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Why hide the truth about CKDu?

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By Dr PARAKRAMA WAIDYANATHA

An open letter to the new Minister of Health

The chronic kidney disease (CKDu) has been a major non-communicable disease prevalent essentially among the Rajarata’s agricultural communities in the last three decades that had, on average, killed several thousand people annually. The disease aetiology is now known, with a high degree of certainty to be hard water in dug wells on high ground contaminated with fluoride. Because it largely affected the farming families, agro-chemicals were justifiably suspected as the cause although without evidence; and many, especially the ignorant politicians, including several key ministers without knowing the facts of the matter, have blamed agrochemicals.

In fact, the term wasa visa krushikarmaya (toxic- agriculture) was coined on conventional agriculture largely because of the misinformation. Ridiculous boards displaying that fruits and vegetables sold in wayside shops are ‘toxin-free’ have been a common sight. The shopkeeper hardly knows the origin of the produce!

Then, there was the much-hyped ‘toxin-free agriculture” or organic farming drive of the Yahapalana government, led by the then President and Ven. Ratana, which again was on the premise that agrochemicals are the cause of the disease. It was, however, a total failure. And it would appear that the current President too, rushed to organic farming with the misinformed judgment that agrochemicals are the cause of CKDu, and probably also of other non-communicable ones, although there has been no evidence for it! He should have consulted the scientists and academics in the relevant fields before rushing to the decision.

However, the new Finance Minister has, in a recent gazette notification, dated 31st July 2021, claimed to be published in order to “regulate the importation of chelated minerals and micronutrients” which were previously banned, has also ‘surreptitiously’ reverted the Presidential decision; allowing imports of virtually all straight chemical fertilizers and mixtures thereof, but on license! So, hopefully, farmers should have access to chemical fertilisers for the coming Maha season!

Be all that as they may, the writer’s concern is that despite the overwhelming research, as also supportive numerical evidence the Health Ministry/Department has been generating on the prevalence of CKD, through a broad surveillance with nationwide sentinel sites that has also supported the observation that drinking water quality is the major cause of the disease, it has hitherto made no formal pronouncement on the disease causation. Regrettably, neither the former Health Minister nor the Agriculture Minister seem to be aware of this fact, from the utterances they have made recently in Parliament and outside. In fact, both of them were seen yelling in Parliament, some days ago, that the cause for the kidney disease is agrochemicals! Further, at a meeting with the farmers some weeks ago, the Agriculture Minister exclaimed that the government has rushed into organic farming to save the kidneys of farmers!

Mr. Minister, please be aware of the following facts and take necessary action to clear the myth in the minds of the President, ministers and other authorities, that agrochemicals are the cause of CKDu, the number one non-communicable in the country:

1.

The scientific and medical community have developed an understanding of the origins of this chronic disease. Steps to control it have shown increasing success as the numbers stricken by the disease have decreased since 2016, following supply of clean drinking water to the residents of the endemic areas. And it is now critically important that people of all affected areas are provided with good quality drinking water. Apparently, when the Yapahalana authorities then “flogging the dead agrochemical horse” came to learn that polluted water was the cause of the disease, rumour was doing the rounds, that the authorities did not want people told about it for fear of an outcry for quality water!

2.

Research by at least five groups and many individuals, local and foreign, have shown that the disease is caused by the consumption of water from wells containing hard water and fluoride, found in geological formations known as Regolith aquifers that hold the water in the relevant dry zone areas. People who were settled rapidly during the Accelerated Mahaweli Programme on higher ground in the late 1970s, had to dig shallow wells or tube wells for their water supply. Estimates reveal that there are some 176,000 such wells in the Rajarata! CKDu is found essentially in villages drinking water from such wells. Residents who get their water from agricultural canals, rivers or reservoirs DO NOT CONTAMINATE CKD, whereas one would have expected them to do so if agrochemicals were the cause of the disease. Please see the attached graph (Fig. 1) from a publication by none other than Dr Asanga Ranasinghe, Coordinator of the CKDu Programme, Ministry of Health and others (BMC Nephropathy, Aug 2019) that reveal a sharp drop in the number of patients in the two most CKD affected districts of Anuradhapura and Polonnaruwa. This was a consequence of provision of safe drinking water, and in fact the people themselves in the affected areas realised that polluted water was the cause of the disease, and not drinking it. Further, the Table 1 below compiled from the data of 2018 Annual Health Bulletin (page 70), also confirm a sharp decline in the increase in patient numbers from 52% between 2014 and 2016 to just 12% between 2016 and 2018, which should essentially be a consequence of drinking good quality water. There is no other evidence to explain this prominent decline.

