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My 18 week ordeal of double trouble

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by Dr. Lakshman Abeyagunawardene

I thought of writing this article in order to share with readers of the Sunday island newspaper, my recent experience as a patient suffering from two illnesses at the same time. I could describe this period as sheer mental agony as I had to bear the social as well as possible medical consequences of illnesses that plagued me over a prolonged period. Writing newspaper articles in my opinion, is one of the best ways in which at least one section of the community can be educated on health issues.

My professional career called for frequent lectures to be given to a wide variety of target audiences ranging from post graduate doctors preparing for examinations in Community Medicine and medical students, to humble village folks like new settlers in Mahaweli areas in the late seventies and early eighties. I always made it a point to emphasize the fact that the occurrence of disease is not only a biological phenomenon but a social one as well, a point that I picked up in my post graduate training and which has got etched in my mind through conviction. Subsequent developments as described later, led to the worst period when I was confined to the guest room in my home as I was not permitted even to climb the stairs that led to my comfortable bedroom upstairs. The move which was to last several weeks, involved shifting many personal items which were indispensable for day to day life.

It all began with a rash on the right side of my face involving the nose, cheek and areas around the eye. Although I suspected Herpes Zoster (commonly called Shingles) particularly because I recalled a bout of chicken pox over 50 years ago, soon after my Internship while working at the Colombo South Hospital. Although it is a self-limiting disease, I decided to seek medical attention because as far as possible, I try to stay away from self treatment except for very minor illnesses. Herpes Zoster is a viral infection that occurs with reactivation of the varicella –zoster virus that had been lying dormant in certain nerves for many years. Symptoms typically start with pain and a rash along the affected path of the nerve, followed two-three days later by a vesicular eruption.

With a 24- hour curfew in force, that weekend happened to be one where all “Channel Centres” were deserted. I therefore decided to go to the Emergency Room (ER) of Sri Jayewardenepura Hospital (SJPH) where the doctor confirmed my diagnosis and prescribed an anti viral drug called Acyclovir, pain killers Gabapentin and Panadeine. I was also referred to the Ophthalmic (Eye) Ward because my right eye seemed to be affected. Fortunately, the Senior Registrar on duty ruled out any involvement of the eye and said that my vision was normal. This was confirmed by the Consultant Ophthalmologist (Eye Surgeon) whom I later channeled as I was very concerned about my eyesight. As always, I diligently took all prescribed drugs but at the end of two weeks, I unfortunately developed Postherpetic Neuralgia (PHN) which is a known complication of Shingles.

I had heard of Post Herpetic Neuralgia (PHN) but never imagined that it was so painful. In general, all pain due to Neuralgia is very painful, difficult to treat and lasts a long time. I realized through experience, what it is like to be the sufferer rather than a doctor treating a patient.

Quite apart from my present illness, I was having spells of dizziness off and on, which I attributed to Gabapentin which is known to cause such side effects. On one such occasion it was so bad that I was about to fall. Fortunately, we were in our bedroom and my wife was at hand to prevent the fall and led me to my bed. My wife was quite helpless in such situations and called my son who lived close by and called for an ambulance. My son and the ambulance arrived almost simultaneously, but as I had not lost consciousness, I was able to explain to the paramedics that I was on Gabapentin and did not need hospitalization. Whether or not the paramedics understood what I said, they withdrew mainly because their patient was a doctor and knew what he was doing!

On a subsequent occasion, I had a syncopal (fainting) attack while I was having breakfast and my wife again had to go through the usual motions of calling my son and the ambulance. This time, I had lost consciousness and when I was back to normal, I myself thought that it could not have been due to the Gabapentin. Therefore, I didn’t resist hospitalization as I previously did. These two episodes clearly showed the importance of family support. I dread to think what a bachelor living alone would have done under such circumstances.

