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Towards a disability-friendly health system

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Gaps in the health care system burden those with disabilities with an added cross. In the backdrop of the International Day of Persons with Disabilities which fell on December 3, we spoke to many stakeholders to push for collective national interventions to enhance the quality of life of those with disability.

by Randima Attygalle

Nisha Shareef from Kandy was born with a rare spinal cord abnormality which left her wheelchair-bound for life. Introduced to rehabilitation at age 11, Nisha’s quality of life improved. Thanks to the vocational training she received through the Ragama Vocational Training School, she learned the art of watch-mending. Today at 50-years, she runs her own business in the Kandy town, her example empowering fellow wheelchair users.

Health challenges for those in Nisha’s shoes are many. Inability to control the passing of urine, catheter and diaper dependency, frequent urine infections and bed sores are among them. Management of all these issues is costly says Nisha who lobbies for a special concession for adult diapers and other medication required by those with disabilities. “Accessibility to public toilets including those at hospitals is a nightmare for us,” she says. Nisha urges the health authorities to have disability-friendly infrastructure at hospitals and to dedicate a help desk and a hotline at least at Teaching Hospitals to assist those with disabilities.

Many young girls and women with mental disabilities and those who are vision impaired left alone at homes are often sexually exploited, she points out proposing a state-supported day-care system to shelter them while their parents or other care givers are at work. This would help ensure their safety.

Having fallen off a rambutan tree at ten, Lasantha Chandimal from Dampe off Madapatha, became paralyzed. Having lost both his parents by 15, Lasantha’s life took a turn for the worse. The Samaritans at the Ragama Rehabilitation Hospital not only uplifted him from a bedridden patient to a wheelchair user but also trained him to maneuver a special tricycle. Lasantha, 36-years old today, has lost his job with the closure of the plastic factory he worked at. His wife, a wheelchair user herself, also worked there.

A spinal cord injury makes Lasantha often susceptible to kidney dysfunction. “I’m a catheter-user and I developed a urine infection during the lockdown which left me helpless with no access to medical treatment. With my temperature running high due to the infection, I called for an ambulance several times to no avail. Finally I had no choice but to scrape my savings and get treatment at a private hospital.”

The absence of special assistance at OPDs, indifference of the support staff and exploitation of those with disability by some, makes matters worse. Improving disabled-health literacy at ground level, improving sanitation facilities for people with disability in hospitals, sensitizing support staff and creating awareness on available help devices are among Lasantha’s suggestions to ease the burden of this community.

Over a billion of people, about 15% of the world’s population, according to the World Health Organization (WHO) have some form of disability. Half those with disability cannot afford healthcare, compared to a third of those without disability. People with disability are more than twice as likely to find healthcare providers’ skills inadequate and people with disability are four times more likely to report being treated badly; and they are nearly three times more likely to be denied healthcare, WHO affirms. The World Bank literature on ‘Disability Inclusion’ documents that ‘many persons with disabilities have additional underlying health needs that make them particularly vulnerable to severe symptoms of COVID-19, if they contract it. Persons with disabilities may also be at increased risk of contracting COVID-19 because information about the disease, including the symptoms and prevention, are not provided in accessible formats such as print material in Braille, sign language interpretation, captions, audio provision, and graphics.’

Translating sensitization on ‘disability and rehabilitation’ into practical reality is urgent, points out Manique Gunaratne, Manager Specialized Training and Disability Resource Centre of the Employers’ Federation of Ceylon. Manique who lost her vision in her 20s due to Retinitis pigmentosa had no proper local guidance to a rehabilitation system. The overseas doctors whom she consulted empowered her on ICT systems available for vision impaired people. “This has made me what I am today,” says the activist who lobbies for help desks which could offer guidance for people with disabilities and their families to make informed decisions. “Very often when a child with a disability is born, parents have no clue what to do with it. If the medical condition turns out to be disability, they are even more helpless,” notes Manique who also proposes a ‘Priority Card’ on health nee

ds and making disability representation stronger at policy-level within the health sector.

