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Yet another blot: Sri Lankan govt., hospital facilities for adolescents

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By Dr B.J.C.Perera 
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

Adolescents and young people are in the news for a variety of reasons; some good, some bad, and some even ugly. However, there is no question about their importance to the nation as our Motherland’s future belongs to them. They are indeed the jewels of Sri Lanka.

Yet for all that, when one looks around at the present time, one sees the grim spectacle of adolescents suffering a great deal through disruption of their education, undeniable problems with transportation, poverty, food insecurity and to cap it all, unsatisfactory provision of facilities in our much-bandied and government-run free health service.

The Convention on the Rights of the Child defines a “child” as a person below the age of 18 unless the relevant laws of a country recognize an earlier age of majority. Sri Lanka is a signatory to this convention. However, currently, all Paediatric Wards of the National Health Service of Sri Lanka, in all hospitals, including the specialized children’s hospitals, admit patients below the age of 14 years. Those over this age are admitted to the adult wards. We need to analyse and mull over this situation in some detail.

There is an abundance of research publications regarding different perspectives of older children and adolescents being admitted to Children’s Wards and Adult Wards. In a nutshell, these youngsters are quite uncomfortable and unhappy in either place. They do not wish to be treated like children and they are quite bothered by what goes on in the Adult Wards. They would dearly love to have Adolescent and Young People’s Wards in which specific facilities are provided for their needs and steps are taken to provide age-appropriate facilities and care for their age group.

The prestigious British Medical Journal Paediatrics Open, in the Special Supplement of Volume 6 published on the 15th of December 2022, has printed not one, or, not two or not even two, or even three; but a total of 70, YES…, seventy, research articles from several countries, related to a myriad of different aspects of providing healthcare for adolescents. These include physical, mental and socio-economic problems faced by adolescents and young people. The central theme of most of those publications is the axiom that the requirements of adolescents differ very significantly from those of children and adults. When one looks carefully at the content of these erudite works, it is evident that these differences are of the utmost importance and are of paramount implications in the ultimate quest towards providing optimal healthcare to adolescents.

At least now, the political and administrative powers in our Motherland should be pushed or even cajoled and even coerced to take useful steps to even to start thinking of providing wards, clinics and necessary healthcare services to adolescents, at least in the island’s major hospitals for a start. These services would need specifically designated wards for adolescent boys and adolescent girls separately, adolescent healthcare clinics and most importantly, specifically trained and qualified grades of all healthcare personnel to cater to the needs of these youngsters. These adolescents need privacy, empathy, and kindness, and they need to develop confidence in and continue to trust those designated to care for their health needs. To foster such an assurance, special training for these workers is absolutely mandatory. As paediatricians who provide healthcare for little children, we are all too familiar with the little ones growing up to be adolescents who still insist on us continuing to provide healthcare for them because they have faith in us. This is particularly true of those who need long-term care.

At the present time, the required facilities for adolescents in our National Health Service are woefully and totally inadequate and for that matter, virtually non-existent. In such a scenario, it will need at the outset, a paradigm shift and a complete revamping of the mindset of the legislators, to get it into their feeble brains that the provision of such facilities is absolutely essential and is one of the ways forward towards the future advancement of our country. If we do not look after the health needs of young people, we will not get anywhere. An endeavour of such an attempt and one of such vast magnitude to look after adolescents would need to start with providing infrastructure facilities to cater to the special needs of adolescents. New wards and clinics will need to be built or commissioned and healthcare staff will need to be specially trained to look after the very distinct needs of youngsters. The infrastructure should be purpose-designed to ensure privacy for these young people.More than anything, these patients have to be provided unmitigated privacy.

It is particularly important to have trained staff to look after adolescents. People working in children’s wards are specially trained for the job at hand to attend to the needs of children. However, those handling adolescents and young people need very special extra training. That includes Specialist Physicians/Paediatricians, Psychologists, Sisters and Nursing Officers and all grades of minor staff.

