by Dr. Jayampathy Wickramaratne, President’s Counsel
The recent arrest of a young man who called upon fellow motorists to sound their horns in protest at the sudden interruption of traffic in Colombo to facilitate a “VIP movement” has led to a discussion on the right to protest by making noise.
The video recording of the incident has gone viral. As was later found, the “VIP movement” concerned was the motorcade of the visiting Chinese Defence Minister. The Police had not announced in advance that the road would be closed. While people resent road closures to facilitate movements of local VIPs, hardly anyone would object if it was known that the VIP was a visiting senior Minister of a friendly country, whether it be China, India or other. President Gotabaya Rajapaksa has set an example by moving around almost unnoticed with only a few vehicles in convoy. In May 2019, when a video showing motorists honking loudly in protest when a road was blocked to facilitate a VIP movement went viral, President Sirisena ordered an end to such road closures. On that occasion, Mahinda Rajapaksa said that “the displeasure shown by the public against the closure of roads for VIP vehicular movements by unceasingly sounding the horn were a reaction to the government’s policies”.
Watching last week’s video, it is clear that the young man thought that it was a local VIP who was being conducted—it would not have made a difference to his right to protest even if it was otherwise. He only called upon others to sound their horns in protest; he did not instigate violence. According to media reports, Police claim that he obstructed the Police in performing their duties. The recording belies that claim. He is even accused of instigating an “unlawful assembly”! That the young man expressed his regret for what he did after being released on bail is immaterial.
The right to protest peacefully is so central to a functioning democracy. It is a right that may be exercised individually or collectively. It is in authoritarian states that the right to protest is not tolerated. A democratic state has a positive obligation to protect the right of peaceful protestors.
The incident also brought to focus an important judgment of our Supreme Court, Amaratunga vs Sirimal, reported at  1 Sri Lanka Law Reports 264. Ironically, the case related to a protest called “Janagosha“, the main organizer of which was Mahinda Rajapaksa, the present Prime Minister. Pictures of Rajapaksa blowing a horn during the protest were widely circulated via social media after last week’s incident. Janagosha was a 15-minute peaceful protest conducted on 01 July 1992, organized by several Opposition parties, including the SLFP, during the Premadasa era. The protest was to show disapproval of the policies and actions of the government on a range of issues such as the unbearable increase in the cost of living, the privatization of public enterprises and the consequent retrenchment, wasteful expenditure on political extravaganzas, corruption, the suppression of discussion on certain matters of public interest, escalating abductions and killings, and the North-East War. According to the judgment of the Supreme Court, delivered by Justice Mark Fernando, “prospective participants were asked to orchestrate their efforts in a noisy cacophony of protest—the ringing of temple and church bells, the tooting of motor vehicle horns, the beating of drums, the banging of saucepans, and the like—so that there might resound, throughout the nation, a deafening din of disapproval.”
Petitioner Amaratunga was a member of the Horana Praddeshiya Sabha. His complaint was that two Police officers had destroyed and silenced his drum, which he used at the Janagosha. The first respondent officer had used a “molgaha” —a rice pounder—to destroy the drum. Justice Fernando was satisfied that the Police acted simply because anti-government slogans were being shouted. The learned Judge stated that there was ample authority that “speech and expression” guaranteed by Article 19 (1) (a) of our Constitution extended to forms of expression other than oral or verbal—placards, picketing, the wearing of black armbands, the burning of draft cards, the display of any flag, badge, banner or device, the wearing of a jacket bearing a statement, etc. The right to support or to criticize governments and political parties, policies and programmes, is fundamental to the democratic way of life, and the freedom of speech and expression is one which cannot be denied without violating those fundamental principles of liberty and justice which lie at the base of all civil and political institutions, Justice Fernando stated.
A European case involving the use of sound to protest was Hashman and Harrup vs The United Kingdom, where proceedings had been brought against the applicants, hunt-saboteurs on their own admission, who disrupted a fox hunt by blowing a hunting horn and shouting. They were each bound over by a Magistrate in a sum of £100 not to breach the peace and to be of good behaviour for 12 months. The European Court of Human Rights held that while the protest took the form of impeding activities which the applicants disapproved, nonetheless, it constituted an expression of opinion within the meaning of Article 10 of the European Convention. The measures taken against the applicants were, therefore, an interference with their right to freedom of expression.