For a number of years, I have been having an irregular pulse. This drew my attention when it continued and my cardiologist referred me to a Cardiologist and Electrophysiologist who put me on what is called a Holter Monitor. After reading the report he said that I have a few extra systoles (ectopic beats) and that accounts for the irregular pulse. He further said that it is normal for some people and I needed no treatment. Mind you, that was about six years ago.

This time round when I lost consciousness, to cut a long story short, after the necessary referrals were made, the EEG that my Neurologist ordered showed some changes and my doctors decided that the origins of the changes had nothing to do with my nervous system but that its origins were cardiac (meaning that the origin of the EEG changes could be due to some defective movement of electrical impulses in the heart). So, I went back to my cardiologist who referred me to a Cardiologist and Electrphysiologist. The latter put me on a Holter Monitor again. Based on the history and the new Holter Monitor reading, he recommended a Pacemaker. I readily complied and he implanted a Permanent Pacemaker on September 8. Sutures were removed after about a week and I had to attend a “Programming Session” on September 27. The doctor reported that the surgical wound was clean and that the whole procedure was successful. The implantation of the pacemaker did not bother me at all, but the anxiety of anyone facing a surgical operation was telling on me.

I had to go through the procedure of pacemaker implantation while the pain in my right eye persisted. It was after my fainting episode and pacemaker implantation was recommended that I was debarred from climbing stairs. I was confined to the Guest Room and this is where my agony really started. My wife did not allow me to even go to the living room which was just three steps below. Towards the latter stages, I watched news on the small TV in the kitchen. I had to be satisfied with the laptop computer that my son brought. But it was a far cry from the Desktop I was used to. I missed my weekly shot of an alcoholic drink! I had not taken even a beer since the beginning of June.

I think I had a turnaround in my fortunes after the doctor did the Programming on September 27. It was this doctor’s advice that I strictly followed (more so my wife and son) because there was nothing more the Neurologist who was treating my neuralgic pain could do. The electrophysiologist who did the pacemaker implantation asked me to resume my regular evening walk but advised me not to drive the car till the end of October. When I asked him whether I could take my weekly shot of an alcoholic drink, he jokingly asked me whether it was Single Malt or Scotch. I replied that I take Single Malt , Scotch, Gin, Rum, Vodka, Tequila and even Ceylon Arrack in rotation, depending on availability. More than anything else, I was happy to be back in my bedroom, using my toilet, 52 inch TV in the TV room and the Desktop in my study.

Once the Eye Surgeon said that my vision is intact and the Cardiologist had successfully implanted the Pacemaker, I was free to take some decisions on my own. As I was bothered by the persisting pain in the eye, I went back to using Gabapentin when the eye pain was severe (discontinued since that episode of dizziness). Picking up information from the Internet, I started trying some home remedies like washing my eyes and using a warm compresses frequently. I also started taking a course of Vitamin B Complex and refrained from eating Bananas and Citrus fruits to help in the recovery of damaged nerves. If I continue to recover from the eye pain and the other minor symptoms of PHN, I will not be able to pin point and say that it was one specific intervention named above that was responsible for the turnaround. Being a doctor myself also certainly helped in many instances. However, I had resigned myself to think that recovery from PHN is very, very slow. As I recover slowly from PHN, I painfully realized the plight of many who are affected by Neuralgic pain and continue to suffer.

As a precautionary measure, I still keep away from my mobile phone and the microwave oven. The Pacemaker also restricts my movements of the left arm. I will continue to live with such restrictions for some more time. But I know that I have already seen and experienced the worst of this period of agony.

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Features

Scholar, Advisor, Innovator and Great Friend

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by AUSTIN FERNANDO

Dr. Wickrema Weerasooria, son of Queen’s Counsel NE Weerasooria, studied at Royal College, and entered the University of Ceylon, Peradeniya, and won Harvard Memorial Prize and the Governor General’s Prize. He graduated in Law from Peradeniya, with First-Class Honours, and was later called to the Bar, as an Advocate.