Of course, at the present time, in a country that is reeling from the unrelenting impact of an economic downturn, rampant corruption, and extremely poor governance, such an initiative as the healthcare of youngsters may come way down in the list of priorities of the people at the top of the legislature. Yet for all that, the emergent and nascent problems for the populace of our beautiful land that is envisaged for the immediate future, which includes wayward education, food insecurity, international indebtedness, poverty, unemployment, as well as a whole host of a conglomeration of catastrophes including repression of the youth, are more than likely to cause severe hardships for the youngsters of our beloved island. We, as adults, and this applies even more to the legislators, are duty-bound to look after our nation’s adolescents and young people. It is said that none are as blind as those who refuse to see and none are as deaf as those who refuse to hear. It is all there to see and also there to hear from the mouths of the horses as well. The best evidence for this notion is the number of young people clamouring to go abroad, seeking greener pastures.

Finally, I would like to echo the immortal words of that great statesman, Nelson Mandela, even at the risk of repeating them again for all to see and hear. He said, “There can be no keener revelation of a society’s soul than the way in which it treats its children. Let us reach out to the children”. I am sure he meant to include adolescents and young people as well. Nelson Mandela would be turning in his grave, over and over, again and again, if we refuse to do so.

It is now over to you, the powers-that-be.



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Opinion

Becoming a water-wise citizen

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By Eng. Thushara Dissanayake

According to current demands and availability, potable water resources are rapidly depleting in Sri Lanka. Finding new potable water sources has become increasingly challenging due to the competition between irrigation water and drinking water needs in many areas. Population growth, industrial demand, pollution, and climate change exacerbate water scarcity more than ever. Despite this, society often overlooks the importance of water conservation, with water waste remaining widespread. As responsible citizens, it is high time to adopt effective water management practices at household and industry level for its sustainability. On the other hand, doing so will reduce the energy requirements for water treatment and distribution, helping lower greenhouse gas emissions.

According to NWS&DB only about 46% of the population in our country are supplied with pipe-borne water. Therefore, wasting water deprives others who really deserves fresh water but currently lack access.

Here are several common ways water is wasted presumably by users due to ignorance, along with effective strategies for reducing waste at the household level.Following are some other practical measures to save water.

Standard plumbing

Using standard pipes and fittings and skilled workmanship are crucial for preventing water waste, especially in embedded areas where such leaks are hardly noticeable. PVC pipes should not be exposed to the sun as that will deteriorate the quality of pipes over time leading to water leaks. Properly installed systems are often devoid of leaks and ensure efficient water distribution minimizing maintenance costs.

Selecting water-saving fixtures

There are many water-saving fixtures available today as low-flow showerheads, taps, and dual-flush cisterns having two flushing options. For instance, kitchen taps with fine mesh give the feeling that more water runs through it than the actual flow. Replacing the existing fixtures with these advanced items will reduce water usage significantly.

Fixing water leaks

If there are leaking taps or pipes in the house or business premises they should promptly be rectified. In addition, it is wise to have regular infections to identify such defects so that possible water wastage can be minimized.

Mindful showering habits

One mode of heavy water consumption at the household level is showering. Even small reductions in shower duration such as reducing the shower time by a few minutes can save many litres of water. Any habits of keeping the shower running while applying soap and shampoo should be avoided.

Using domestic appliances only for full loads

Making a habit of using washing machines and dishwashers only for full loads not only saves water but also reduces electricity consumption. Operating appliances at full capacity also enhances their efficiency and prolongs their lifespan while reducing repair costs.

Harvesting rainwater

Rainwater can be used for many household activities, especially for gardening, landscaping, and washing vehicles. Currently, treated water is often used for these purposes, which results in unnecessary treatment costs. Rainwater can be used even for drinking if properly collected, treated, and filtered for better hygiene. However, rainwater can be used for drinking after boiling if it is collected through a clean roof exposed to sunlight. Avoiding early rain is advisable to minimize the risk of impurities mixed with rainwater.