Sadly, however, the 2019 Annual Health Bulletin does not carry any information on the CKDu status, despite there being a nationwide Sentinel Survey of patient numbers; and the 2020 Annual Health Bulletin too has not been published to date! Why are the health authorities so negligent about the number one non-communicable disease in the country! Table 1

3. There is CKDu in areas like Mullaitivu where no agro-chemicals whatsoever have been used due to the Eelam wars. So it is now amply evident that residents who drink hard water rich in fluoride contract CKDu, but not those who drink water from streams, reservoirs and wells in the planes.

4.

No CKDu is found in the Hill Country (vegetable and tea cultivation) and in most other areas such as Kalpitiya (vegetable cultivation) where agrochemicals are used much more heavily than in the Rajarata.

5.

The WHO Report, 2013, concluded, amongst other things, that some CKDu patients secreted pesticide residues above the reference (permissible) levels, but did not refer to the pesticide residue status in the urine of the control subjects (from Hambantota) in the trial! Our subsequent analysis of the pesticide residue raw data, revealed that the numbers of subjects with urine pesticide levels were two to three times higher from the non-CKD (Control) area than among the CKD patients (See Table 2). Why did the WHO Report omit this critically important control data? Referring to pesticides, the Report merely stated that some CKDu patients had residues of some pesticides above reference limits! Was it to give the impression that pesticides were probably the cause? However, an International Expert Consultation held in 2018 on CKDu in Colombo, concluded that there is no evidence to implicate agrochemicals in the causation of the disease.

6.

Several ministers and most importantly even the President of the GMOA, Dr Padeniya have been repeatedly claiming that Sri Lanka is the country consuming the highest quantities of agrochemicals in the world. However, the published data of the World Bank (see Table 3) reveals that in this part of the world, we are the country consuming the lowest amount of fertiliser and the second lowest amount of pesticide per unit area!

In conclusion, the disease is evidently caused by consuming naturally contaminated well water. It has nothing to do with fertilisers or pesticides. The disease is prevented by supplying clean water to the endemic villages. This has been done largely by the distribution of rain-water collection tanks, and by the installation of reverse-osmosis water filtration plants by benevolent donors. Moreover, people in the affected areas are now aware of the cause of the disease and are taking preventive measures themselves, as evident from the data.

Please bring this information to the attention of the President and other authorities, so that vital national decisions are based on facts, and not myths!



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Opinion

Dr. Lal Samarakoon (01-09-1955-12-07-2024)

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Dr. Lal Samarakoon was born in Dehipe, Padiyapalella, Nuwara Eliya. He had his primary education at Gampola Zahira College and Ratnapura Ferguson College, and entered the University of Kelaniya from Matale Science College.

Obtaining a B Sc. degree in Physical Science with a first class, he qualified as a Surveyor from the National Survey Department and started serving the Mahaweli Development Program in Girandurukotte in 1986. Lal was awarded a Monbusho Scholarship, by the Government of Japan to obtain the Doctor of Philosophy degree in remote sensing from the university of Ehime.

He served Nippon Koei, a planning, design and construction company for several years. In 1998, Lal was appointed the Director of Geoinformatics Center of the Asian Institute of Technology, Thailand. He served in this position till 2018.

Dr. Lal Samarakoon has represented a generation that has seen the disaster risk management discipline transition from the sidelines of a welfare-oriented subject to a full-fledged discipline, which has emerged as a component of development discourse subsequently. He was a deep-thinking technocrat, innovative scientist, and dependable professional who firmly believed technology applications are needed to manage disasters and build climate resilience in Asia.

He observed the significant capacity gaps that exist in Asia in applying remote sensing and GIS tools in disaster risk management, and supported the countries in the Asia region to reduce these capacity gaps over the last 30 years. During his longstanding career at the Geoinformatics Center of the Asian Institute of Technology (AIT) he developed methodologies which provided better exposure for disaster management professionals in the region to use spatial information in Disaster Risk Management.

He successfully partnered with other international technical and academic institutes, including with the postgraduate Institute of Science in Sri Lanka, broadening the objectives and opportunities for cross-learning. His work was instrumental to prove that scientific advancement can be utilized successfully and cost-effectively to improve disaster risk management and climate adaptation practices.

