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Quitting smoking is as important as wearing a mask

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World ‘No Tobacco Day’ falls tomorrow on the theme ‘Commit to Quit’

by Randima Attygalle

Chemicals found in nail polish, rat poison, battery acid, car exhaust fumes, paints, rubber cement and gasoline are just a handful of what you will find in a single cigarette. A lighted cigarette create more than 7,000 chemicals and nearly 70 of them are known to cause cancer; and many are toxic. While many of these chemicals found in consumer products carry warning package labels (eg. rat poison), there is no such warning about toxins in tobacco smoke, points out the American Lung Association.

While cigarette smoking is the most common form of tobacco use worldwide, all forms of tobacco including water pipe tobacco, smokeless tobacco products, cigars, pipe tobacco, bidis and kreteks (used in Indonesia) are all harmful. ‘The tobacco epidemic’, according to the WHO, is one of the biggest public health threats the world has ever faced, killing more than eight million people a year around the world. More than seven million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to tobacco smoke. ‘Over 80% of the 1.3 billion tobacco users worldwide live in low and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco,’ notes the WHO.

Cigarette smoke reduces the amount of oxygen carried to tissues and even in case of COVID patients, oxygen saturation (percentage of oxygenated hemoglobin returning to the right side of the heart) levels are low. Consultant Respiratory Physician and Senior Lecturer from the Department of Anatomy, Faculty of Medicine, University of Colombo, Dr. Yamuna Rajapakse points out that several studies have now confirmed that oxygen saturation is less in patients who smoke compared to non-smokers. “Smokers function in a low oxygen saturation environment, hence they are at greater risk than non-smokers during COVID lung involvement.”

Smoking causes thrombosis or blood clot formation. This could lead to stroke, heart disease and peripheral vascular disease. COVID too causes thrombotic effects and smoking may increase this risk she explains. Tobacco smoking is a significant risk factor for both viral and bacterial infections of the respiratory system. Smokers are five times as likely to develop influenza and twice as likely to have pneumonia. This, as many reputed medical journals including the British Medical Journal (BMJ) confirms, is an important factor worsening the impact of COVID-19. ‘There is evidence from case series that smoking is associated with more severe disease, a greater risk of intensive care need and excess mortality in people with COVID-19 admitted to hospital,’ notes the BMJ.

Smokers have more phlegm in their system and experience bouts of what is commonly known as the ‘smoker’s cough’. “Tobacco smoke burns the protective mechanism we have in our lungs which acts as a buffer against dust, viral and bacterial particles entering the respiratory system,” says the physician. She adds that smokers are more likely to develop pneumonia and this risk is aggravated in COVID patients who smoke.” Dr. Rajapakse also remarks that while the majority of COVID patients are asymptomatic, smokers show more COVID symptoms as research findings from China and UK also confirm.

New tobacco trends such as shisha smoking (smoking tobacco through a water bowl via a hose or tube) has also become an added problem notes Dr. Rajapakse who also warns that sharing of cigarettes and shisha tubes could increase the transmission of COVID and other respiratory infections.

Lung cancer which is the leading cause of cancer death the world over with smoking long established as a major cause, is now being diagnosed in a younger adult population. “Today we see advanced lung cancers in those in their 30s and 40s. Although genetic predominance is also present in lung cancer, a sizable percentage is attributed to second-hand or passive smoking (involuntary inhalation of other people’s smoke). Victims include women exposed to a smoking spouse.” Pregnancy is the worst time one could be around smoke, says the physician who warns that babies born to mothers exposed to passive smoking have lower lung reserves. Low birth weight is also common among such babies. Third-hand smoke where residual nicotine and other chemicals are left on indoor surfaces, clothing etc. is also bad for people who are exposed to them.

Entailing symptoms similar to asthma with wheezing and coughing, Chronic Obstructive Pulmonary Disease (COPD) is another serious smoke-induced condition. A non-reversible condition, COPD does not respond very well to inhalers, explains Dr. Rajapakse. Smokers with a specific enzyme deficiency can end up with COPD prematurely, she warns. Besides noncommunicable diseases such as high blood pressure, heart disease and stroke, smokers are also at a higher risk of having intermittent claudication and vascular ulcers leading to amputation of limbs, she says.

Despite tobacco smoking being established as a real risk factor for COVID-19, seriously compromising immunity and structural functioning of the respiratory system, there is very little discourse on it, observes the Consultant Psychiatrist from the National Hospital of Sri Lanka and the Director, Centre for Combating Tobacco, Dr. Mahesh Rajasuriya.