I have known and associated with Dr. Wickrema Weerasooria in different capacities. First, I knew him as a pioneer Law Educator at Vidyodaya University. His students at Vidyodaya, and later even at the Post-Graduate Institute of Management, recall how he lectured, without even a short note in hand, attracting students’ attention, and enthusiasm. Additionally, he focused on teaching Commercial, Administrative, and Constitutional laws, and published texts in Sinhala, one on the Law of Contracts, another on Commercial Law.

His vast knowledge as an author was exhibited, mostly in Banking Law. Some of his publications were on Australian banking systems. Later, he delved into Buddhist Ecclesiastical Law, which produced a monumental work and a Treatise on Sri Lankan Statute Law and Judicial Decisions on Buddhist Temples and Temporalities.

His book ‘The Law Governing Public Administration in Sri Lanka,’ is a text that must be read by all public administrators and politicians. Whilst at Monash University, he wrote ‘Links between Sri Lanka and Australia: A Book about Sri Lankans (Ceylonese) in Australia’, dealing with Sri Lanka- Australia links.

With President JR Jayewardene in Office, Wickrema was appointed as the Secretary to the Ministry of Plan Implementation– a completely different role for him in public service. Working with him was also a novel experience and challenge for officers too, since he pushed them to the deep end to make quick, practical, non-traditional, sometimes unsavoury decisions for the benefit of the public.

He was the innovator of Integrated Rural Development Projects, for which he harnessed foreign assistance, and a performer, evaluator, programmer, and institution builder, proven by the establishment of Secretariats for Women, Children, Fertilizer, Nutrition, Population under his Ministry.

Sri Lanka Planning Service was made a professional service in 1985, for which the initiatives and support given by Wickrema were substantial. Accordingly, planners were made responsible for planning to achieve the goals of the respective institutions, formulate policies, strategies, and evaluate the development projects and programmes.

Wickrema was responsible for enhancing human resources among cadres through foreign exposures, which culminated with some officers obtaining post-graduate degrees, some even PhDs, and reaching apex ranks in public services, i.e. Secretaries of Ministries.

Specifically, his contribution to my work when I served as Government Agent, Nuwara Eliya was substantial. He was the guide, mentor, and sometimes savior. His involvement was on behalf of his brother-in-law Minister Gamini Dissanayake. Wickrema was instrumental in planning Nuwara Eliya through the establishment of Nuwara- Eliya Development Commissioners Committee, where I served as Chairman, with professionals as Commissioners. The initial planning was done by the Urban Development Authority.

He was the key organizer of the Spring Festival in Nuwara-Eliya. I remember how he planned the city and revived the Car Racing event, after a lapse of some years. I remember Upali Wijewardena taking part in the first motor car road race. The new Motor-Cross racing event on the newly constructed track was added to the Mahagastota Hill Climb for motor racers. Motor-Cross racing spread to other areas later. He attended these events and enjoyed the great company.

A little-known fact about Wickrema is that the Sri Lanka Council for the Blind (as President) and Sri Lanka Federation of the Blind (as Advisor) still appreciate his services rendered to the blind community, especially in resource mobilization and housing.

He was a person with subtle wit and humour. While teaching, he used this talent, as a student has reminisced, for “easing the pressure and stress of learning.” His lighter vein utterances and behaviour in groups made him a more sought-after teacher, friend, relative, colleague, and boss. His wit and humour depicted by cartoons in political campaigning, (i.e. The Family Tree), left an indelible mark in canvassing votes at the 1977 Elections. It is recycled even today, making Wickrema’s talent eternal.

I am reminded that even regarding efficiency creation he had humorous comments. I remember his “evaluation of the efficiency” of public officers. He used to quip that when asked to produce relevant documentation within two days to send an officer on a foreign scholarship, knowing it would take weeks, he would swear with utmost certainty that the officer would fulfill the requirement within two days. The best litmus test of the efficiency of an officer is the offer of a foreign scholarship! He lamented that such efficiency is lacking to serve the people.

