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The Unseen Victims: The Collateral Damage of COVID-19

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By Dr. Chiranthi K Liyanage

Senior Registrar in Rheumatology & Rehabilitation, National Hospital of Sri Lanka

Lecturer, Department of Pharmacology, Faculty of Medicine, University of Colombo

I am a doctor working at the National Hospital of Sri Lanka (NHSL), Colombo, and I lost two patients within 24 hours, last week.

The first was a young girl, just 19 years old, from a village in a district bordering Colombo. She was suffering from an autoimmune illness, which required close monitoring and long-term treatment. Her mother called me several times last week saying that her daughter had aches and pains, and that she was feeling a little feverish. I told her that I could not decide on specific treatment without seeing her and running tests. Every time I told her to bring the daughter to the hospital, her answer was “aney doctor, all the wheels (Tuks) are refusing to come to Colombo because of the travel restrictions.”

I asked her whether she could go to the nearest District General Hospital because we could liaise with the specialist there and arrange for a transfer to Colombo if necessary. The answer was “we have no way of going even there. No one is willing to take us”. She was also running low on medicines, and she could not afford to refill the prescription from a private pharmacy. Finally, she agreed to get the required tests done and send a relative to Colombo, so we could at least see the test results, talk to her daughter over the phone and do our best to treat her, given the circumstances. However, the next day morning, the mother called again. She said that her daughter has not passed urine the whole night. She admitted that the daughter’s face looked puffy, and I immediately knew that her kidneys were shutting down. Her disease was very likely flaring up again or she has got an infection and we had to act very quickly. I told her to take her to the nearest hospital as quickly as possible. I got two calls from that number after that. One, about an hour later; it was the patient’s sister this time. In between sobs, she said was “aney doctor, my sister is very ill. We are here and getting admitted now”. I was at NHSL, and she was miles away in another hospital. As we had informed the specialist team there about the patient ahead of admission, I assured the sister that she will be taken care of. Another hour later, the sister was on the phone again. All she said to me was “we lost her”. The pain in her voice was palpable, but she was not crying any more.

The same day, another young woman with a similar autoimmune condition who was already admitted to a medical ward at NHSL got critically ill. She died a few hours later as she developed uncontrollable bleeding into the lungs and her kidneys shut down. Earlier this week, as she lay propped up in a hospital bed with laboured breathing, I saw her for the first time in a long time, because she had not come for any follow up clinic visits for months. The first thing she said as she saw me was “Doctor, you are the one I take treatment from”. I asked her to lower her mask to see her face, but I still could not recall the patient. It has been too long. Perusing through her records, I saw my old notes and wondered how she recognized me even with the mask and the face shield on. She has not come to clinic for over a year because of the fear of catching COVID-19 and travel restriction. She has finally got admitted this week, as she became too ill and had no other choice. Although we tried our best, it was too late for her at the end.

 

As I thought about why we could not save these two young lives, I realized with a very heavy heart, that this is the collateral damage of COVID-19! They were either reluctant or unable to obtain the care they needed due to actual or perceived barriers to access healthcare imposed by the prevailing COVID-19 pandemic. However, their deaths will never be counted. They will be forgotten along with the hundreds or even thousands of others who would have lost their lives under similar circumstances, unable to reach a hospital, get medicines, or even see a doctor. We will never know. According to the official sources, the death toll from COVID-19 in Sri Lanka is just over 1600 now. However, this is just the tip of the iceberg. There are countless others who die in their homes, either of COVID-19 itself or other ailments because they do not get the medical care they need due to inaccessibility of healthcare faculties. As more and more healthcare resources are diverted to manage the ever-increasing numbers of the COVID-19 cases, the resources available to the millions of others who suffer from non-COVID illnesses contract and dwindle further. The preventive health sector including maternal and childcare services are also severely affected as all medical officers of health, public health midwives and public health inspectors are overburdened with COVID -19 related duties. If our state hospitals get overwhelmed with the soaring COVID-19 case load, not only COVID related deaths but deaths due to other illnesses will also rise exponentially due to the limited resources available. Therefore, the seemingly low number of deaths we see on paper today is a gross misrepresentation of actuality.