His work as a scientist supported applying spatial data in several countries in the Asia region; the Lao PDR, Cambodia, Vietnam, Nepal for disaster risk reduction. Dr. Samarakoon will be remembered for his pioneering and outstanding contributions to Sri Lanka, and other countries in the Asia region with scientific innovation, training, education and policy support. His untiring efforts have helped create a pool of disaster risk management practitioners in mandated institutions, a much needed contribution for meeting the current day disaster and climate risk challenges.

May he attain nibbana,

N.M.I.S. Arambepola
Nirmala Fernando
Madhavi Malalgoda Ariyabandu

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Emerging narrative of division: Intellectual critique of NPP following presidential appointment

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President Dissanayake

In the wake of Anura Kumara Dissanayake’s appointment as President, an unsettling narrative has emerged from a small but vocal group of intellectuals within the Sri Lankan society. This faction seems intent on portraying the National People’s Power (NPP) as a social entity burdened with history of violence, a portrayal that is not only misleading but also dangerous in its potential repercussions for national unity.

The intellectual critique in question often draws upon past events from Sri Lanka’s turbulent history—specifically the insurrections of 1971 and 1988. These events, which were marked by political unrest and significant bloodshed, are being referred to create a negative image of the NPP, depicting it as an organisation with a legacy of violence.

While these incidents undoubtedly left deep scars on the national psyche, the selective emphasis on these periods, while glossing over other equally important historical contexts, is concerning. Most notably, the narrative ignores the three-decade-long terrorism perpetuated by the LTTE, which claimed thousands of lives and posed an existential threat to the country’s sovereignty. This omission, whether deliberate or inadvertent, raises questions about the motives behind such critiques.

Interestingly, this narrative is not confined to private intellectual circles. It has found its way into the mainstream media, including television programmes where a small section of the elite has voiced these concerns. Their views, though presented under the guise of objective analysis, appear to be rooted in specific historical grievances rather than a balanced understanding of the NPP’s present-day policies and leadership.

The portrayal of the NPP as a violent faction is not only misleading but also problematic for the broader national discourse. By continuously referring to past insurrections without addressing the socio-political context in which the NPP operates today, these intellectuals risk fostering division, rather than promoting constructive dialogue about the country’s future.

What is particularly troubling is the potential impact of these narratives on the minds of the innocent populations in the North and East of Sri Lanka. These regions, already burdened by decades of conflict, are especially vulnerable to manipulations of historical narratives. The attempt to seed fear and distrust through selective memories of the past could widen ethnic and political divides, reversing the hard-won progress made in reconciliation and peacebuilding efforts.

The implications of these actions are profound. If left unchecked, this manipulation of historical facts could fuel distrust, especially in communities that are still healing from the traumas of war. Such divisive rhetoric, which paints certain political movements in broad, negative strokes, undermines efforts to foster national unity, which is critical at this juncture in Sri Lanka’s development.

It is imperative that both the government and the informed public remain vigilant in the face of these developments. While free speech and intellectual discourse are essential in any democracy, the dissemination of false or misleading information must be addressed with caution. The current administration, along with media outlets and thought leaders, must prioritise the accurate representation of political parties and movements, ensuring that all voices are heard in an atmosphere of respect and truth.

Furthermore, the intellectual elite must recognise their responsibility in shaping public opinion. Rather than perpetuating narratives rooted in selective memory and old political rivalries, they should engage in constructive dialogue about how Sri Lanka can move forward—socially, politically, and economically. Only by acknowledging the complexities of the past and focusing on the present can the country achieve the progress and development it desperately needs.

In conclusion, the emerging portrayal of the NPP as a faction tainted by historical violence is a dangerous oversimplification of a more complex reality. It is crucial that all stakeholders, from the government to the intellectual elite, approach political discourse with a sense of responsibility and an eye toward the future. Only then can Sri Lanka continue its path toward reconciliation, unity, and sustainable development.

K R Pushparanjan

Canada

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Opinion

Towards a more profitable and sustainable agriculture

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One of the key happenings in human history, is the so-called “Industrial Revolution,” that originated about two centuries ago, (principally in Europe, North America and Japan), as the focal points. These are now broadly defined as “Developed Countries.” They distinguish themselves as having higher per capita incomes, and thereby offering their citizens better living conditions than do the “Developing” or “Less developed” ones.

