and his comedy team producing good entertainment suitable for all.

And then comes the “Two Ronnies” – Ronnie Barker and Ronnie Corbett, with their dry sense of humour and wit. Search and you will find other uplifting shows such as Dave Allen, with his monologues and humour.

All these shows have been broadcast in Britain over the last 50 years and are well worth viewing on the Internet.

Similarly, in The USA of America. There are some really great entertainment shows. And never forget Fats Waller in the film “Stormy Weather,” where he was the pianist in the unforgettable, epic, comedy song “Ain’t Misbehavin”. And then there is “Bewitched” with young and glamorous Samantha Stevens and her mother, Endora who can perform magic. It is amazing entertainment! This show, although from the 1970s was a milestone in US light entertainment, along with many more.

And do not overlook Charlie Chaplin and Laurel and Hardy, and all the Disney films. Donald Duck gives us a great wealth of simple comedy.

The US offers you a mountain of comedy and good humour on Youtube. All these shows await you, just by accessing the Internet! The internet channel, ‘You tube’ itself, comes from America! The Americans reach out to you with good, happy things right into your own living room!

Those few people with the ability to understand English have the key to a great- great storehouse of uplifting humour and entertainment. They are rich indeed!

by Priyantha Hettige

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Lalith A’s main enemy was lack of time and he battled it persistently

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Athulathmudali

Presidential Mobile Service at Matara amid JVP terror

Like most Ministers, Mr. Athulathmudali over programmed himself. In this respect his was an extreme case. He was an early riser and after his morning walk and the usual routines of a morning, was ready for business by 6.30 a.m. In fact he once shocked an IMF delegation by fixing the appointment with it at this hour. The delegation had to be persuaded that they had heard right, and that the appointment was indeed for 6.30 a.m. and not 6.30 p.m. This desire to get through much as possible during a day inevitably led to certain imbalances. Certain matters which needed more time did not get that time, whilst at the level of officials, we felt that we needed more time with him, and quality time at that.

I had spoken to him several times on this subject. He always had good intentions and wanted to give us more time. But with his political, social and even intellectual responsibilities in regard to speaking engagements of a highly professional nature, it was not often possible to find this time. This situation was highlighted in a comic way, when one day on hearing that the minister had arrived in office for a short time, I grabbed some important papers which I wanted to discuss with him, and made for his room. When I entered, I found three officers, with files in their hands milling outside the door of the washroom. The minister was inside.

I suggested that we might as well form a queue outside the door, a queue which I also joined. An official who came after me also joined the queue. When the minister opened the door, to his great astonishment, and then to his amusement, he found five senior officials, including his Secretary lined up outside the bathroom door! It was funny and we made it funny. But the underlying intentions were quite serious, and we wanted to send him a message that we wanted more time with him. We had to however grab moments such as these in order to keep the flow of work going.One day he good humouredly said, “You all swamp me as I come in,” to which I lightly replied “As a distinguished lawyer you should know that possession is nine-tenths of the law, and now we are in possession of both your room and your attention.” Mr. Athulathmudali chuckled.

An important requirement under Mr. Athulathmudali was a report that had to be submitted to him if any official under his Ministry went abroad on official business. The report had to be reasonably brief, more analytical than descriptive and wherever possible or relevant contain specific recommendations in regard to the betterment of the officer’s area of work. Since the Ministry was quite large, a considerable number of officials went abroad for seminars, study tours, research collaboration, conferences, negotiations and so on. There were, therefore a significant number of reports coming to him. Many of these he read, and on some, he commented or asked questions or sought clarifications. What amazed us was how he found the time. His main enemy was time and he battled it with persistence and determination. Most of us were also in a similar position, and in this, his powerful example was a source of encouragement.

Duties not quite pleasant

As mentioned in several places in these memoirs, a senior public servant’s or a Secretary’s job is not always a pleasant one. At the level of the hierarchy of officials the buck stops with you. Thereafter, when necessary, battling the minister becomes your business. I used to insist to my officials that I needed a good brief. I was not prepared to go and start an argument with a minister unless I was in possession of the full facts. Interpretation was my business. But I needed verifiable facts and authentic figures. Officers who worked with me were soon trained to comply with these requirements. After that was done, if there was any flak, it was my business to take it upon myself. On one such occasion, I had to speak rather firmly to the acting Minister, Mr. G.M. Premachandra. He was young, energetic and even aggressive and was somewhat of a “stormy petrel.” He was an effective speaker in the Sinhala e and could be a formidable debater.

When he became State Minister for Food, he took it upon himself to probe everything. He started getting involved in administrative matters, the implications of which he did not understand, and the details of which he had no time for. During the course of these he not only started criticizing officials liberally, but also employed innuendo to suggest that they were corrupt. When interested parties got to know this, they fed him with halftruths and sometimes plain lies. This naturally confirmed the suspicions in his own mind. He blindly felt around and got hold of some tail and thought that was the elephant. The State Secretary, Mr. Sapukotana, an experienced and balanced official tried his best to advice the minister of the consequences of his actions.