I have a personal regret. Just before I left for India as High Commissioner, he promised to visit me in Delhi with his dear wife Rohini, which he could not fulfill, bidding adieu in weeks. Hence, I missed his company, advice, wit, and humor before departure.

I may say, he was a great student, scholar, academic, educator, public officer, diplomat, social worker, an advisor, innovator, and above all a great friendly human being, who enjoyed life and made others enjoy too, with his friendship, and camaraderie. Sadly, we will miss him forever.

May he attain the Supreme Bliss of Nibbana!

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Ethiopia: War in Tigray

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By Gwynne Dyer

“Love always wins. Killing others is a defeat,” said Ethiopia’s Prime Minister Abiy Ahmed in June 2018, shortly after surviving a grenade attack at a rally in Meskel Square in the capital, Addis Ababa. How was he to know that just thirty months after saying that he would have to stop loving and start killing?

That’s the problem with being a reforming zealot who becomes Prime Minister: you have to deal with some really stubborn people, and sometimes it’s hard to shift them without a resort to force. That’s why Abiy launched an invasion of Tigray state on 4 November, and so far it’s been doing very well.

“The next phases are the decisive part of the operation, which is to encircle Mekelle using tanks, finishing the battle in the mountainous areas, and advancing to the fields,” Col. Dejene Tsegaye told the Ethiopian Broadcasting Corporation on 22 November.

Here we are only less than two weeks later, and the federal government’s troops have already captured Mekelle, a city of half a million people that is Tigray’s capital. It’s not clear how many people were hurt or killed in the fighting, but it went so fast that the butcher’s bill can’t be all that high.

In fact, it has all gone so well that Abiy Ahmed’s soldiers are probably thinking they might be home in time for Christmas. When Col. Dejene talked about “finishing the battle in the mountainous areas and advancing to the fields,” however, he was talking about the nine-tenths of Tigray that has seen no federal government troops at all, or at most a brief glimpse as they passed through.

Tigray is exactly the size of Switzerland, with about the same ratio of mountains to fields (although the mountains are somewhat lower). In other words, it is ideal guerilla territory, and a high proportion of the seven million Tigrayans are rural people who know the land. Moreover, they have long experience in fighting the central government’s troops.

That was the old central government, of course: the Communist dictatorship called the Derg, led by Mengistu Haile Mariam, that murdered the emperor and ruled the country with an iron fist from 1977 to 1991.

Tigrayans were the first ethnic group to rebel against Mengistu’s rule. They are only 6% of Ethiopia’s population, but the Tigrayan People’s Liberation Front (TPLF) was the most effective of the ethnically-based rebel groups that finally defeated the Derg.

The federal government that took over afterwards, called the Ethiopian People’s Revolutionary Democratic Front (EPRDF), was formally a multi-ethnic alliance. In practice, however, TPLF cadres controlled most senior posts and prospered greatly as a result – a situation that continued until the EPRDF appointed Abiy Ahmed prime minister in 2018.

It was a non-violent revolution, conducted not in the streets but in ranks of the federal bureaucracy. Abiy was the ideal candidate: in religion and ethnicity he is Ethiopian everyman, with a Muslim Oromo father and a Christian Amhara mother. (In person he is Pentecostal Christian, and very devout.)

As a young man Abiy fought in the war against Eritrea; he has served as a senior intelligence official and knows where the bodies are buried; he is well educated and speaks Amharic, Afaan Oromo, Tigrinya and English fluently. His first and most important job was to prise the fingers of the Tigrayan elite off the levers of government without a civil war.

Unfortunately, Abiy’s approach – merging all the parties based on the various ethnic militias into a single ‘Prosperity Party’ – didn’t work. The resentful TPLF cadres refused to join, and gradually withdrew to their heartland in Tigray. They don’t yet openly advocate secession, but they do point out that they have that right under the current federal constitution.