Mazdoor Kisan Shakti Sangathan v Union of India
was a batch of cases against decisions of the National Green Tribunal (NGT) which concerned the right to protest near the iconic Jantar Mantar in Central Delhi, a popular place of protest. The NGT had prohibited all protests, agitations, assembling of people, public speeches, using of loudspeakers, etc., near Jantar Mantar. Residents of the area had complained that their right of movement had been restricted and that they had been greatly inconvenienced by the sound emanating from the protests. The NGT had issued directions that included the shifting of protestors, agitators and people holding dharnas to an alternative site in Delhi.
The Indian Supreme Court observed that undoubtedly, the right of people to hold peaceful protests and demonstrations, etc., is a fundamental right. The question was whether disturbances, etc., caused to residents is a larger public interest which outweighs the rights of protestors to hold demonstrations and, therefore, amounts to reasonable restriction in curbing such demonstrations. While the demonstrations had caused serious discomfort and harassment to the residents, it is also to be kept in mind that for quite some time Jantar Mantar had been chosen as a place for holding demonstrations and was earmarked by the authorities as well. Primacy cannot be given to one right whereby the right of the other gets totally extinguished. Total extinction is not balancing. Balancing would mean curtailing a right of one class to some extent so that the right of the other class is also protected. Justice Sikri directed the Commissioner of Police, New Delhi to devise, in consultation with other concerned agencies, a proper mechanism for the limited use of the area for protests, demonstrations, etc,. but to ensure that they are regulated in such a manner that they do not cause any disturbance to the residents of Jantar Mantar Road or the offices situated there. Detailed guidelines in this respect should be formulated.
The Police should not be overzealous in dealing with peaceful protests. The state must not only tolerate peaceful protests but also safeguard the right of citizens to protest.
From Cylinder to Liquid Oxygen Plant
Story of Oxygen supply at National Hospital –
The National Hospital of Sri Lanka (NHSL) is the largest and best equipped Teaching Hospital in the country with a bed strength of nearly 4,000. It has 26 operating theatres, 28 Intensive Care Units (ICU) and several institutes including one for Cardiology housed in a large number of buildings. It is located on a 32-acre land standing in the middle of Colombo.
NHSL is circled by a ring of busy public roads while some roads are running through the premises. Hospital premises and surrounding roads are always filled with hurriedly pacing medical staff, siren blaring ambulances, patient-carrying trolleys, distressed relatives and tired visitors. One would not miss the sight of a cylinders loaded truck crawling across in this melee and wonder why the truck. They ensure continuous and uninterrupted supply of most essential medical oxygen for the patients treated in ICUs and those undergoing surgery in operating theatres.
A few years ago, a visitor would not have missed the outside walls of these operating theatres and ICUs each of which decorated with 6-7 hanging jumbo oxygen cylinders. When I made the morning strolls down the hospital corridors my eyes always caught the sight of these cylinders. Oxygen is taken through a copper tubing system fixed to these cylinders to the respective destinations. i.e. Oxygen outlet in the bedside of patients treated in ICUs and in operating theatres. Hospital had a sufficient number of cylinders filled with oxygen. Employees efficiently replaced empty cylinders with new ones.
Every day employees collected empty cylinders, loaded them on a truck and transported to the Oxygen Company in Mattakkuliya for refilling. On certain days when the oxygen consumption was high, this operation has to be doubled. Hospital had its own truck and a group of specially trained skilled employees assigned for the task. Loading and unloading of these jumbo cylinders was a specialised job.
I noticed this operation during my afternoon inspection tour. In fact, the noise made in loading unloading as well as dismounting and mounting cylinders on the walls and the sight itself, to say the least, was a nuisance. Once the truck returned, the refilled cylinders were immediately distributed among the theatres and ICUs. Needless to say this was a hectic task considering the large number, and the spread of theatres and ICUs in the hospital.