Senior officials in the Food Department were being kept off balance much of the time. Paralysis as creeping into the decision making process. No one was taking decisions because taking decisions risked misinterpretation, suspicion and innuendo. The Deputies were pushing papers up to the Food Commissioner, and soon the Food Commissioner was pushing papers up to the State Secretary. Matters were getting really serious, because delays in calling for and deciding on tenders, attending to commercial disputes and so on were bound to have a serious effect on the availability of timely food supplies, and the maintaining of food security.

Mr. Sapukotana kept me informed from time to time of the developing situation. He tried his best to handle it without disturbing me. But it gradually came to a point that we were both of the view that my intervention was necessary. I took an opportunity that presented itself after a “mini cabinet” meeting which Mr. Premachandra chaired as Acting Minister. I asked him whether he would stay back for a moment. His Secretary seemed embarrassed to stay, but I asked him also to sit. Thereafter, I politely but firmly explained to the minister, the consequences of his actions.

I asked him whether he was aware that nobody was prepared to take a decision in the food sector. I pointed out that should disaster strike, Minister Athulathmudali would certainly ask him for an explanation. I told him further, that in such a contingency, that we as officials will have to tell the truth to the minister. The acting minister listened in silence. I wondered as to what forces of counter attack were gathering in his breast. He did not have the reputation of bowing meekly to a challenge and here I was calling into question his entire approach to his work.

Ultimately when he spoke, he said something that we least expected and which took us completely by surprise. He said that he listened carefully to me; he said that until now he had not realized the gravity of the situation that his actions were precipitating. Then to my great astonishment he said: “You have given me advice like a parent, like a father. Even parents don’t always give such good advice. I will act according to your advice.” Mr. Sapukotana and I were rendered speechless. This was one more of the many experiences I had in public service, where the totally unexpected had occurred.

Through my experience I have been convinced that one should not shirk one’s duty to advice ministers. This duty has to be performed in the public interest and one should not be deterred by possible consequences. However, there is a way and manner of giving this advice. One has to be polite. One should not adopt a confrontational attitude. In my experience, some of these “consequences” which people fear are more imagined than real, and ministers and politicians do not always act according to their perceived public characteristics. On this occasion Mr. Premachandra was a case in point.

Presidential Mobile Service – Matara

The second Presidential Mobile Service was to be held at Matara on November 3, 1989. This was a time of intense JVP activity when the country was gripped by fear. The decision to hold the service in Matara in the deep south was it a sense a challenge to the JVP. Rumours were rife that they would disrupt activities. We were to leave during the early morning of Nov. 3 and this itself was scary. In fact the country had reached a stage where there was very little traffic on the roads after about 9 p.m. We had now to leave for Matara to face an unknown situation leaving home around 4.30 in the morning.

When we left, we noticed that there was hardly any traffic on the roads. All around was in pitch darkness. Even some of the street lights were not functioning. It was quite eerie. We made our way past numerous check points at a couple of which we were stopped.

All this was not a comfortable experience. One felt apprehension. I was booked at the Weligama rest house but when I reached it I found that the power had been disrupted by the JVP during the previous night. We would have to be without lights or fans. But what was far worse was that the disruption of power had affected the pumping of water and the toilets could not be flushed.

The rest house was in short uninhabitable. The authorities there informed us that power would be restored by evening. But none of us had confidence that this would be done or if done, that it would not be disrupted again during the night. Some of us therefore decided to make alternative arrangements, which were not easy to make. Most of the hotels in the vicinity of Matara and even somewhat beyond had already been booked. Eventually, after a diligent search and with the assistance of friends, I found myself a room at Koggala Beach hotel.

This was an immense relief. In fact, it turned out to be much more than mere relief because of the interesting crowd of public servants in occupation. They were a jolly group of story tellers who had a variety of the most hilarious anecdotes to retail, which spared no one. When we reached the hotel at the end of a tiring day, we were able to forget the grim reality outside. Perhaps we really needed to laugh our cares away. Most of us had been subjected to considerable strain for a significant period of time.

At the mobile service itself in the Rahula College premises where the service was held was almost completely deserted on the first day. People were afraid to defy a JVP ban on attending. On the second day however the dam burst. People flocked in from all quarters and directions jamming the space and facilities available. Long queues formed outside areas allocated to all Ministries. The people themselves had suffered due to the disruption of their lives and activities, and when some relief seemed available, one day was all they could contain themselves however dire the threat. They voted with their feet.

On that second day we couldn’t finish at 5 p.m. There were so many people that hours were extended till 6.30 p.m. By the time we got back to our hotels, it was well past 8 p.m. Usually, the third day of the service was a half day, where we finished by 1 p.m., had lunch and started for home. But because of the lost first day and the crowds, the third day was extended to 5 p.m. But that was the official time. Many of us were stuck till about 7 p.m. We did not want to abandon the people still in the queue and who were now looking pretty desperate that they would not be attended to. They had suffered much. This meant once again traveling in the dark, this time to get home.

(Excerpted from In Pursuit of Governance, autobiography of MDD Peiris)

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