The most disconcerting realisation is that the COVID-19 pandemic is disproportionately affecting the already disadvantaged populations more. It is widening the already existing health inequalities by limiting availability, affordability and accessibility of medicines and healthcare due to loss of income, lack of reliable information and education as well as paucity of transportation facilities. The more affluent who wish to avoid the crowded wards in a government hospital will seek medical care in a fee-levying private healthcare institute, while the underprivileged who cannot afford such a luxury will be forced to choose between getting the required treatment while running the risk of contracting COVID-19 or not getting any treatment at all. Over utilisation of public healthcare resources to combat COVID-19 further worsens this disparity. The video consultations and other telemedicine solutions, online pharmacies with delivery systems, drive-through laboratory services and mobile units all cater to a wealthier segment in our society. The thousands who are solely reliant on the public health institutions are inadvertently overlooked and underserved.

The System which should safeguard the right to health of all Sri Lankans, is miserably failing the neediest, already disadvantaged segments due to its many inadequacies. For example, the mechanism adopted very early on in the second wave to send medicines by post to clinic attendees in government hospitals is still not fully operational, although the country is in a much dire situation now. Albeit not a perfect system, it limited movement of people within the country, reduced usage of public transport and ensured continuity of care to a great extent. Moreover, the improperly planned, poorly regulated vaccination drive against COVID-19 paved way for those with the ‘right kind of connections’ to jump the queue while the disadvantaged high-risk populations were deprived of the same opportunity. A strictly enforced secure system based on eligibility, with transparency, phased out rolling out of the vaccine and stringent monitoring would have prevented such a fiasco as the public would have had faith in The System and awaited their due turn. The travel restrictions which are in place to prevent the spread of the disease is in fact driving the already impoverished societies into a miserable poverty-stricken abyss. Meanwhile, some more well-to-do fellow countrymen, political stooges and those in positions of power commit brazen acts of violation of the very regulations. They roam around in their big cars and jeeps under the guise of essential services, throw birthday parties, and dinner parties at a time the rest of the country is grappling with a deadly virus wreaking havoc and leaving death and destruction in its wake.

So, what can we do within a flawed System? It is a System that has been corrupted by a few which has in turn corrupted many more, who otherwise may have been decent, law-abiding citizens who value justice, equality and morality. It is a malady that is spreading like a pervasive, self-perpetuating parasitic disease. Yes, there is no doubt that the system MUST change. However, is it rational or even acceptable to simply blame The System and be complacent when each of us ARE in fact a part of it? Are we not complicit in one way or another in either being corrupted by The System, or worse, in corrupting it? Only you can answer for yourself. We as Sri Lankans citizens cannot disregard our duties and social responsibilities. We must self-examine and reflect on what we can do as individuals at this very moment to get our country out of the peril it is in. We must not forget that we are all a part of The System and therefore we have the ability and the power to change it from within.

All countries who have so far successfully curbed the spread of COVID-19 have used a multipronged approach encompassing strict enforcement of travel restrictions to limit the daily new infection rates to manageable numbers, rational testing to identify and remove sources of infection, with pre-planned, well-coordinated vaccination to immunize an adequate proportion of the population. While most of these strategies are already in place and operational to an extent in Sri Lanka, the success of these measures depends hugely on the compliance of the public. This is a virus. It is spread by humans to other humans. Our country’s need of the hour is to prevent further spread of COVID-19 and it should be the priority of its entire populace.

One must not forget that even if you are vaccinated and your whole family is vaccinated, it does not guarantee that you will not spread the disease. A significant proportion of the population has to be immunised to break the chain of transmission. Sri Lanka is not even close to achieving that target yet. If you are fully vaccinated, you are unlikely to get severe disease or develop complications, but another person you unknowingly transmit it to might not be so lucky. The poor patients in the outskirts of cities and villages who are unable to reach a hospital, the ones who are unable to put food on the table let alone get medicines for their loved ones are suffering because we as a nation is failing them. Soaring infection rates within a city not only affects those who are infected, but millions across the country as it distorts the very fabric of our society and disrupts an already imperfect System. The health guidelines and restrictions are in place not only to protect you, but to protect the rest of the society from you. Adhering to these guidelines will protect you, your family and countless others who you have never even met, as the spread of the disease will be prevented limiting the direct as well as collateral damage of COVID-19.