There were tensed situations when the truck did not return on time due to a break down, a traffic congestion or an accident on the way. Thought of the delay of the truck with refilled oxygen cylinders gave me many sleepless nights. I was waiting to welcome the irritating noise made when cylinders fell on one another during unloading. While others were cursing, I got a sense of relief as it was an indication that the oxygen truck has arrived. My official residence was in very close proximity to the Merchants Ward where many cylinders were unloaded. No sooner had I heard the clattering sound than I ran to the window to witness the unloading.
As the Director of the country’s largest hospital, I was responsible for the overall smooth functioning of the hospital itself and that of men, material and machinery. And among all, ensuring the continuous and uninterrupted supply of oxygen for patients who were critically ill and those undergoing surgery was foremost.
Majority staff including doctors and nurses did not know the complexity behind the smooth flow of oxygen through the outlet whenever they open the valve to administer oxygen to a patient. Only a handful of people knew the complexity of the ‘oxygen supply operation’ in the hospital. It was a nightmare for me personally and all my predecessors.
While worrying over this cumbersome complex manual operation, I was wondering how fitting this type of oxygen supply for a Teaching Hospital of the magnitude of the National Hospital. My mind was busy in exploring and weighing alternatives.
While listening to the clattering of cylinders and watching the swift movements of workers’ hands in the unloading operation in the middle of the night, with a cup of steaming coffee in my hand, a thought struck my mind. I heard my own voice shouting over the clattering sound of falling cylinders; Hey! Man, be practical, install a Liquid Oxygen Plant in the hospital premises itself.
Early next morning ignoring the supervision tour, I was busy preparing a comprehensive proposal to the Ministry of Health with a clear justification of the investment. Having submitted the proposal followed by a few telephone calls the Ministry responded by approving the proposal.
The proposal was designed to have a Liquid Oxygen Plant with the highest capacity for the hospital and another with less capacity dedicated for the Institute of Cardiology located a little away from the main hospital premises across the street.
A few moons later, a Liquid Oxygen Plant near Ward 13 and a separate smaller plant on the premises of Institute of Cardiology rose to the sky. The copper pipelines were laid connecting all the operating theatres, intensive care units and high dependency units which required continuous uninterrupted supply of oxygen. The project was completed within a matter of a few months providing a great sense of relief to me.
The company which installed the two oxygen tanks is attending to maintenance and repairs. The company regularly monitors the level of consumption and replenishes the tanks. The hospital staff need not intervene.
Needless to mention the relief it brought to me. It was in the year 2006 during which the Hospital installed the two oxygen plants. Since then we did not have to wait for the truck or bother about cylinders. There has not been any loading unloading or clattering of cylinders. I wanted to ensure that my successors would have a permanent reliable source of Oxygen supply for our patients and avoid sleepless nights unlike me and my predecessors.
After the COVID-19 pandemic Oxygen has become the mostly used word among the healthcare workers. After retirement today, I reminisce my time as the Director of NHSL and recall how the disturbed night dawned upon me the idea to install a Liquid Oxygen Plant to ensure the continuous supply of Oxygen to patients gasping for oxygen.
Our neighbouring India is losing thousands of young lives a day due to unavailability of Oxygen. I am happy about the forethought I had 15 years ago long before the term ‘COVID-19 Pandemic’ entered our vocabulary.
Boosting immune system to fight Covid-19: Is it possible?
By Saman Gunatilake
Emeritus Professor of Medicine
University of Sri Jayewardenepura
Immune boosting is a trending topic these days with the COVID-19 pandemic. The concept of “immune boosting” is scientifically misleading and often used to market unproven products and therapies. There is no current evidence that any product or practice will contribute to enhanced “immune boosting” protection against COVID-19. This lack of evidence has not stopped wellness gurus with vested interests, and commercial entities from propagating notions of boosting immunity. Internet and popular press are flooded with messages of this nature resulting in an abundance of misinformation circulating online. The public is increasingly going online for health information and questions persist around the kinds of inaccurate information the public is absorbing and the impacts it may be having on health-related decisions and actions.
What are Immunity Boosters?
Immunity boosters are products which claim to be able to support your immune system so you aren’t as likely to get sick. Additionally, if you do get sick, taking the supplements will make your illness pass faster. There is no scientific and clinical evidence in humans to support claims of ‘immunity boosting’ foods and other products which supposedly enhance immunity. The body has its own immune system which fights against viral and bacterial invaders. With a normal immune system, we are capable of protecting ourselves against most infections but with certain situations the infection manages to overcome our immune system and cause serious disease and even death. The current Covid 19 pandemic is such a situation. We are in the grip of a spike in infection with over 1000 cases per day seen during the last few days. Total deaths from the pandemic in our country is nearing 700 and the total cases up to now amounts to around 111,800.