Whether or not the shooting war began with an unprovoked attack by the Tigrayan militia on the federal army’s base in Mekelle at the start of last month, as Abiy’s spokesmen claim, it was bound to end up here. All Tigray’s cities have now been taken by federal troops, but almost none of the rural areas.

This could be a brilliant victory for the federal troops that puts a swift end to the fighting. It’s more likely to be the result of a decision by the TPLF leadership to skip the conventional battles they were almost bound to lose, and go straight to the long and bloody guerilla war that they might eventually win.

That would mean secession, in the end, for they can never win power back in Addis Ababa. The risk is that if the war goes on long enough, other major ethnic groups may break away from Ethiopia as well. Abiy’s loosening of the tight centralised control that prevailed under the emperor, the Derg and the TPLF has already unleashed ethnic and sectarian violence that has rendered 2 million Ethiopians homeless.

Abiy recently got a PhD in peace and security studies from Addis Ababa University, but he’ll be concentrating on the ‘security’ part for the foreseeable future.

 

 

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Safety Equipment and Procedures and Exploding Fire Extinguishes

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by Capt. G A Fernando MBA

gafplane@sltnet.lk

RCyAF, SLAF, Air Ceylon, Air Lanka, SIA, SriLankan Airlines

Former SEP instructor/ Examiner Air Lanka

By law the Regulator Civil Aviation Authority Sri Lanka (CAASL) requires all Airline Crew to annually undergo continuous training and achieving proficiency in Safety Equipment and Procedures (SEP). At the end of the training, also answer a written examination to prove to all and sundry that the particular Flight Crew Member has sufficient SEP knowledge to continue serving in the Cabin or Flight Deck of that Airline, for another year. The SEP questions were relatively easy (no tricks) but each crew member had to score over 80% and carry out mandatory, practical proficiency tests such as operation of aircraft doors and Emergency exits, conduct evacuations, Life Raft operations (in the swimming pool), know the location and use of emergency equipment such as megaphones, Crash Axes, Asbestos Gloves, Emergency Locater Transmitters (ELT’s), the administration of Oxygen, First Aid and use of equipment such as smoke hoods and fire extinguishers to combat Cabin smoke and Fires, The airline is usually delegated to carry out these duties and functions at the behest of the Civil Aviation Authority.

The first year after Air Lanka was established (September 1979), crew members had to go to Singapore Airlines or get the instructors across to Colombo to carry out these checks on behalf of Air Lanka. After about the second year of existence, it was decided that a team SEP instructors/ examiners would be appointed ‘in house’ to carry out this training and mandatory checks. Three of us from the ‘Flight Deck’ crew were appointed to the team. They were First Officer Elmo Jayawardene, Flight Engineer Gerrard Jansz and yours truly. We had, had some experience in crew SEP training in Air Ceylon.

We were sent to the British Airways (BA) Flight Training (Cranebank), UK, during our regular stay overs in London, to undergo refresher training, so that we could incorporate some of the BA curricula in our own (Air Lanka) programs. The then Air Lanka Manager Operations had been an ex BOAC (British Overseas Airways Corporation) Captain. As a direct result of our visit to BA, the then airline doctor (Dr Mrs Sherene Wilathgamuwa) was inducted to the SEP team to lecture the ‘troops’ on not only First Aid but also on delivering babies, with limited facilities on board!  I believe that this information has been extremely useful many times during the last 40 years of Air Lanka. This was not taught to us in Air Ceylon. The training curriculum was developed by the SEP team.  

