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When docs flout health guidelines

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I went to the Osusala Agent (branch) at Thalawathugoda to buy some medicine for our dog specially because I was keen to obtain generic products obviating the need to pay through my nose for branded products. There was a notice very prominently displayed on the door that there should be no more than three customers inside at any given time. This was one of the rare places that still had a functioning water source to wash hands and a sanitizer dispenser too for those who preferred the latter. There were three customers already being served so I waited outside till one of them came out.

When it was my turn, I walked in and waited till a shop assistant (Pharmacist/Dispenser) was free to talk to. A couple of minutes into my being served two chaps walked in (now four inside, one more than the number allowed) and one of them tried to show something on his cell phone to the shop assistant. I told him “Son, I am still being served and you are not maintaining the one metre distance either”. He apologised and distanced himself. I was still being served and this chap accompanied by the other bloke approached the counter again when I reminded him that I was still being served. He then said “meka pana adina pilika ledekuta” backed up by the other man. The accomplice was a stout curly haired light tan complexioned chap who seemed self-important. He said, “I am a doctor”. I replied “I am a doctor too. That is why I am so particular about following health guidelines myself and am very concerned about those around who break them with the greatest impunity”. He apologised, didn’t he? What’s the point in apologising when he keeps repeating the same ‘mistake’? I am an MO at the NHSL, you may be a Consultant but don’t shout as he had apologised to you. Yes, I have been a Consultant in the Department of Health Services of Sri Lanka for 25 years. Apologising cannot prevent the spread of Covid, I said. The two barged to the counter from my left showed the phone to the pharmacist, asked if that drug was available and disappeared from the premises shouting derogatory remarks at me.

This doctor if he is one, needs to be disciplined by the SLMC for many reasons

1) He blatantly flouted the instructions given on the door of the pharmacy by coming in as the fourth person.

2) He and his friend openly and blatantly disregarded the health guidelines by almost abutting against me.

3) He tried to justify all the wrongdoing

4) He was helping the friend to find an anticancer drug for a patient, who in their own words “pana adinawa” (NO ANTICANCER DRUG CAN BE ADMINISTERED TO A GASPING PATIENT)

5) It is most likely that the drug they were looking for was not an anticancer drug at all but said so to justify their wrongdoing.

Gone are the days when doctors were treated as demigods and quite rightly so as well. These are people who gain admission to the Med school with 50 or 60 marks less but from Timbuktu. For them it is like winning a lottery. These people have no empathy. They disown their own ranks after ascending the social ladder. They do sweet nothing in the hospital marking time till 4.00p.m. to make a B-line to their private practice to squeeze the sap out of the helpless and the hapless. Most of these people even do not have the necessary basic knowledge to practice as a doctor. In a country where people don doctorates brewed in the backyards of China and call themselves ‘Acharya’ what more can you expect? Over to you Mr. President, Sri Lanka Medical Council.

Dr. M .M. Janapriya



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Opinion

Losing Oxygen

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Loss of free atmospheric Oxygen: We are taking out more than ecosystem can put back

The ability of expressing our fundamental right to breathe clean air is over. The Global Commons of air is rapidly being impacted, in addition to an increase in the concentration of Carbon Dioxide and a decrease in Oxygen concentration. The concentration of toxic gasses and airborne particulate matter in the atmosphere is increasing. While a global compact on the quality of air as a fundamental right, is urgent consideration of its impact on health must also become a matter of concern. he most essential thing for our existence is the ability to breathe. The air that we take for granted is like an invisible river of gasses considered a part of the ‘Global Commons’ or those resources that extend beyond political boundaries. The Commons of air is composed of a mix of gasses, the dominant being Nitrogen at about 78%, followed by Oxygen at 21%. Carbon Dioxide that is contributing to climate change accounts for only 0.04% and demonstrates how small changes in the concentration of gasses in the atmosphere can bring about massive changes to those that live in it.