Humans, however, are driven by the primal instinct of self-preservation. Most are self-serving by nature. There is an inherent need to fulfill one’s own desires and needs and protect their own even at the expense of another. That is why there is an intrinsic disinclination to let go of personal liberties and compromise for the betterment of the society at large, unless there is a perceived direct benefit. However, I believe that most are compassionate human beings who tend to overlook the potential damage they may cause as they are simply unaware of it. Those who clamour to get the gyms and bars open, use their connections to throw clandestine parties and simply try to enjoy their usual indulgences, do so because they probably do not understand the harm it causes not only to those in their immediate circles but the entire population. There are no perpetrators in this pandemic, all are victims in one way or another. It is not an exaggeration when I say that there has never been a time in history when the actions of each and every person in this country has mattered as much. Every single Sri Lankan, man, woman or child has a role to play in combating this horrid pandemic. Even in the absence of a System that firmly enforces regulations externally, self-discipline could right the wrongs and make an imperfect System work. We could still save hundreds of lives if each of us fulfill our duty to the nation and be socially responsibile.

The real extent of death and devastation caused by this pandemic will probably never be known. However, for those of us who see these people suffer, fight for their lives and still loose, it is unimaginable and immeasurable. They are not just another number to be added or disregarded from a daily report. To us, these are mothers, fathers, daughters, sons or siblings of another fellow human being. Every life matters, and every life is precious. So, this is my plea to my fellow Sri Lankans…. please be socially responsible, put the societal needs above your own personal liberties. Each of you have an immense power to stop the spread of this deadly pandemic, so please do your part as Sri Lanka needs you now.



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Opinion

This Pretentious Plenitude

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(loketa parakase, gedarata maragate )

“On 3 June, 1400, the Byzantine Emperor Manuel II Paleologus entered Paris. By the showy standards of contemporary state visits, Manuel cut a sory figure. Accompanied by fewer than sixty of his own attendants, speaking nothing but Greek, mounted on a borrowed white charger and dependent for his travelling expenses on his hosts, he had come to beg for money and troops in the hope of preserving his shrunken domains from the Ottoman Turks.”

– Cursed Kings, The Hundred Years War IV, 2015)

By Usvatte-aratchi

A few days ago, I went to Panadura to see my brother, 95 years old. We parked the car to go to the Arpico Supercentre at the southwestern corner of Galle Road and Nirmala Mawatha. From the park, I did not go into the store; I sat in the car. There were about 20 cars parked and people went into the store and drove away after making their purchases. There were more women shoppers than men. The women were distinctly well-clothed and appeared well-fed. They all wore slacks or skirts and upper garments, all in good taste with no garish hues. None wore a sari. All men wore slacks and shirts and none a kapati suit or sarong. All the cars glistened in the morning sun; none had scratches or worse damage. One car had a number plate BK; all the others had number plates with three letters. There was plenitude; where is the austerity the country is published to undergo? Or is austerity the burden borne by only one category of citizens? A few days later, as I entered through the gates to a hospital compound, I noticed that the man who issued tokens from a little cubicle in the heat and humidity wore a necktie. Public servants assembled before ministers invariably wearing a suit. The rooms are airconditioned to accommodate them. Doesn’t it make more sense to wear simple shirts in rooms cooled to a higher temperature to save fuel? Why this pretence of plenitude in this land of austerity? It is so poor that it bears the odium of having defaulted on its sovereign debt.

What are the rules of etiquette that require us to wear evening dress, no matter who the dignitary that one has to meet? Well, of course, anyone is entitled to wear funny clothes, even silken wigs in this high temperature and high humidity in torrid tropical weather. But in this impoverished hungry land, where children who attend school faint from starvation? There are reports of stunted and underweight children. I expect to read infant and maternal mortality rates for 2021, 2022 and 2023 higher than the excellent levels that our health services had ensured for us. The age cohorts born in 2020-2024 will bear the scars of this scourge throughout their lives.