The role of collaboration between doctors, physiotherapists and the beneficiary in determining the best assistive device cannot be understated says H.D. Mala Nandani, Administrative Officer, Rehab Lanka which manufactures s

uch devices. “An assistive device has to be a customized and very often there is little awareness among the poorest of the poor who depend on a donated wheelchair which could very often compound the disability.” The National Secretariat for Persons with Disability provides a stipend for such devices, she adds. The local manufacturing volume of assistive devices should be increased for better availability, notes Mala who lost the use of one leg due to a vaccination mishap as a child. “At ground level, the knowledge of personal hygiene among those with disabilities is very poor; hence there should be a system similar to that of midwives to help the families of the disabled in terms of knowledge and guidance to proper health channels.”

The COVID emergency situation which put the local public health system under unprecedented strain has driven the health authorities to design new interventions including meeting the needs of people with disabilities, notes Dr. Shiromi Maduwage, Consultant Community Physician from the Youth, Elderly and Disability Unit of the Ministry of the Health. “We are now developing a system to reach out to those in need in future emergencies. We have already launched a programme to empower care givers during the pandemic. This is facilitated by the National Secretariat for Persons with Disability.

A system to improve the COVID-related health messages through Braille and sign language is also underway she says. While the state provides a monthly disability allowance, certain gaps in the system including the need for disabled-friendly infrastructure have been identified; and these need to be bridged, says Maduwage. “The elderly population is growing and disability will be an added burden. Community based rehabilitation is already being strengthened by the health sector to mitigate the challenges and ground level officials sensitized though the MOH divisions.”

Upgrading the school curriculum to incorporate health issues of those with disabilities including their sexual an

d reproductive health and safety can help sensitize future health policy makers to 

catering for their needs, remarks Dr. Harischandra Yakandawala, Medical Director of the Family Planning Association and Consultant to the project on sexual and reproductive health during emergencies. “People with disabilities often have barriers in accessing information and we are collaborating with several agencies in addressing this including making online counseling services accessible by victims of gender based violence.” Women and girls with disabilities are the most vulnerable to sexual violence which could result in unwanted pregnancies and sexually transmitted diseases, he says citing the need for organized shelters to provide care for young girls and women enabling their caregivers to be productively employed during day time.

Encouraging all parents to “dream for their child” despite odds, Samanmali Sumanasena, Professor in Paedeatric Disability and Head of the Department of Disability Studies, Faculty of Medicine, University of Kelaniya, urges all partners in paediatric health services to support families with children with mental and physical disabilities. “Research shows that early intervention can make children more cognitively competent and they can be developed into very productive citizens”. In this process, access to correct information, proper referral systems, child intervention services, updated technology for optimum benefits, access to general health care and family support systems are imperative, she says. Training parents and caregivers to routinely intervene to improve their children’s quality of life is important, she points out. Lack of specialists who

 can address the concerns of children with special needs in the country is a major bottleneck in enabling wider reach. The Special Needs Programme which was launched in Colombo District in July to meet this challenge is being expanded to the rest of the island as well, says Prof. Sumanasena.

Rehabilitation which is recognized as a human right by the United Nations’ Convention on the Rights of Persons with Disabilities, improves the functioning status of people with disability to achieve the highest possible functional outcome, notes Dr. Sachithra Adhikari, Acting Consultant in Rehabilitation Medicine from the Rheumatology and Rehabilitation Hospital, Ragama.

“Lack of an established care pathway directed towards rehabilitation following initial treatment of disability, is a major drawback. Rehabilitation services are provided only by a few hospitals which hardly meet the need.” She goes on to note that the need to generate awareness on the importance of rehabilitation and its cost benefit both among the healthcare professionals and the public is urgent. Drawing attention to limitations in available rehabilitation personnel and infrastructure, she said the lack of coordinated service provision, leadership for financial and administrative support required for rehabilitation service are problems that need addressing. Also, social acceptance of those with disabilities rather than mere sympathy is important together with sensitivity to their plight.