The Oxygen component of the air we breathe was made by those earliest plants, the Bryophytes, which colonized land from 470 Ma onwards. This land colonization increased atmospheric oxygen to present levels by 400 Ma. The fire-mediated feedbacks that followed have stabilised high oxygen levels ever since, shaping subsequent evolution of life. Oxygen is the most crucial element on earth for the aerobic organisms that depend on it to release energy from carbon-based macromolecules. The current stocks have been maintained over millions of years by plants, terrestrial and oceanic. To sustain a gaseous concentration at around 21% of the air we breathe. This level is required to maintain a healthy body and mind. A lowering of this concentration has consequences. At 19% physiologically adverse effects begin. Impaired thinking and attention, reduced coordination, decreased ability for strenuous work is experienced, at 15% Poor judgment, faulty coordination, abnormal fatigue upon exertion, emotional upset Levels below this lead not only to very poor judgement and coordination but also impaired respiration, lung and heart damage. The question often arises: ‘If the atmospheric Oxygen concentration is 21% how can it vary so widely in different areas ? The answer is that ‘when you add other gasses, smoke and aerosols into the atmosphere, the concentration of atmospheric gasses will decrease in concentration. In some cities like New Delhi or Mexico have Oxygen concentrations measured at about 18% or lower.

There has been a clear decline in the volume of oxygen in Earth’s atmosphere over the past 20 years. Although the magnitude of this decrease appears small compared to the amount of oxygen in the atmosphere, it is difficult to predict how this process may evolve, due to the brevity of the collected records. A recently proposed model predicts a non-linear decay, which would result in an increasingly rapid fall-off in atmospheric oxygen concentration, with potentially devastating consequences for human health.

The free Oxygen in the atmosphere is 1.2×1015 tonnes (12,000,000,000,000,000 t), but it is unstable in our planet’s atmosphere and must be constantly replenished by photosynthesis in green plants. Without plants, our atmosphere would contain almost no O2. An important thing that needs international address is the fact that the system that replenishes the Oxygen of our atmosphere is under threat. We remove the vegetation that produces the Oxygen at a prodigious rate. According to Global Forest Watch we fell about 15 billion trees each year. With one tree one tree producing about 120Kg of Oxygen per year, the loss of Oxygen production through deforestation is massive. The impact on the oceans is becoming just as serious.

As human activities have caused irreversible decline of atmospheric O2 and there is no sign of abatement, It is time to take actions to promote O2 production and pay for industrial use and consumption of O2. Vehicular traffic in cities with poor air flow design transforms molecular oxygen O2 into Ozone O3. Ozone is good when it is high up in our atmosphere. It protects us from sunburn. Ozone is bad when it is near the ground where we can breathe it in. You can’t see ozone in the air but bad ozone levels is sometimes called smog. It is formed when chemicals coming out of cars and factories are cooked by the hot sun. Breathing in ground-level ozone can make you cough. It can also make it harder for you to breathe. Ozone might even make it hurt to take a breath of air. When you breathe in ozone, it makes the lining of your airways red and swollen, like your skin would get with a sunburn.

All this becomes even more pressing with the discovery of the “human oxidation field” a beneficial chemical microenvironment formed around the body’s surface that helps protect it from volatile organic compounds (VOCs). This field is generated by the reaction of ozone with oils and fats on our skin, especially the unsaturated triterpene squalene, which constitutes about 10 percent of the skin lipids that protect our skin and keep it supple. The reaction releases a host of gas phase chemicals containing double bonds that react further in the air with ozone to generate substantial levels of OH radicals. As the Ozone levels as in cities rise, the individual ‘human oxidation field’ looses its ability to maintain skin health.

In looking at the question of why there was such a rapid loss in the quality of air, the first study to systematically analyse the global O2 budget and its changes over the past 100 years, found that anthropogenic fossil fuel combustion is the largest contributor to the current O2 deficit, which consumed 2.0 Gt/a in 1900 and has increased to 38.2 Gt/a by 2015.