“Not smoking is as important as wearing a mask, yet the tobacco industry has been careful in downplaying this,” says the Psychiatrist who adds that apart from developing very serious complications, tobacco smoking also directly violate COVID control measures. “Smokers are compelled to remove their masks to smoke and even if they are smoking outdoors, there is a tendency for them to interact with a few more people in a small enclosure inhaling and exhaling each other’s breath more sharply. Here the risk of contracting COVID is enormous. Secondly our health care system is already exhausted with COVID patients and if a smoker suffers a heart attack, a stroke or gets pneumonia to which they are more susceptible, it will add to the burden.”

While hardly anyone “pledges to smoke to the grave”, most smokers wish to quit at sometime but several factors prevent them from doing so, says Dr. Rajasuriya. “These can be broadly classified into demand and supply factors. While the former makes smokers want to smoke again, the latter keep the environment conducive to smoking such as making cigarettes cheaper and more accessible.” Although the price of a cigarette should be more than what it is now in the Sri Lankan market compared to other consumer goods, it has on the contrary become more affordable, driving those from lower socioeconomic levels and youngsters who are still dependent to become addicted, says Dr Rajasuriya. “The tax increases on cigarettes too has been fraudulent with less money going to government coffers and larger proportions to the tobacco industry.”

The non-availability of a local license system as in the case of many countries including several in the region such India and the Maldives, makes cigarettes freely available, he points out. The absence of a law banning single stick sales adds fuel to fire during the pandemic he says. “Added to the physical touch when selling single sticks, the smoker does not see the pictorial health warnings on cigarette packs.”

A large majority of smokers quit without any psychological help says the psychiatrist who observes that the tobacco industry has created a myth that quitting is an uphill task and only those with extraordinary willpower can do so. “It is imperative to see through this myth first if you want to quit smoking,” he reflects. Certain stereotypes ingrained in the brain such as the need for physical pharmaceutical support for quitting often discourages a smoker wanting to quit the habit. “Another myth which needs to be debunked is that cigarettes need to be replaced with another chemical to help one to quit.”

The benefits of quitting tobacco are almost immediate, confirms the WHO. ‘After just 20 minutes of quitting smoking, your heart rate drops. Within 12 hours, the carbon monoxide level in your blood drops to normal. Within two to 12 weeks, your circulation improves and lung function increases. Within one to nine months coughing and shortness of breath decreases. Within five to 15 years, your stroke risk is reduced to that of a non-smoker. Within 10 years, your lung cancer death rate is about half that of a smoker. Within 15 years, your risk of heart disease is that of a non-smoker.

While some can navigate the transitional phase after quitting, many experience ‘withdrawal symptoms’ such as irritation, anxiety for which medication may be required. Getting rid of not merely cigarettes but all smoking associated paraphernalia including lighters and ashtrays is vital when preparing to quit says Dr. Rajasuriya. The comprehensive course designed by the Centre for Combating Tobacco, Help Quit sponsored by the WHO country office helps those who aspire to quit smoking and other support personnel including doctors, nurses, psychotherapists, counselors etc. to assist others to quit.

“The image about smoking is negative today, although the tobacco industry is trying hard to project otherwise. In this exercise, social media is now heavily used to induce the smoking habit and also to target a locally untapped market of young girls and women. Hence it is important for the public to see the true picture and not be deceived by the tobacco industry’s marketing strategy,” concludes Dr. Rajasuriya.



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TNGlive relieving boredom

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Yes, indeed, the going is tough for everyone, due to the pandemic, and performers seem to be very badly hit, due to the lockdowns.

Our local artistes are feeling the heat and so are their counterparts in most Indian cities.

However, to relieve themselves of the boredom, while staying at home, quite a few entertaining Indian artistes, especially from the Anglo-Indian scene, have showcased their talents on the very popular social media platform TNGlive.

And, there’s plenty of variety – not just confined to the oldies, or the current pop stuff; there’s something for everyone. And, some of the performers are exceptionally good.

Lynette John is one such artiste. She hails from Lucknow, Uttar Pradesh, and she was quite impressive, with her tribute to American singer Patsy Cline.

She was featured last Thursday, as well (June 10), on TNGlive, in a programme, titled ‘Love Songs Special,’ and didn’t she keep viewers spellbound – with her power-packed vocals, and injecting the real ‘feel’ into the songs she sang.

What an awesome performance.

Well, if you want to be a part of the TNGlive scene, showcasing your talents, contact Melantha Perera, on 0773958888.

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Supreme Court on Port City Bill: Implications for Fundamental Rights and Devolution

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The determination of the Supreme Court on the Colombo Port City Economic Commission Bill was that as many as 26 provisions of the Bill were inconsistent with the Constitution and required to be passed by a two-thirds majority in Parliament. The Court further determined that nine provisions of the Bill also required the approval of the people at a referendum.