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The uncommon touch at ‘The Commons’

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by Malinda Seneviratne

On the face of it the name of the small, cosy and friendly restaurant on Ernest De Silva Mawatha, Colombo 7, sounds pretentious. ‘The Commons’ after all refers to ‘land or resources belonging to or affecting the whole of a community.’ The restaurant is not common property. The onus, one would think, is on the owners to ensure ‘belonging.’

That’s about good service, mostly.

Now I’ve not bothered about the labels for I’ve dabbled enough in the advertising industry to know what’s what and what’s not. I’m old enough to focus on substance and leave it at that.  For example, Sooriya Village, formerly a restaurant which was ‘surrounded’ by a practice studio, recording studio, bookshop, hangout place for anyone in any of the arts and a location for interviews, weddings, book launches etc., was not a ‘village.’ There was sun but not always, and anyway shade was what I preferred. There was warmth and like any village, there was a sense of belonging amidst multiple ways of differentiation.

The Commons. That’s what this is about. I’ve been here hundreds of times, literally. Sometimes I’ve ordered a coffee, sometimes food. Sometimes it’s been, much like Sooriya Village, an office of sorts. People meet me here. I ask them to come. Most days though, I just sit somewhere and write. Always received with a smile. No questions asked, except if I wanted some water. Indeed, sometimes, the water is served even without the question.

You could put it all down to familiarity and general Sri Lankan hospitality. After all, I’ve not surveyed others who sit here and hardly ever order anything.

This morning, Thursday January 14, in a Covid-19 encumbered world, I realized that it was not just about familiarity. Here’s my story.

I walked in. My way was partially blocked by what I thought was a television crew.

‘Are you shooting a film?’ That’s what I asked.

‘No, it’s a shoot,’ I was told.

So I went to the open space at the back of the restaurant, sat down as I often did, opened my laptop and started to type.

The ‘crew’ moved to where I was. A camera on a tripod and a photographer. A young man was seated at the table. A young woman appeared to be arranging things. Food was served to a nicely laid table. I realized they were photographing the food.

‘Are you going to shoot the entire menu?’ I asked.

They smiled and affirmed it was so.

‘He won’t be able to eat all the food — you might as well give me some!’ I said in jest.

They shot. I wrote. A few minutes later, the owner, the legendary Harpo, arrived. He saw me and greeted me with that inimitable smile of his, brought his hands together a la Covid-19-induced greeting protocols and said ‘hi.’

I responded and repeated my observation: ‘if they are going to photograph the entire menu, you could distribute the food among all of us.’

In jest. Didn’t think twice about it. Went back to my work.

Fifteen minutes later, Prasanna, one of the waiters, came up to me with a platter of wraps. Cheesy eggs and bacon tortilla wraps with some dip that I couldn’t identify. Prasanna didn’t know that I didn’t eat meat. There was a hint of dismay in his eyes so I said ‘I will remove the bacon and eat the rest.’ I avoid eggs too, but I indulged. Great stuff. Lunch, for me. On the house.

I didn’t need that to feel at home. I’ve always felt at home. I don’t own ‘The Commons’ but I was always convinced I belonged here or rather that it belongs to me. Everyone, from the security guards Kingsley and Sudakaran, to the waiters (the long-standing ones and the students doing internships or side-jobs), the managers and Harpo himself never once said or did anything to make me doubt this.

I don’t recall having seen Pravin Jayasundere, a student at Law College who has been doing photo-shoots on the side for a few months now, and Rajeev Coltan, the ‘model,’ at ‘The Commons.’ I don’t know what they feel or how they’ll ‘see’ this place if they became visitors as regular as I have become. I don’t know if they’ll secure common ownership, so to speak. I don’t know if they’ll feel as ‘belonged.’