With no scientifically established cure for Covid-19 yet and the available recommended treatments limited to severe cases and being not so effective, recovery in most cases has largely been reliant on the human body’s natural defence, the immune system. Fighting the infection by boosting our immune systems had been the buzzword since the beginning of the pandemic. This has led to many misconceptions, misinforming and misleading the public. Improving the diet, taking vitamins and herbal products, lifestyle changes are proposed as ways of doing this. As a result, the market has been flooded with an array of products that claim to boost one’s immunity.
One of the common misconceptions is that high doses vitamin supplements and other minerals and nutrients boost one’s immunity. Ayurvedic concoctions, fruit juices, vitamin pills, zinc tablets have flooded the market with an array of products that claim to boost one’s immunity. Promoters of these products indicate that the body’s natural defences can be strengthened or enhanced by the consumption of certain foods, herbal products or the use of specific products.
Is there robust scientific evidence to support these claims for immune system boosting? The answer is no. Immunology experts believe that there is no way for healthy adults to improve their immunity through foods or other products. The immune system is very complex and these claims about boosting immunity are irrational and unscientific.
The Immune System
The immune system is activated by things that enter the body that the body doesn’t recognise as its own such as bacteria, viruses or even particles that cause allergy, like food, drugs and pollen. Most pathogens have a surface protein on them that the immune system recognizes as foreign. These are called antigens. Then the immune system sets in motion a complex process that fights the invader – this is the immune response.
There are two kinds of immune responses in the human body. The innate immune response is the first to kick in and is common among all animals. It is non-specific and immune cells mount an immediate attack on antigens. The response is subsequently replaced by the adaptive immune response, which tailors defences based on the kind of pathogen that is being encountered. The innate immune response consists of white blood cells like neutrophils, macrophages, and monocytes, while the adaptive response involves Lymphocytes -T cells and B cells, as well as antibodies produced by these cells as a specific response to the invader’s antigens. Stimulated immune systems release chemical proteins known as pro-inflammatory cytokines in large numbers, which can cause soreness and pain. So boosting immunity may lead to unwanted inflammations causing swelling, redness and pain locally and fever and other organ damage.
The Internet searchers will find that the myth of “boosting immunity” is extremely pervasive. Of the approaches that claimed to boost immunity, the top ones were diet, fruit, vitamins, antioxidants, probiotics, minerals. Interestingly, vaccines, the only proven method that enhances our immune response to an infection is ranked very low. One of the biggest misconceptions is that consuming more vitamins than required helps the immune system. It has been proven, time and again, that mega-doses of Vitamin C or of any kind of vitamin are not effective on the body at all. Another misconception is that zinc tablets can play a role in mitigating Covid-19. However, this isn’t backed by evidence either.
Zinc is not an immunity booster. It is an essential mineral for the body which is a ‘cofactor’ for a large number of proteins and enzymes. A cofactor is a non-protein chemical compound or metallic ion that is required for an enzyme’s activity as a catalyst. Like zinc, vitamin C is also a cofactor, and is important for the body to function. So, if you have a deficiency of these essential micronutrients, you will face a problem. But, if a person does not have any such deficiency, an excess amount of these taken does not improve one’s chances of fighting off a virus. Vitamin C and Zinc deficiencies are very rare unless someone is starving or following an extreme diet depleted of nutrients. Iron and Iodine deficiencies are seen in communities and more than immune deficiency they cause other problems.
An extremely active immune system, can also be problematic. In severe Covid-19 cases, the body launches an aggressive immune response resulting in the release of a large amount of pro-inflammatory proteins. This is known as a cytokine storm and is one of the common causes of death in Covid-19 patients. A cytokine storm occurs when the body’s immune system goes into an overdrive, killing healthy cells and causing organ failures. Several research studies suggest that the cytokine storm causes lung injury and multi-organ failure. So, if this is the case boosting the immune system in a Covid patient is not a wise thing to do.