The inability to defend our fundamental right to breath seems to stem from the ability of any industry to discount the consequences of burning fossil fuels as a ‘negative externality’. Climate Change is one consequence, but the impact that lowered Oxygen concentrations will have on emerging urban populations seem disturbing. There is only one way to arrest the fall in atmospheric Oxygen, increase the rate of photosynthesis. There must be a protection of the existing stocks of photosynthetic biomass and programs that encourage increasing the standing stock of Oxygen to be able to sustain our fundamental right to breathe clean air.

by Dr. Ranil Senanayake

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Opinion

Appreciation: Upali Tissa Pieris Seneviratne

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My brother, close on two years senior to me, was into sports – cricket, football, and athletics were his favourites. We were at De Mazenod College for our primary schooling, moved apart thereafter – he to Ananda College which had hosted all our male relatives from our father and his brothers, our mother’s brothers and all our male cousins on either side, while I was sent to Royal. He moved, thereafter, to the Royal Post-Primary which turned into Thurstan College.

There he distinguished himself at cricket and, together with his captain, Brindley Perera, provided the runs. He also had the distinction of being the first at Thurstan to pass the SSC examination. At that point he returned to De Mazenod where he won, what was called, the Senior Proficiency Prize, captained the cricket eleven, and was the senior athletics champion.

That last was witnessed by the district head of the Police and led to his being rapidly drawn into the Police force.

Following initial training at Katukurunda the new recruits were posted to distant Police Stations as Sub-Inspectors. He had spells in the Hiniduma area and in Galenbindunuweva, off Anuradhapura.

It was while he served at Anuradhapura itself that he met with an accident that almost took his life. He came out of that with a limp.

That did not prove to be a substantial handicap and he served with distinction in Kosgoda and other stations on the south western coast before he was moved to the CID. There he played a major role in solving what came to be known as ‘the Kalattawa Case’, which led to the arrest and due punishment of a wealthy producer of illicit booze – a man who had ‘pocketed’ a good many public servants who were entrusted with the enforcement of the law.

In the early 1970s, he was entrusted with investigations related to the activities of a group of agents of Lankan and foreign right-wing politics, which called itself ‘the JVP’. Among those he had arrested was a colleague of mine, Susil Siriwardena, who later managed to secure a show of incarceration in a Ward at the General Hospital (where the only luxury he enjoyed was access to some books). In due course, many years later, President Premadasa, besides other responsibilities imposed on him, related to his initiatives in Village Reawakening (Gam Udawa), put Susil in charge of the Janasaviya programme.

It is a pity that my brother and fellow officers have not placed on record their experience of that ‘April Insurgency’.

My brother served with distinction in both the CID and the CDB. When Lalith Athulathmudali was in charge of Internal Security, in the late 1970s, my brother was seconded for service in that Ministry as Director of Training. The Secretary was Denis Hapugalle, who was an Army man – and their approach to ‘training’ differed. After a year or two, Upali reverted to the Police and took early retirement to set up a Security service that served several Mercantile establishments for over 30 years.

He contributed much to the development of the Police retired senior officers organisation, which he served for many years as its Secretary and its President.

He was the most generous of men and gifted with a sense of humour that he would have inherited from our father. May he reach the bliss of Nirvana!

D G P (Gamini) Seneviratne

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Opinion

Archaic rules affecting bank customers

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At present, there is a rule in (state-owned) commercial banks that prevents individuals from opening accounts if they reside in an area different from the address stated on their National Identity Card (NIC). The justification offered is that this helps prevent money laundering and the handling of illicit funds.

However, one must question the logic of this rule. How exactly does it stop such individuals? A person with ill intentions could just as easily open an account in the area mentioned on their NIC. Moreover, even if there are, say, one lakh fraudsters in the country, this rule effectively imposes restrictions on twenty lakh genuine citizens — penalising the many for the misdeeds of a few. How fair is that, and how does it encourage people to save and participate in the formal banking system?

The government constantly speaks about digitalisation and technological advancement, yet continues to tolerate outdated and impractical regulations like this.

Consider another case: a customer of a state bank urgently needed to encash a fixed deposit opened at a distant branch. When he approached the branch near his current residence, he was told to visit the original branch, as that branch must physically receive the original FD certificate upon encashment. One wonders what is the use of highly paid branch managers, fax machines, emails, and even WhatsApp, if two branches cannot coordinate to resolve such a simple issue?

Unfortunately, the customer has to travel 200 km to reach the original branch.

If the government truly wishes to build a modern, technologically advanced financial system, it must first eliminate such archaic rules and adopt smarter, technology-driven safeguards against fraudsters — without punishing honest citizens in the process.

A Ratnayake

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