I can’t speak for others. This is my place, and I don’t mind others owning it, Harpo included. It’s common property in the middle of a high-end residential area of Colombo. Pretty uncommon.

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Tastes and flavours from around the world

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Plates is a 24 hour muilt cuisine restaurant bring the best of World cuisines together. Ou can embark on a journey of culinary discovery form around the globe.

by Zanita Careem

Having always been a trailblazer in epicurean experiences, Cinnamon Grand Colombo continues that momentum with the launch of Plates, its 24-hour gourmet dining venue with an unparalleled collective of tastes and flavours from around the world. The restaurant will be open to the public from Saturday, 16 January.

Plates is all about experiences: the experience of friends and family dining together, the experience of enjoying multi-country multi-cuisine dishes at any time of day, the experience of having a gastronomic tour of global cuisine in a single venue and the experience of enjoying the tropics in alfresco dining or seated within the contemporary sleek interiors in air-conditioned comfort. It also boasts a unique range of beverage options, specially crafted with local ingredients. The unusual, yet satisfying blend of components will give guests a wide variety of beverages to choose from, to complement their meals.

Cinnamon Grand Colombo General Manager Kamal Munasinghe, commenting on the new restaurant, said, “Plates offers a place for guests to come together and experience a multitude of international cuisine, 24-hours of the day. The ambiance and décor have also been done to support togetherness, and an environment where food can be enjoyed on many levels, in different types of ‘plates’. The fresh new look, as well as the unique offerings in both food and beverage, which have been developed with intricate detail, are aimed at giving guests the finest culinary experiences.”

Plates’s interiors hold a modern colour palette of white, blue and copper, with a contemporary look and feel intended to compliment the view of the pool, with its blue hues encircled by verdant greens. This tropical canvas is seen through large French windows which open onto a deck and outdoor bar for the perfect alfresco dining ambience. The delightful tropical weather which Sri Lanka has can be enjoyed at any time of year due to the retractable awning that sits atop the deck of this alfresco space.

The essence of Plates is all about togetherness, echoing the axiom that “the fondest memories are made gathered around a table”.  Add the multiple plates of Continental, Indian, Asian and Sri Lankan into the gastronomic recipe and food does bring people together. 

Whether it’s the decadent buffet spreads for breakfast, lunch and dinner, a special children’s menu, all day A la carte dining or an extensive range of beverages including wines and cocktails. The night snack menu includes hand-picked selections from the À la carte menu.  Curated music styling accompanies each gourmet journey adding to the unique ambience.

The buffets have always been legendary at Cinnamon Grand Colombo and Plates is heaven on a plate.  While the international breakfast buffet includes continental, American, Sri Lankan, Indian and even a Japanese corner, the lunch and dinner buffets add Far Eastern, Mediterranean, Arabic, carveries, pasta station, live pizza oven, a salad bar, a healthy corner and desserts with an action station, promising to pile those plates high. 

For lunch, guests who wish to enjoy a light and healthy lunch can enjoy the salad-and-dessert-bar only option. And memories of blissful Sunday brunches are brought back to life at the Sunday Brunch Buffet which has all of the above and more, including a surfeit of seafood from oysters, mussels, jumbo and lagoon prawns, shoe lobsters and salmon, Shawarma and Mongolian counters, an extensive range of carveries and grilled meats and a delightful chocolate fountain adding to the desserts.

Adhering to stringent COVID-19 guidelines as directed by the Government and the Ministry of Health protocols, Plates has a total seating capacity of 163, with the deck area seating 41, while all guests are subjected to strict health and safety protocols. More details are available at www.cinnamonhotels.com/cinnamon-care.

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“Selling the Family Silver” and India-SL bilateral relations

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by Dr Sarala Fernando

A remark attributed to the US Congress that “Sri Lanka is a valuable piece of real estate” had made the news here hinting at the strategic value of our island location while some had connected the remark to the MCC, an economic project integral to the US pivot to the Indo Pacific.

