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‘Spread Awareness, Stop Resistance’

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World Antimicrobial Awareness Week – 18th to 24th Nov. 2021

by Dr. Kavindya Marapana

Antimicrobial resistance (AMR) has become a global health and developmental threat. World Health Organization (WHO) has declared it as one of the top 10 global public health problems facing humanity, and at the same time it has also shown to have a major impact on animal, plant and environmental health. The misuse and overuse of the drugs are the main causes of this problem, and awareness as well as proper actions by the stakeholders including policymakers, healthcare providers and the general public, is of utmost importance to combat this threat.

As the world marks the “World Antimicrobial Awareness Week”, two experts on the field, Dr. Primali Jayasekara, Consultant Medical Mycologist at the Medical Research Institute, Colombo, and Dr. Madumanee Abeygunawardane, Consultant Microbiologist at National Hospital Kandy, share their expertise on antimicrobial resistance, in a brief discussion.

Q: What is the significance of World Antimicrobial Awareness Week (WAAW)?

WAAW is a global campaign, held annually since 2015, which aims to raise awareness of antimicrobial resistance worldwide and encourages best practices among the general public, health workers and policymakers to slow the development and spread of drug-resistant infections.

This year, the WHO has declared the period from 18th to 24th November, 2021, as Antimicrobial Awareness Week with the theme, “Spread Awareness, Stop Resistance”.

Previously named ‘World Antibiotic Awareness Week’, it was changed in 2020 to ‘World Antimicrobial Awareness Week’ as it will reflect the broadened scope of the theme to include all antimicrobials including antibiotics, antifungals, antiparasitics and antivirals.

Q: What are antimicrobials?

Antimicrobials are medicines that are used to prevent and treat infections in humans, animals and plants which include antibiotics, antivirals, antifungals and antiparasitics.

Q: What is Antimicrobial Resistance (AMR), and how does it occur?

Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time, usually through genetic changes, and no longer respond to the drugs. The misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant infections.

Q: Why is Antimicrobial resistance a major concern?

Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally making treatment of infections harder. It increases the risk of disease spread, severe illness and even death, following any common infection.

Currently, we observe the treatment of bacterial infections including urinary tract infections, pneumonia and sepsis becoming difficult with high rates of resistance against antibiotics in all the hospitals of Sri Lanka. Bacteria like Klebsiella pneumonia Acinetobacter spp have become major causes of hospital-acquired infections such as pneumonia, bloodstream infections, and infections in newborns and intensive-care unit patients. We are observing such bacterial organisms becoming resistant to all antibiotics available in Sri Lanka, leaving no option to save lives of the patients with such infections.

Q: How does it affect the healthcare and economy of our country?

The cost of AMR to the economy is significant. In addition to death and disability, which is irreversible, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those affected. Being a developing country with the majority of the people depending on free healthcare services, the additional cost it entails is significant.

Without effective antimicrobials, the success of modern medicine such as organ transplants and cancer treatment (chemotherapy) would be impossible with no option to manage infections.

Raising public awareness of antimicrobials can help reduce the misuse of them and slow resistance emergence as a result.

Q: What is the role the public can play in preventing AMR?

It is important to make the public well aware that no antibiotic can cure viral infections including COVID-19. Besides, the consumption of antibiotics without any indication can be harmful.

Other practices which contribute to the emergence of antimicrobial resistance are as follows:

Self-treatment with antibiotics by getting antibiotics over the counter for common colds, diarrhoea, sore throat and chronic wounds.

Incompletion of the antibiotic course (stopping when clinically feeling better).

Reducing the dose, expecting to reduce side-effects.

Sharing antibiotics with family members with similar symptoms.

We need to know that cough and cold, sore throat and diarrhoea are most of the time caused by viruses and they are self-limited. And even for a bacterial infection, it is very important to take the correct dose of antibiotic at the correct time for the correct duration for cure and to avoid the emergence of resistance. A very common example is that many people suffer from urinary tract infections caused by resistant bacteria as a result of not completing the course of antibiotics during the previous episodes.

It is strongly advised to take antibiotics only when a qualified Medical Officer prescribes them.

The emergence of resistance can be slowed by using antibiotics correctly only when indicated, and we can save antibiotics for future.

Q: What is the danger of drug-resistant fungal infections?

Resistance to antifungals is a mounting global public health threat. Existing antifungal drugs are often associated with important negative side effects. Besides, a few new drugs are under development.

Fungal infections also frequently complicate other illnesses. This was most recently illustrated by the devastating impact of mucormycosis (Black Fungus) and invasive aspergillosis during the COVID-19 pandemic.

The prevalence of drug-resistant fungal infections is increasing and exacerbating the already difficult treatment situations. Many fungal infections have existing treatability issues such as toxicity especially for patients with other underlying infections (e. g. HIV). Drug-resistant Candida auris, one of the most common invasive fungal infections, is already widespread with increasing resistance reported to commonly used antifungal drugs and emerging resistance to other newer antifungal drugs.