Sometime in the mid-1980s, a friend of mine was the Indian Ambassador to Vietnam. She was very keen to learn Vietnamese. After a few weeks in the country, she hired someone to teach her Vietnamese. Although now written in Latin script, there is a range of diacritical marks to help one to speak a word with the proper tones -more complex than in Mandarin or Thai. (The Latin script was introduced in the 17th century by Portuguese Jesuit priests.) In the second week of lessons, the tutor took the liberty of raising a question with the Ambassador, one evening after the lesson. ‘Madam, with the flaps of the dress you wear, I can make a pretty blouse’. Isn’t it a pity that so much cloth must is wasted’? (Vietnamese are still small-made, perhaps genetically and the result of centuries of malnutrition.) The ambassador who was very sympathetic to what Vietnam was trying to achieve, was shocked by how right the tutor was. She took her lesson seriously. I was a student in Britain in the 1960s and stayed in my lodgings all summer, except to go to the theatre in London. One summer, I was invited to tea in the garden with the queen. Many students from Commonwealth countries were so invited. I had no suit to wear for the occasion nor did I consider it wise to invest in one, just to attend a tea party. (Mad Hatter might have considered it otherwise.) We are still a poor country and anyone who yearns for the use of expensive clothing must seek a fitting clime. Some of you must have observed the army-style warm collarless cardigan that President Volodymyr Zelensky wore when he addressed the US Congress, a rare honour bestowed on men from outside the US. Does a caparisoned elephant look more dignified than the real thing in the wild? Do murderers, plunderers, women abusers and forgers gain dignity when they wear kapati suits buttoned up to the chin? If clothes make for dignity, mannequins in shop windows must present the most dignified postures in the world.

Take the case of cars. In this small island with a short mileage of expressways and a speed limit of 100km per hour, where do people go in a Mercedes 350 or BMW 740 ? Those gas guzzlers, V8 vehicles which even Bhikkhu covet, are symbols of pretentious plenitude. I recall some MPs explaining in parliament that they needed expensive vehicles because they had to travel in their electorates on uneven roads. When NIssanka Wijewardene was the government agent in Badulla in the early 1960s, he toured the district on horseback and Uva is still not an area roads in good condition in that part of the country. Leonard Woolf, 123 years ago, toured the Hambantota district on horseback. Riding a horse on rough tracks and rural roads is no fun. I cannot see why MPs cannot travel about in cheaper cars which are less expensive to buy and also consume much less gas. All this plenitude is at the expense of rich and poor taxpayers. The frequent use of helicopters by the president and ministers is something we cannot afford. Once a relative of a president flew in a helicopter from Ratmalana to Maharagama, at government expense. A president travelled by helicopter several times to ‘inspect’ construction work on the Moragahakanda dam. I wondered how much engineering the man had in him to waste so many resources for so flimsy a reason. When a dam was built across Gal Oya at Inginiyagala in 1950-52 with two months to spare before the end of the contracted date, there was nobody flying around in helicopters. The Ampara-Siyambalanduwa road was a decade away and one had to drive to Chenkaladi to get to Inginiyagala, a tiring journey for a young man even in 1968-69. When a poor population struggles to climb higher in the income ladder, it does not help to grease it with opulent lifestyles by its leaders. That grease pulls down people back into poverty.

Our religious leaders do not help. The Durutu perahera was held a few weeks back. Navam perahera is on a grand scale. Then comes Avurudu when the whole country takes a holiday and eats and drinks as if there were no tomorrow. May is for vesak. June, and people sojourn in Anuradhapura. July is for many festivals in devale in the south. August puts up the spectacle in Mahanuvara. September opens a period of quietude in pansal only to begin again in November. Who objects to religiosity among believers but please undertake them without denying the rest of this economy resources. It is more important that a child goes to school regularly than that votive candles are lit on an altar.