This sudden interest in Sri Lanka’s land assets made the headlines after Harvard economists in 2016 advised on the incorporation of a land project under the MCC to address constraints to national growth by a re-survey, re-valuation and deed grants on lands around the country. Local experts argued that such a programme would lead to pressure on smallholders to sell land to more powerful entities for commercial exploitation increasing rural poverty, environmental and wild life destruction and water scarcity.

The Harvard economists and the MCC have come and gone. However, it seems the spirit of their view of land as a commodity is still alive judging by recent government decision to release nearly 1.5 million acres of other state forests to be repurposed for development work. This has become a hot topic of discussion and environmentalists have filed court cases to revert to the previous protection provided to unrecognized forest covers.

The silent constituents, the trees and the animals have felt the brunt of this decision with the increased deforestation and destruction of mangroves, the killing of large mammals like elephants and even our prized leopards and most recently hundreds of birds found dead, probably poisoned, off Wilpattu. Are there criminal gangs behind the sudden spate of shooting of tuskers and snaring of leopards, questions still not answered by the authorities? The government focus on land has extended to the urban areas where long standing wholesale markets, social and sports clubs have been taken over by the UDA with scant explanation of the reasons behind the seizures and plans for redevelopment of these valuable lands (urban housing/recreation for the public?). Selling lands, the equivalent of the proverbial “family silver” is to be expected in these extraordinary times where Sri Lanka has heavy foreign debt obligations.

However since the government land acquisition strategy remains opaque, without consultation or explanation of any business plan, public protests are now spreading even to non-agricultural foreign investment proposals ranging from allocating the ECT terminal in Colombo port and the KKS port to India, to mining of titanium from sands in Mannar – a water scarce area – to an Australian company . Land issues came to the fore early when the Tourism authorities set up a one-stop shop for new hotel construction despite the crisis in the hotel industry with the Covid epidemic and drying up of tourist flows. In other countries, empty hotels are being taken over by the government and converted to new uses like urban housing; however our authorities seem more concerned about allocating land in water shortage areas like Kalpitiya and Mirissa for 600 room hotels, so called “foreign” investments promoted by local barons.

In Yala, a new foreign managed hotel has suddenly emerged and is said to be destined for those “high spending” East European tourists irrespective that Yala is suffering from over-tourism and the animals are more in need of food and water. Added to the confusion, in parliament it was announced that the source of the second wave of Covid infection had been traced to a Ukrainian pilot and now the public is in a panic over the pilot project to bring in hundreds of Ukrainian tourists.

Public protests are spreading in agriculture areas with the Mahaweli authorities demarcating lands for large scale foreign investment taking from forest reservations and commons, dislocating animal feeding grounds and overriding even the demands of the local villagers for protection of their rights to customary land and forest use.

A recent news item featured the Agriculture Ministry offering Rs 700 million to local farmers to grow fruit for a foreign multinational company which will provide the plants and drip technology and presumably buy the fruit cheap and retain the export earnings for its own profit! What will be the value addition for the government if they have also provided tax concessions for the foreign investor? Even more serious, what will be the negative impact of these tasteless new hybrids on our heritage varieties of delicious local pineapple and bananas? Once the valuable land is allocated, the promised foreign money transfer may not even take place, the foreign investor’s preference usually being to bring in little foreign exchange and to borrow from local banks. Thus, when there is trouble, the “footloose” foreign investor gets away leaving local banks and insurances saddled with non-performing loans.

From the time of the Greek civilization, people have been lamenting over the vagaries of weather and other threats invariably faced by agriculture, which makes large scale operations a risky business. The problem is that tax concessions are being offered today to promote large- scale agriculture without the safeguards to prevent expensive failures. Even local large plantation companies are finding it difficult to operate today with all their experience, given the issues of soil depletion, non use of chemical pesticides and fertilizer and rising labour costs. Yet it seems an intrepid developer with more experience in seafaring than agriculture had demanded 40,000 acres to grow maize – (mind you he may not have heard about the fallworm crisis). Fortunately those in charge of the Mahaweli lands had allocated only 5,000 acres for a trial project but still this is hardly a good example of due diligence which should look for experience in agriculture rather than the usage of prison labour, as announced by the entrepreneur.