Among the grounds of challenge was that the Bill effectively undermined the sovereignty and territorial integrity of Sri Lanka and infringed on the sovereignty of the people. It was argued that several provisions undermined the legislative power of the People reposed on Parliament. Several provisions were challenged as violating fundamental rights of the People and consequently violating Article 3, read with Article 4(d) of the Constitution. Another ground of challenge was that the Bill contained provisions that dealt with subjects that fall within the ambit of the Provincial Council List and thus had to be referred to every Provincial Council for the expression of its views thereon as required by Article 154G(3).

 

Applicable constitutional provisions

Article 3 of our Constitution recognises that “[i]n the Republic of Sri Lanka, sovereignty is in the People and is inalienable”. Article 3 further provides that “Sovereignty includes the powers of government, fundamental rights and the franchise”. Article 3 is entrenched in the sense that a Bill inconsistent with it must by virtue of Article 83 be passed by a two-thirds majority in Parliament and approved by the people at a referendum.

Article 4 lays down the manner in which sovereignty shall be exercised and enjoyed. For example, Article 4(d) requires that “fundamental rights which are by the Constitution declared and recognised shall be respected, secured and advanced by all the organs of government and shall not be abridged, restricted or denied, save in the manner and to the extent hereinafter provided”. Article 4 is not mentioned in Article 83. In its determinations on the Eighteenth Amendment to the Constitution Bill, 2002 and the 19th Amendment to the Constitution Bill, 2002, a seven-member Bench of the Supreme Court noted with approval that the Court had ruled in a series of cases that Article 3 is linked up with Article 4 and that the said Articles should be read together. This line of reasoning was followed by the Court in its determination on the 20th Amendment to the Constitution Bill.

Under Article 154G(3), Parliament may legislate on matters in the Provincial Council List but under certain conditions. A Bill on a matter in the Provincial Council List must be referred by the President, after its publication in the Gazette and before it is placed in the Order Paper of Parliament, to every Provincial Council for the expression of its views thereon. If every Council agrees to the passing of the Bill, it may be passed by a simple majority. But if one or more Councils do not agree, a two-thirds majority is required if the law is to be applicable in all Provinces, including those that did not agree. If passed by a simple majority, the law will be applicable only in the Provinces that agreed.

 

Violation of fundamental rights and need for a referendum

Several petitioners alleged that certain provisions of the Port City Bill violated fundamental rights. The rights referred to were mainly Article 12(1)—equality before the law and equal protection of the law, Article 14(1)(g)—freedom to engage in a lawful occupation, profession, trade, business or enterprise— and Article 14(1)(h)—freedom of movement. Some petitioners specifically averred that provisions that violated fundamental rights consequently violated Articles 3 and 4 and thus needed people’s approval at a referendum.

The Supreme Court determined that several provisions of the Bill violated various fundamental rights and thus were required to be passed by a two-thirds majority in Parliament. The question of whether the said provisions consequently violated Article 4(d) and thus Article 3 and therefore required the approval of the People at a referendum was not ruled on.

The Essential Public Services Bill, 1979 was challenged as being violative of both Article 11 (cruel, degrading or inhuman punishment) and Article 14. Mr. H.L. de Silva argued that a Bill that violates any fundamental right is also inconsistent with Article 4(d) and, therefore, with Article 3. The Supreme Court held that the Bill violated Article 11 but not Article 14. Since a Bill that violates Article 11 has, in any case, to be approved at a referendum as Article 11 is listed in Article 83, the Court declined to decide on whether the Bill offended Article 3 as well, as it “is a well-known principle of constitutional law that a court should not decide a constitutional issue unless it is directly relevant to the case before it.”

A clear decision on the issue came about in the case of the 18th Amendment to the Constitution Bill; a seven-member Bench of the Supreme Court held that the exclusion of the decisions of the Constitutional Council from the fundamental rights jurisdiction of the Court was inconsistent with Articles 12 (1) and 17 (remedy for the infringement of fundamental rights by executive action) and consequently inconsistent with Article 3, necessitating the approval of the Bill at a referendum.

When the 20th Amendment to the Constitution Bill sought to restore the immunity of the President in respect fundamental rights applications, the Supreme Court determined that the “People’s entitlement to remedy under Article 17 is absolute and is a direct expression of People’s fundamental rights under Article 3 of the Constitution.”

In the case of the Port City Bill, however, the Supreme Court only determined that certain provisions of the Bill violated fundamental rights and thus required a two-thirds majority, but did not go further to say that the offending provisions also required approval of the people at a referendum.

Perhaps, the Court took into consideration the Attorney-General’s assurance during the hearing that the impugned clauses would be amended at the committee stage in Parliament.

However, Parliament is not bound by the Attorney-General’s assurances. In the absence of a clear determination that the clauses concerned required a referendum as well, Parliament could have passed the clauses by a two-thirds majority. The danger inherent in the Supreme Court holding that a provision of a Bill violates fundamental rights and requires a two-thirds majority but makes no reference to the requirement of a referendum is that a government with a two-thirds majority is free to violate fundamental rights, and hence the sovereignty of the People by using such majority. It is respectfully submitted that the Court should, whenever it finds that a provision violates fundamental rights, declare that Article 3 is also violated and a referendum is necessary, as it did in the cases mentioned.