Some places of religious importance in this country are mighty rich. Their daily income probably is in the millions. What is the educational institution or hospital that they financed to build and run? Even the Vidyodaya pirivena receives, to date a subvention out of taxpayers’ money. Why isn’t it maintained with the collections in the shrine with a Bo-tree in Kalutara? The collections are administered by the Public Trustee but why not give a sense of ownership to those that collect the money? The Venkateshwar kovil in Andhra Pradesh runs a fine university with a part of the huge income it earns. Superstitious politicians from our country contribute to that income. Satya Sai Baba organization in Bengaluru runs schools and provides pipe-borne water to villagers close to their offices. The Rama Krishna Mission in India has a brilliant record of having established and run many schools and colleges in India. Tatas have established research institutes that put out high-quality work. In the 13th and fourteenth centuries when England was probably poorer than Sri Lanka then and certainly poorer than even impoverished Sri Lanka today (2023), colleges that now comprise Oxford and Cambridge universities, were built and run by Roman Catholic churches, monasteries and rich individuals. Many Bishops established colleges in Oxford and Cambridge. Walter de Merton started Merton College in Oxford; Peterhouse in Cambridge had similar beginnings. They had to wait for Edward III and Henry VI to meet Royal benefactors of colleges. In the first settlements in Boston Bay, the immigrants established Harvard College (now Harvard University) in 1635 well before a systematic government came into being there. Someone needs to inquire why well-endowed religious establishments in this country, do not find it fitting that they establish educational facilities for bright students. They would rather gild with 13.5 kg of gold, a fence around a venerated tree.

Why do we so often mistake appearances for substance? More than 120 years ago, Thorstein Veblen coined the term ‘conspicuous consumption’ to identify behaviour patterns of people in opulent societies. What does one call this pretentious plenitude in a land where hunger haunts almost every household day after day?

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Opinion

The ‘Smiling Chancellor’- educationist par excellence

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The most reverend Dr Oswald Gomis, Emeritus Archbishop of Colombo and the former Chancellor of the University of Colombo, was called to his heavenly home on 03.02.23

It is with sincere gratitude that I pay this tribute to him for his invaluable service to the field of education in general to the University of Colombo and to me as an academic

It was Father Bonjean, a Catholic priest, who has been acclaimed as the greatest contributor to Catholic education at that time through his submissions to the State advocating a system of state-aided schools to be run by each religious denomination for its children. He pointed out, not only Catholics but also the adherents of other religions in the island (Hindus, Buddhists, Muslims) should be fairly treated. The Denominational or Assisted Schools System, which it was hoped would benefit all religions, thus came into being and lasted nearly a century until the takeover of schools by the state in 1960. Fr. Bonjean came to be known as ‘the Father of the Denominational School System’

Father Bojean was considered ‘the Father of the Denominational School System’, and most Rev. Dr. Oswald Gomis can be considered the modern father of Assisted schools. Being a product of St Bendict’s college, he wanted to provide similar education through equality and religious harmony for the students. At an interview he said that when he was appointed Archbishop of Colombo, he had a special objective – that is to provide a good education for the people. To achieve this, he wanted to expand the catholic education. Hence, he made a valiant effort within the existing legal framework to establish branch schools of the popular catholic private schools. St. Peter’s College, Gampaha and Udugampola Branches, St. Joseph’s College, Enderamulla and Kadolkele branches and many more such branch schools. Further, a branch of St. Nicholas’ International College in Negambo and St. Thomas Catholic International College in Seeduwa were also established. School of Hope, Paiyagala and– Don Bosco Technical Institute – Nochchiyagama were also founded under his patronage.

Most Rev. Dr. Oswald Gomis as a historian and author has also contributed to education. For example, he has disproved that, i.e. Catholicism was introduced for the first time in our country by the Portuguese, in his book, “Some Christian Contributions in Sri Lanka”

The Archbishop, has pointed out that one Jordanus Catalha de Severac, a Dominican Friar, was appointed to Colombo as a bishop by Pope John XX11 on 5th April 1330 according to a document in the Vatican Archives, and he (Jordanus) has written a book called “Mirabila Descripta”(also in Vatican Archives) giving vivid description about various countries including ancient Sri Lanka and about two kings during his stay here. He also forwarded evidence according to Vatican sources that another missionary, a Papal Legate by the name of Giovani de Marignolli who was sent to East by the same Pope stayed in Colombo for eighteen months around the years 1348/1349 and taught catechism in a church dedicated to St. George and also erected a huge stone Cross here, before his departure to Europe. The Archbishop also quotes that Prof. Paranavithana, in his book , “Story of Sigiriya” has proved that Christianity was in ancient Sri Lanka with irrefutable evidence based on details found in the rock inscriptions in various parts of our country. A stone Cross in Anuradhapura he claims bears testimony to this.