This is leading to more difficulty treating fungal infections, treatment failures, longer hospital stays and much more expensive diagnostic and treatment options.

The world urgently needs to change the way it prescribes and uses antimicrobials. Even if new medicines are developed, we will not be able to keep up with the development of resistance as long as our practices are not changed. Without urgent action, we are heading towards a post-antibiotic era, in which common infections and minor injuries can once again cause death. Therefore, all of us at all levels are responsible for doing our part to save the antimicrobials for the future.



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UK support for govt.’s pragmatic reconciliation process

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Lord Ahmad with GL

By Jehan Perera

The government would be relieved by the non-critical assessment by visiting UK Minister for South Asia, United Nations and the Commonwealth, Lord Tariq Ahmad of his visit to Sri Lanka. He has commended the progress Sri Lanka had made in human rights and in other areas as well, such as environmental protection. He has pledged UK support to the country. According to the President’s Media Division “Lord Tariq Ahmad further stated that Sri Lanka will be able to resolve all issues pertaining to human rights by moving forward with a pragmatic approach.” The Minister, who had visited the north and east of the country and met with war-affected persons tweeted that he “emphasised the need for GoSL to make progress on human rights, reconciliation, and justice and accountability.”

Prior to the Minister’s visit, President Gotabaya Rajapaksa had announced in Parliament that his government had not violated nor would support “any form of human rights violations.” This was clearly an aspirational statement as the evidence on the ground belies the words. Significantly he also added that “We reject racism. The present government wants to safeguard the dignity and rights of every citizen in this country in a uniform manner. Therefore I urge those politicians who continue to incite people against each other for narrow political gains to stop doing so.” This would be welcome given the past history especially at election time.

The timing of Lord Ahmad’s visit and the statements made regarding human rights suggest that the forthcoming session of the UN Human Rights Council in Geneva, commencing on February 28, loomed large in the background. The UN High Commissioner for Human Rights will be presenting a written report on that occasion. A plethora of issues will up for review, including progress on accountability for crimes, missing persons, bringing the Prevention of Terrorism Act in line with international standards, protecting civil society space and treating all people and religions without discrimination.

The UK government has consistently taken a strong position on human rights issues especially in relation to the ethnic conflict and the war which led to large scale human rights violations. The UK has a large Tamil Diaspora who are active in lobbying politicians in that country. As a result some of the UK parliamentarians have taken very critical positions on Sri Lanka. Lord Ahmad’s approach, however, appears to be more on the lines of supporting the government to do the needful with regard to human rights, rather than to condemn it. This would be gratifying to the architects of the government’s international relations and reconciliation process, led by Foreign Minister Prof G L Peiris.

REACHING OUT

In the coming week the government will be launching a series of events in the North of the country with a plethora of institutions that broadly correspond to the plethora of issues that the UNHRC resolution has identified. War victims and those adversely affected by the post war conditions in the North and livelihood issues that arise from the under-developed conditions in those areas will be provided with an opportunity to access government services through on-the-spot services through mobile clinics. The programme coordinated by the Ministry of Justice called “Adhikaranabhimani” is meant to provide “ameliorated access to justice for people of the Northern Province.”

Beginning with Kilinochchi and Jaffna there will be two-day mobile clinics in which the participating government institutions will be the Legal Aid Commission, Office for National Unity and Reconciliation, Office for Reparations, Office on Missing Persons, Department of Debt Conciliation Board and the Vocational Training Authority to mention some of them. Whether it is by revising 60 laws simultaneously and setting up participatory committees of lawyers and state officials or in now launching the “Adhikaranabhimani” Justice Minister Ali Sabry has shown skill at large scale mobilisation that needs to be sustained. It is to be hoped that rather than treating them as passive recipients, the governmental service providers will make efforts to fulfill their need for justice, which means that the needs of victims and their expectations are heard and acknowledged.

It will also be important for the government to ensure that these activities continue in the longer term. They need to take place not only before the Geneva sessions in March but also continue after them. The conducting of two-day mobile clinics, although it will send a message of responsiveness, will only be able to reach a few of the needy population. The need is for infusing an ethic of responsiveness into the entirety of the government’s administrative machinery in dealing with those problems that reaches all levels, encompassing villages, divisions, districts and provinces, not to mention the heart of government at the central level.

The government’s activities now planned at the local level will draw on civil society and NGO participation which is already happening. Government officials are permitting their subordinate officials to participate in inter-ethnic and inter religious initiatives. It is in their interest to do so as they would not wish to have inter-community conflicts escalate in their areas which, in the past, have led to destruction of property and life. They also have an interest in strengthening their own capacities to understand the underlying issues and developing the capacity to handle tensions that may arise through non-coercive methods.

BUILDING PEACE

Many of the institutions that the government has on display and which are going to the North to provide mobile services were established during the period of the previous government. However, they were not operationalized in the manner envisaged due to political opposition. Given the potency of nationalism in the country, especially where it concerns the ethnic conflict, it will be necessary for the government to seek to develop a wide consensus on the reconciliation process. The new constitution that is being developed may deal with these issues and heed the aspirations of the minorities, but till that time the provincial council system needs to be reactivated through elections.