Market interests add to the myth
The truth is natural immunity in normal people cannot be improved. There are immunocompromised individuals with a poor immunity who are susceptible to infections due to certain illnesses, and how can they stay safe from this highly infectious virus that spreads rapidly? The most effective way is by keeping our communities safe.
We can do this by attending to the public hygiene of the population exposed to the infection. Providing safe drinking water, providing clean air, providing adequate nutrition — are ways of keeping the people healthy and strong to fight any infections. There are parts of our country fortunately not as bad in India, without access to these basic health requirements. Achieving social distancing in these communities that live in overcrowded households is impossible.
This background, and a new infection with no treatment, led to various interested parties with good and bad intentions in promoting the myth of immune boosting. They have become self-proclaimed experts exploiting this crisis, putting forth all kinds of miraculous non allopathic substitutions. As allopathic medications to be approved, a rigorous procedure has to be observed, they resorted to the easier approach of promoting quick remedies in traditional and herbal products. Unproven ‘natural’ remedies came to the fore in our country in this background where people felt helpless. The vaccine, the only proven way of boosting the immunity of an individual and the population against a specific disease was not available around this time.
There are added dangers in such situations. There may be a lot of drug-drug interactions. If people are consuming allopathic medicines, and then also start consuming these medicinal herbs, the components of the herb will interact with the drug resulting in unknown complications. These unapproved medications can have toxic effects on your kidney, liver and other organs.
Even during the Spanish Flu pandemic in 1918 companies jumped in on the opportunity to hail themselves as immunity boosting drug producers. However, no products were ever proven to be effective in improving immune responses.
Maintaining a normal immune system
A poor immune system is seen in people with certain ailments. Some are born with defects in their immune system and they are known as immunodeficiencies. People with chronic illnesses like diabetes and auto immune disorders are also vulnerable to catch illnesses easily as their immune systems are weak. People on immunosuppressant medications like steroids and cancer drugs also have a weakened immune system and easily catch infections and develop serious complications easily.
Lifestyle is key for keeping your immune system normal and ready to act with an adequate response when necessary. For now, there are no scientifically proven direct links between lifestyle, exercise and enhanced immune function. Researchers are exploring the effects of diet, exercise and stress on the immune response. There are indeed processes that do affect our immune cells and improve their responses. The best one of them, perhaps, is exercise. Many studies have shown that moderate exercise of less than 60 minutes can improve the circulation of anti-inflammatory cytokines, neutrophils, natural killer cells, T cells and B cells. This can work effectively — not for combating diseases at a specific point in time, but to combat stress hormones in general, which can suppress immune cell function. Extremely high intensity exercise leads to a short duration of compromised immunity, increasing risk for disease in this time period. This is one of the reasons marathon runners or professional sports persons tend to catch a fever or cold in the days following a sporting event. Regular exercise is known to improve cardiovascular health, lowers blood pressure, helps control body weight. Therefore, adopting general healthy-living strategies make sense since they are likely to have other proven health benefits. But whether they help to boost the immune system is a controversial issue with no proven answers.
The immune system can also be compromised by many lifestyle habits such as smoking, which is known to affect T and B cells, among a host of other parameters. Diseases like diabetes by themselves result in compromised immune systems. This is why diabetic patients are particularly susceptible to infections. Obesity is another condition with a weak immune system as it predisposes to the development of other illnesses like diabetes and hypertension. There appears to be a connection between poor nutrition and immunity and this is a problem especially in the elderly. Poor nutrition can lead to micronutrient malnutrition, in which a person becomes deficient in some essential vitamins and trace minerals. Deficiency of these can result in a poor immune response to infections. Older people tend to eat less and often have less variety in their food. In them dietary supplements may have some beneficial effects and they should discuss this with their doctors. Taking mega doses of vitamins do not help and can even be harmful.
Every part of your body, including your immune system that fights against infections function better when protected from unwanted damage and bolstered by healthy-living styles. These are – not smoking, taking a diet high in fruit and fibre, exercising regularly, maintaining a healthy weight, avoiding alcohol or consuming in moderation, getting adequate sleep, washing hands regularly, developing good food habits, minimizing stress.