The early days of Air Lanka wasn’t easy. While an operational profit was made, the ‘debt servicing’ put an unbearable strain on the overall profitability. We had neither a designated training department nor proper equipment. Our ‘wet drill’ constituted jumping into the pool in shirts and trousers for the boys and ‘made up’ Sarees without the ‘fall’ for the Girls, wearing life jackets of course. Initially the Sri Lanka Air Force (SLAF) Katunayake pool was used and subsequently the pools of the two hotels down Katunayake airport road were used till Air Lanka got its own pool. We didn’t even have a permanently deployed Slide/ Raft either for teaching purposes. It all cost money. I was the Instructor in charge of the ‘wet drill’. In contrast SIA I worked for subsequently, had a pool with a ‘wave maker’ to give a realistic experience. There was no doubt Air Lanka at that point of time was ‘pinching pennies’ where crew SEP training was concerned.

To provide fire fighting experience to the Flight Crews we were forced to use regular Industrial Fire Extinguishing equipment to keep the costs down. That was acceptable since the basic fire fighting principles were the same. The fire fighting part of the training was carried out by the Ground Safety Section Instructors who were mainly ex SLAF types. A few months before, Lalantha one of the Chief Stewards was practicing the use of a Carbon Dioxide (CO2) extinguisher on a fire and the extinguisher exploded and flew off his hand, narrowly missing Leone who was just behind him. The on-board extinguishers were much smaller, lighter and more manageable than the industrial ones. A complaint was filed by me, but treated by the ‘Management’ as a one off case! It seemed as if one swallow doesn’t make a summer!  The extinguisher had been certified as serviced. The Administrative Executive in charge of SEP those days was a young man who had a degree in Marine Biology and perhaps was clueless on safety issues and couldn’t champion our cause.  We were all part time Instructors.

The annual recurrent training programme took two days. On one particular day, Chief Stewardess Jayantha and I were the instructors in charge. When it came to the Fire Fighting exercise, we handed over students of our class to the Air Lanka Ground Instructors and proceeded to the parking apron (opposite the Terminal Building), to check out a Lockheed L1011 ‘Tri-Star’ aircraft which was newly leased, by Air Lanka. It was a pre-owned, aircraft that had arrived the day before. Unfortunately, the locations of and the make of emergency equipment in the same type of aircraft (L-1011) differed from airline to airline. Therefore in the name of air safety and standardisation, it was important to resolve matters before the said aircraft saw service on the line on regular revenue flight services. It was a big deal as all Flight Crew had to know by memory as to where the specific locations of safety equipment were, so that when a ‘push’ came to a ‘shove’, no time would be wasted by the crew members involved, looking for these essential items. It could be a matter of life and death.

 I was not too happy sending the participant boys and girls by themselves for fire fighting and had an uneasy feeling. On other hand, our task too was also extremely important. So it was a case of ‘risk management’ and gave in. 

While we were checking out the new addition to our L 1011 Tri-Star fleet, we received a frantic message saying that another water type extinguisher had exploded and the injured had been removed to the Air Force Hospital across the runway to the Northern side.

Jayantha and I rushed to the SLAF Base Hospital in her ‘Mini -moke’ the long way around, up the Airport Road and via the 20th milepost main entrance along the Negombo road and found two crew members injured and in shock. Steward Senaka who had got the wheel shaped handle smack on his face, had injuries in the same shape and Naomal too had some minor injuries. We were assured by the Air Force doctor, Dr Narmasena Wickremasinghe that injuries were not too serious. We stayed there till the arrival of the next of kin who had been informed and went back to Office to meet Mr Wilmot Jayewardena, the Air Lanka Senior Manager Inflight Services.

When Jayantha and I sheepishly walked into his office he gave us the silent treatment initially and then softly declared that being responsible for the wellbeing of the participants, at least one of us Instructors should have been present when fire fighting was going on, even under the supervision of the Ground Safety Instructors. We accepted our mistake and defused the situation. When I look back now I am amazed as to how we coped with such limited resources to keep the National Carrier going. Safety Experts today, recommend that during risky activity, we should trust our ‘gut feeling’. It is usually correct as there is a connection between the brain and the gut resulting in feelings like ‘butterflies’ in the stomach. Needless to say the lesson was learnt.  

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