It is tempting yet erroneous, to believe that what prevailed two centuries ago, can be transposed today to other countries including Sri Lanka, presently classified among the “Developing Countries.”

Typically, the industrial era manifested as a movement away from farming and towards machinery driven enterprises. The unspoken corollary is that what worked for them then, should do for us now.

This is a presumption that is unlikely to happen. Although a small tropical country within the Monsoon belt, we are fortunate in being spared weather-related atmospheric perturbations such as hurricanes, cyclones and tsunamis, that assail other similar countries and locations.

Overall, we are fortunately blessed with largely favourable climatic conditions and reasonably fertile soils, to ably support a sustainable, diversified and a seemingly unique mosaic of farming, livestock and forestry. This is worthy of protection.

By virtue of our geography, climate, tradition and aptitude, we are well positioned to be a dominant base for a vibrant Agrarian Economy.

A composite of the sectors deriving from plants and animals, best suits our natural strengths. This leads us logically to seek economic advancement through this sector, with a blend of farming, livestock and forestry, to best support environmental stability as our long-term goal.

Two factors that are poised to impact on Worldwide agriculture, are “global warming” and a looming water crisis. These will affect different regions with differing severity. This has aroused much international concern. Sri Lanka would do well to prepare itself for this eventuality.

In the particular context of Sri Lanka, the priority considerations in the agricultural sector, calling for close and timely attention are as follows:

(i) Correcting weaknesses in the Extension Services which are primarily blamed for under- performance. All officers concerned, would benefit from periodic exposure to training that is designed for upgrading knowledge and sharpening requisite skills.

(ii) The Sri Lankan Agricultural Sector divides into two components, –namely, the Export and Local Crop sectors. Animal farming is set apart, and historically has received less attention. However, the recently expanding poultry industry, has resulted in greater attention to livestock expansion.

(iii) In Ceylon’s colonial history, it was the British, who exercised their sovereignty over the whole island, succeeding the Portuguese and Dutch, who were confined to the coastal regions. Cinnamon was the first crop that attracted the colonizers, this was followed sequentially by Cinchona (Pyrethrum, on a small scale) and Coffee. In the 1840’s, the invasion by the Coffee Rust (Hemileia vastatrix) laid waste the Coffee plantations. Tea took over and rapidly expanded, mainly by encroaching into Highland Forest areas. Little attention was given to environmental and social consequences. Meantime, Rubber plantations dominated in the wetter Lowlands. A while later, attention was directed towards coconut.

Research Institutes – TRI, RRI and CRI were established to cater to the needs of the fast-developing Plantation Crops.

The introduction of Plantation Crops had far-reaching and lasting Economic, Political, Social, Environmental and Cultural consequences. The recently established Minor Export Crops, mainly serviced the Spice Crops Cinnamon, pepper, Nutmeg and Cardamom. Also, Cocoa and Coffee. Sugar, Cashew and Palmyra are crops that are developing their own support structures.

All others are catered for by the Department of Agriculture, whose main efforts are focused on the Paddy sector. This is a sector that had received scant attention from the colonial British, who had an understandable preference for importation of rice from colonial Burma and Thailand.

(v) This cleavage (into export and local sectors), while having several operational advantages, also created problems. These include social and citizenship complexities, arising from the large importation of labour from South India, to develop the rapidly increasing new plantation areas. The early tea estates were in the Central Hills, and also resulted in widespread expropriation of private and peasant- owned lands. This is still a silent concern.

(v) Since it is impossible to balance the requirements and production of agricultural produce, scarcities and gluts are not uncommon. Scarcities are met by imports, while surpluses largely result in wastage. This can be as high as 35% in the case of perishable vegetables and fruits. To deal with such surpluses, obvious remedies include providing better storage facilities with protection from insects, fungi, rodents and other marauders. Such storage could suit Paddy, maize, pulses, peanuts and some fruits.

In the case of vegetables, much fruit and other perishable produce,

post-harvest handling and transport are key needs.

Where appropriate, preservation by simply drying (by Sun, ovens or other equipment), freezing, canning, bottling and packaging are means of coping with surpluses and in most cases, also as a means of value addition.

These are the considerations paramount in developing a profitable and sustainable Agriculture – which will continue to play a key role in the National Economy.

Dr. Upatissa Pethiyagoda

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