However, there currently exists no evidence of any consumable foods or products being able to induce an improvement in immune function. Although some preparations have been found to alter some components of the immune system, so far there is no evidence that they actually boost your immunity to the point where you are protected against infection. The only scientifically proven way to boost immunity, the immune system, and an immune response is through vaccinations. Vaccines prime your immune system to fight off infections before they take hold in your body.
So, where do we stand today? Vaccines to boost our immunity against Covid, prevention of spread and catching infection by proper wearing of masks, washing hands and maintaining social distance. These are the scientifically proven methods and others appear to be market-driven myths.
This is not Australia!
Most of us are aware of the video clip that did the rounds on the Internet, showing a man organising a protest in the form of vehicle drivers sounding their horns, against a road closure for a VIP convoy to pass. The response was very strong (for the request to sound the horns) and this should be taken as a warning by the government that the average citizen has had enough, but the result has been the arrest of this young man. He has been subsequently released on bail. I was horrified to read that the alleged miscreant had been warned that this was not Australia, (where this young man had spent some time in and recently returned from) and he should behave in accordance with the laws of Sri Lanka! If this is the way the people in charge of rectifying wrongs think, is it a wonder that we will NEVER reach the status of even Singapore, let alone Australia? Oh, We KNOW that this is not Australia! It is not even the Sri Lanka of the 1970s and certainly not the Ceylon that was described as the Pearl of the Indian ocean in the 1960s. Let’s not even go to pre-Independence or back into the realms of our 2000+ year documented history. It will NEVER ever be anything other than the doomed banana republic and failed state that it is and has become due to the stupid, idiotic, and disgusting thinking of the majority of people holding positions of power and with the ability to shape society. The self-centred, non-forward-thinking desire to preserve their own jobs at all costs and make as much money as possible regardless of ethics and principles that have been the cornerstone of thinking ever since independence from the British. Without change we will NEVER progress! What we should do is to protest and stand in the way of VIP convoys and see if they dare to shoot or baton charge us, after all a lone man has stood in front of a battle tank due to his commitment remember? That unforgettable picture from the protests in Tiananmen Square in China! Then again, we are not people who care that much for our rights or for what is going to happen to the future of our country, are we? We just believe in voting people in who sell us the biggest lies and tell us how many freebies they are going to give us and then whinge and moan when they cannot deliver what we knew they couldn’t deliver in the first place. Talking of politicians, I can see a big fuss being made about the anticipated arrest of a minor politician. This “boy” is the very person whose first naïve response to the Easter suicide bombings was that his father had told him not to go to church on that day due to a rumour of a pending attack! Are these the people we are going to entrust the future of our country to? If this person––and I use this word with respect to my editor, for should I use the words I want to, a lawsuit may result!––was aware of the possibility of such an occurrence and all he did was not go to Church and possibly warn his direct kith and kin, where has his sudden love for the people of this country come from? How can it possibly be justified or believed? I will tell you now that the protest, if and when this politician is arrested, will outweigh anything that is done on behalf of the outstanding young man who tried to protest against the deprivation of the basic human rights of his fellow citizens including the RIGHT to use a public highway and go about their business during peacetime. Yes, SIR in Australia there are heads of state of much higher rank than those who visit banana republics, but the roads are never closed and the general public inconvenienced. Even if they are, notice is given, and people are advised to adapt their schedules accordingly. What elected government has the right to operate with no regard for the very people who they are supposed to serve? The very people who voted them in! A nondescript black man with a dubious reputation and character was idolised and his murder at the hands of the Police in America sparked off worldwide protests and started a movement for black lives and how they matter. A very real case of a young man who knows a better life and wants to make a difference in his home country will be ignored and cast aside into the rubbish heap of contemporary history of this once Pearl of the Indian Ocean. In fact, we are told he has apologised, no doubt at the behest of members of his family who are looking at survival rather than idealistic behaviour. After all, it is easy for those of us who live in real democracies and not “demockeries” to preach from our positions of relative safety. Something that yours truly is constantly told!
When we either reach the level of failed states such as Ethiopia, Zimbabwe, or Afghanistan of becoming a colony of China with the possibility that the visitor who the roads were closed for becoming the new Viceroy, we will realise what happens when “GOOD MEN DO NOTHING”!
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