 

The need to refer the Bill to Provincial Councils

The Port City Bill had not been referred to the Provincial Councils, all the Provincial Councils having been dissolved. The Court, following earlier decisions, held that in the absence of constituted Provincial Councils, referring the Bill to all Provincial Councils is an act which could not possibly be performed.

In the case of the Divineguma II Bill, the question arose as to the applicability of the Bill to the Northern Provincial Council, which was not constituted at that time. The Court held while the Bill cannot possibly be referred to a Council that had not been constituted, the views of the Governor (who had purported to express consent) could not be considered as the views of the Council. In the circumstances, the only workable interpretation is that since the views of one Provincial Council cannot be obtained due to it being not constituted, the Bill would require to be passed by a two-thirds majority. Although not explicitly stated by the Court, this would mean that if the Bill is passed by a simple majority only, it will not apply in the Northern Province. The Bill was passed in Parliament by a two-thirds majority. The Divineguma II Bench comprised Shirani Bandaranayake CJ and Justices Amaratunga and Sripavan, and it is well-known that the decision and the decision on the Divineguma I Bill cost Chief Justice Bandaranayake her position.

It is submitted that Article 154G (3) has two requirements—one procedural and one substantive. The former is that a Bill on any matter in the Provincial Council List must be referred to all Provincial Councils. The latter is that in the absence of the consent of all Provincial Councils, the Bill must be passed by a two-thirds majority if it is to apply to the whole country. If such a Bill is passed only by a simple majority, it would apply only in the Provinces which have consented.

The Divineguma II determination accords with the ultimate object of Article 154G(3), namely, that a Bill can be imposed on a Province whose Provincial Council has not consented to it only by a two-thirds majority. It also accords with the spirit of devolution.

A necessary consequence of the Court’s determination on the Port City Bill is that it permits a government to impose a Bill on a Provincial Council matter on a “disobedient” Province by a simple majority once the Provincial Council is dissolved and before an election is held. What is worse is that at a time when all Provincial Councils are dissolved, such as now, a Bill that is detrimental to devolution can be so imposed on the entire country. It is submitted that this issue should be re-visited when the next Bill on a Provincial Council matter is presented and the Supreme Court invited to make a determination that accords with the spirit of devolution, which is an essential part of the spirit of our Constitution.

 

 

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‘Down On My Knees’ inspires Suzi

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There are certain songs that inspire us a great deal – perhaps the music, the lyrics, etc.

Singer Suzi Fluckiger (better known as Suzi Croner, to Sri Lankans) went ga-ga when she heard the song ‘Down On My Knees’ – first the version by Eric Guest, from India, then the original version by Freddie Spires, and then another version by an Indian band, called Circle of Love.

Suzi was so inspired by the lyrics of this particular song that she immediately went into action, and within a few days, she came up with her version of ‘Down On My knees.’

In an exclusive chit-chat, with The Island Star Track, she said she is now working on a video, for this particular song.

“The moment I heard ‘Down On My Knees,’ I fell in love with the inspiring lyrics, and the music, and I thought to myself I, too, need to express my feelings, through this beautiful song.

“I’ve already completed the audio and I’m now working on the video, and no sooner it’s ready, I will do the needful, on social media.”

Suzi also mentioned to us that this month (June), four years ago, she lost her husband Roli Fluckiger.

“It’s sad when you lose the person you love but, then, we all have to depart, one day. And, with that in mind, I believe it’s imperative that we fill our hearts with love and do good…always.”

A few decades ago, Suzi and the group Friends were not only immensely popular, in Sri Lanka, but abroad, as well – especially in Europe.

In Colombo, the Friends fan club had a membership of over 1500 members. For a local band, that’s a big scene, indeed!

In Switzerland, where she now resides, Suzi is doing the solo scene and was happy that the lockdown, in her part of the world, has finally been lifted.

Her first gig, since the lockdown (which came into force on December 18th, 2020), was at a restaurant, called Flavours of India, with her singing partner from the Philippines, Sean, who now resides in Switzerland. (Sean was seen performing with Suzi on the TNGlive platform, on social media, a few weeks ago).

“It was an enjoyable event, with those present having a great time. I, too, loved doing my thing, after almost six months.’

Of course, there are still certain restrictions, said Suzi – only four to a table and a maximum crowd of 50.

“Weekends are going to be busy for me, as I already have work coming my way, and I’m now eagerly looking forward to going out…on stage, performing.”

In the meanwhile, Suzi will continue to entertain her fans, and music lovers, on TNGlive – whenever time permits, she said,

She has already done three shows, on TNGlive – the last was with her Filipino friend, Sean.

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