Before it is too late, we should learn from the experience of our neighbour India. I recall a lecture by the eminent Dr M. S. Swaminathan many years ago at the Lakshman Kadirgamar Institute (then Sri Lanka Institute of International Relations) where he prophesied that the intensive agriculture “green revolution” would eventually render barren productive areas of their country due to heavy chemical applications degrading the soil. In India today, they are returning to traditional farming practices to revive the soil, re-foresting and trying to connect the farmer to the markets.

Instead of cattle grazing on open land, sheds are being constructed within the village and herders encouraged to bring feed to the cattle. Should we not even now look to small, smart and more sustainable practices to make small farmers more independent? Talking with farmers growing organic high value rice varieties on their lands in Wellawaya with support from Jetwing, it seems they still have faith in traditional practices, calling the mechanical harvester “boothaya” and preferring to bring down buffaloes from Bandarawela to the tractor! Bangladesh is tapping the Indian experience in elephant conservation which is a new area of their bilateral cooperation. Private sector investors in India have recently set up a hospital for treatment of sick domesticated elephants with ultra modern equipment.

Here in Sri Lanka, despite the interest of private philanthropists, the government appears unwilling to give land for an elephant sanctuary or “soft” release area for translocated bull elephants. A central question is why, as a Buddhist nation, Sri Lankans have not included into the Constitution, the protection of animals and living creatures as illustrated in every step of the Gautama Buddha’s life journey and his preachings? Even today, many proposals to strengthen the environmental safeguards and ethical treatment for animals have been sent to the Committee to prepare a new Constitution, but no one has even received an acknowledgement! By contrast, the Indian Constitution is way ahead of us, Article 51-A (g) which deals with Fundamental Duties of the citizens states: “It shall be the duty of every citizen of India to protect and improve the natural environment including forests, lakes, rivers and wildlife and to have compassion for living creatures.”

Our land endowment also includes the small islands, over 100 around the mainland, enabling extension over expanses of territorial seas. Instead of pushing only commercial fisheries, should the government not think about declaring a marine sanctuary zone all around our island, a domestic security Zone of Peace with proper management safeguards for national land and maritime resources? Sri Lanka received too many multi-day boats after the tsunami, several of which have been converted to nefarious purposes like illicit immigration and smuggling.

Furthermore, why prioritize investment in commercial fisheries at a time when global attention is being called to clean

ing the oceans, replenishing fish stocks, restoring coral reefs and mangroves affected by rising sea waters and ocean temperature rise? Protecting our seas and coastline should be given high priority since our island is in the vicinity of some of the busiest sea lanes in the world and vulnerable to disasters such as New Diamond oil tanker which caught fire off the East Coast.

Cooperation with India has been vital in this regard throughout the years as they have access to both expertise and stocks of fire fighting foam which can be quickly deployed.

While enhancing cooperation with India in addressing marine disasters and security issues such as smuggling, illicit immigration and terrorism/criminal related activities of mutual concern, as a small state with no pretensions for offensive power projection, we should feel free to disagree with India on the imperatives of high defence spending and partnering with the US on security manoeuvres in the Indian Ocean with their latest weaponry.

The recent Malabar naval exercises by the Quad in the Bay of Bengal and naval sonars are believed to have impacted the unprecedented beaching of some 100 pilot whales in Kalutara around the same time, rescued after a marathon effort by our navy and volunteers.

(Sarala Fernando, retired from the Foreign Ministry as Additional Secretary and her last Ambassadorial appointment was as Permanent Representative to the UN in Geneva. Her Ph.D was on India-Sri Lanka relations and she writes now on foreign policy, diplomacy and protection of heritage).

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