Sooner rather than later, the government needs to deal with the core issue of inter-ethnic power sharing. The war arose because Sinhalese politicians and administrators took decisions that led to disadvantaging of minorities on the ground. There will be no getting away from the need to reestablish the elected provincial council system in which the elected representatives of the people in each province are provided with the necessary powers to take decisions regarding the province. In particular, the provincial administrations of the Northern and Eastern provinces, where the ethnic and religious minorities form provincial majorities, need to be reflective of those populations.

At the present time, the elected provincial councils are not operational and so the provincial administration is headed by central appointees who are less likely to be representative of the sentiments and priorities of the people of those provinces. In the east for instance, when Sinhalese encroach on state land the authorities show a blind eye, but when Tamils or Muslims do it they are arrested or evicted from the land. This has caused a lot of bitterness in the east, which appears to have evaded the attention of the visiting UK minister as he made no mention of such causes for concern in his public utterances. His emphasis on pragmatism may stem from the observation that words need to be converted to deeds.

A video put out by the UK Foreign, Commonwealth and Development Office confirms a positive approach with regard to engaging with the Sri Lankan government. In it Lord Ahmad says “the last three days illustrated to me that we can come together and we can build a constructive relationship beyond what are today with Sri Lanka. We can discuss the issues of difference and challenge in a candid but constructive fashion.” Lord Ahmad’s aspiration for UK-Sri Lankan relations needs to be replicated nationally in government-opposition relations, including the minority parties, which is the missing dimension at the present time.

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Yohani…teaming up with Rajiv and The Clan

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I know many of you, on reading this headline, would say ‘What?’

Relax. Yohani, of ‘Manike Mage Hithe’ fame, is very much a part of the group Lunu.

But…in February, she will be doing things, differently, and that is where Rajiv and the Clan come into the scene.

Rajiv and his band will be embarking on a foreign assignment that will take them to Dubai and Oman, and Yohani, as well as Falan, will be a part of the setup – as guest artistes.

The Dubai scene is not new to Yohani – she has performed twice before, in that part of the world, with her band Lunu – but this would be her first trip, to Oman, as a performer.

However, it will be the very first time that Yohani will be doing her thing with Rajiv and The Clan – live on stage.

In the not too distant past, Rajiv worked on a track for Yohani that also became a big hit. Remember ‘Haal Massa?’

“She has never been a part of our scene, performing as a guest artiste, so we are all looking forward to doing, it in a special way, during our three-gig, two-country tour,” says Rajiv.

Their first stop will be Dubai, on February 5th, for a private party, open-air gig, followed by another two open-air, private party gigs, in Oman – on February 10th and 11th.

Another attraction, I’m told, will be Satheeshan, the original rapper of ‘Manike Mage Hithe.’

He will also be a part of this tour (his first overseas outing) and that certainly would create a lot of excitement, and add that extra sparkle, especially when he comes into the scene for ‘Manike Mage Hithe.’

Yohani and her band, Lunu, last performed in Dubai, a couple of months back, and Satheeshan, they say, was the missing link when she did her mega internet hit song – live, on stage.

There was a crowd to catch her in action but it wasn’t a mind-blowing experience – according to reports coming our way.

A live performance, on stage, is a totally different setup to what one sees on social media, YouTube, etc.

I guess music lovers, here, would also welcome a truly live performance by Yohani de Silva.

In the meanwhile, I’m also told that Rajiv Sebastian plans to release some songs of the late Desmond de Silva which he and Desmond have worked on, over the years.

According to Rajiv, at this point in time, there is material for four albums!

He also mentioned that he and his band have quite a few interesting overseas assignments, lined up, over the next few months, but they have got to keep their fingers crossed…hoping that the Omicron virus wouldn’t spike further.

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Multi-talented, indeed…

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Thamesha Herath (back row – centre) and her disciples (students)

We all know Trishelle as the female vocalist of Sohan & The X-Periments, so, obviously it came to me as a surprise when it was mentioned that she is a highly qualified Bharatanatyam dancer, as well.

What’s more, she has been learning the skills of Bharatanatyam, since her kid days!

And, to prove that she is no novice, where this highly technical dance form is concerned, Trishelle, and the disciples (students) of State Dance Award winning Bhartanatyam Guru, Nritya Visharad Bhashini, Thamesha Herath, will be seen in action, on January 29th, at 4.00 pm, at the Ave Maria Auditorium, Negombo.

Said to be the biggest event in Bharatanatyam, this Arangethram Kalaeli concert will bring into the spotlight Avindu, Sithija, Mishaami, Nakshani, Venushi, Veenadi, Amanda, Sakuni, Kawisha, Tishaani, Thrishala (Trishelle), Sarithya, Hewani, Senuri, Deanne and Wasana.

In addition to her singing, and dancing skills, Trishelle has two other qualifications – Bachelor in Biomedical Science, and Master in Counselling Psychology.

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