Bishop Oswald Gomis’s Contribution to the University of Colombo and to me personally is invaluable. In 1994 in response to an application I sent to the University of Colombo for a Post of Probationary lecturer in Humanities Education I was called for an interview. At the interview I was amazed to find his lordship most Rev. Oswald Gomis the Archbishop of Colombo on the interview panel. I thought that my nervousness was making me see a vision! However, later I learnt that he was indeed there as a member of the University Council as an educationist. Years later as the Dean of the Faculty of Education when I met him at a convocation, I mentioned this incident to him. With his usual endearing smile, he said “I am glad we made the correct decision at that time”. In 2019 at the Post Graduate Convocation when he as the Chancellor handed me the Vice Chancellor’s award for excellence in research in the Faculty of Education in the year 2018, beaming with pride he told the Vice Chancellor “I selected her to the University”. Such was his memory!

Bishop Gomis has been on the Council of the University of Colombo from 1977-2001. Later, he was appointed the Chancellor in 2001 and continued to serve the university in this capacity till 2021. Every year I hear the graduands after the convocation commenting on the “smiling Chancellor’ who wished each and every one of them. In spite of the arduous task of sitting through three days of four sessions , and handing over the scrolls , he made it a point to make their big day memorable by that personal touch. He continued to discharge his role as Chancellor to perfection by attending all the University functions he was invited irrespective of whether it was X’mas carols or Pirith. He took pride in the achievements of both the students and staff of the University of Colombo. I have heard him saying to the students, referring to raging such unfortunate incidents do not happen in our university. Bishop Gomis held his position with dignity and pride. In turn the students and staff respected and liked him.

When Bishop Gomis was appointed the Archbishop of Colombo the Bishop’s Conference in a statement said, he brings to Colombo valuable expertise as a scholar, educationist, historian, author and above all, a revered pastor”. He has indeed used his expertise to the maximum and in his retirement continued to impart this knowledge through his writings. People of Bishop Gomis’s calibre is very rare today.

We will miss you dear father, but you will live through your good deeds.

May host of angels lead you to your eternal rest!

Marie Perera
Professor Emeritus
University of Colombo

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Opinion

Senerath Rajakaruna

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Senerath or Sene, as he was affectionately called, passed away on January 7 plunging his near and dear and a host of his friends and associates into a pool of tears and agony. According to his wife in whose arms he breathed his last, death was instantaneous.

True, he had a few health issues which however did not warrant the kind of quick “exit” he encountered. Senerath, my son-in-law was a doughty fighter who braved his affiliations with great fortitude. The doctors who treated him were baffled by the composure he evinced when confronted with the complications he was doomed to go through. Admirable, isn’t it?

An alumnus of D.S. Senanayake College, he cultivated a strong link with the school and was an active member of the Old Boy’s Association of the school. After a brief career as a Demi Chef in a prestigious hotel in the Middle East, he showed his powers in Real Estate in later years. He was over the moon and basking in the success of his trade.

Sene was an entertainer par excellence. He ran an open house for his plethora of friends and associates. The gregarious animal he was, prompted him to hold musical evenings where singing and dancing went on till the wee hours of the morning. He sang with lilting and melodious resonance. “Baila’ was his forte good lord Bacchus was an indispensable invitee to his parties where he had free rein.

This popular personality was a compulsive humorist who left his audience roaring with uncontrollable laughter. His infectious smile is missed by many. His philanthropy extended far and wide especially to the poor and helpless people in and around where he lived. The received monetary assistance, dry rations and produce from his cultivations.

He had traveled widely and was planning to visit his son who is employed in New Zealand but it was not to be. His daughter had left to the United Kingdom just three days before her father’s passing. He was a loving husband to his wife Lalana and a fond father to Lakitha and Lasandhi. As his father-in-law I join them to invoke blessings of the Noble Triple Gem to help Sene to tread the path to Nibbana.

Bandula Abeyewardene

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