Gardening and landscaping

For hotels, public parks, playgrounds, and similar venues with extensive gardens growing native and drought-tolerant species that require less water can lead to massive water savings. This approach not only conserves water but also enhances landscape resilience during times of water shortages. Further applying mulch to retain soil moisture and installation of drip irrigation systems and garden sprinklers for watering can minimise water requirements. Watering the lawns should be done in the morning or late evening to minimise evaporation losses.

Water Recycling

Water from sinks, showers, and washing machines which are called “grey water” can be used for toilet flushing and gardening. By diverting grey water away from the sewer system and integrating it into these activities, freshwater requirements can significantly be reduced.

Awareness and Education

Making children aware of water conservation is crucial for fostering responsible water usage habits. At the domestic level parents and elder family members can be role models by demonstrating water-saving habits. As organization-level initiatives, educating children at schools, public awareness campaigns, promoting and giving incentives for water-saving appliances, and formulating sustainable water management policies are vital.

Adopting simple, yet effective methods as discussed can save water to ensure the sustainability of this scarce resource. As the adage goes, “Water is life”, every citizen has to be water-wise by understanding its value and actively taking steps to use water efficiently and responsibly.

(The writer is a chartered Civil Engineer specializing in water resources engineering)

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Opinion

Key takeaways from British election

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PM Keir Starmer

By Dr Upul Wijayawardhana

The fact that political parties splintered by internal strife, culminating in open warfare, would be punished mercilessly by the electorate at the first available opportunity is, perhaps, the key takeaway from the UK parliamentary election held on 4th July. Conservatives, who held power for 14 years were humiliated and reduced to only 121 seats, 9 fewer than even exit-poll predictions. However, exit-polls predicted the landslide for Labour spot-on, missing the mark by only two; Labour ending up with 412, prediction being 410. This Labour win was second only to the massive victories by Tony Blair in 1997 and 2001. Terms used by news media to qualify this Labour victory, tsunami and earthquake, perhaps, are inaccurate as both are unexpected events whereas this win was not. What surprised most, however, was not the Labour victory but the scale of the humiliating defeat of the Tories, losing 251 seats. This to a large extent, was self-inflicted!

Conservatives ended 13 years of Labour rule in 2010, but as they did not have an outright majority, winning only 306 seats in a house of 650, were forced to form a coalition government with Liberal Democrats who won 57 seats. In the subsequent election in 2015, Conservatives won 330 seats, just clearing the threshold of 326. David Cameron, who was PM from 2010, resigned in 2017 when the UK voted for Brexit in a referendum, which he forced on the country, hoping to get the opposite result. Conservative divisions bloomed following the referendum disaster and Theresa May, who succeeded Cameron, went for a snap poll hoping to get a larger mandate but was unsuccessful getting only 317 seats, forcing her to continue with a minority government. However, she too, had to resign in 2019 as the draft withdrawal agreement with the EU, she negotiated, was rejected by the parliament. Boris Johnson, who succeeded her, went for an election in 2019 and was able to secure a comfortable victory with 365 seats and it was the worst defeat ever for the Labour Party, which got only 202 seats. This catastrophe resulted because of Labour being out of tune with its own supporters, majority of whom were for Brexit whereas the party policy was to remain in the EU. This was a unique event in British political history where Labour supporters switched in droves to Conservative. Worsening internal strife in the Conservative Party and the blatant breeches of Covid rules, led to the ouster of Johnson in 2022, which resulted in the disastrous 45-day tenure of Liz Truss, shortest in British history. She had to resign in disgrace when the British economy tanked with the drastic economic policies she rushed through. Not surprisingly, she could not even retain her seat, which she won with a huge majority of over 26,000 in the previous election in 2019.

Most political analysts opine that the Conservatives lost the general election in October 2022, when their acknowledged economic competence was thrown into question with the antics of Liz truss. Rishi Sunak, who took over under the most difficult of circumstances, in addition had to face frequent backstabbing, mostly from a colleague also of Indian origin. He had the unenviable task of leading a badly divided party, on top of attempting to repair the massive economic damage caused by his predecessor. Although he could have gone on until December, he called a snap election and, ultimately on 4th July, faced the inevitable!

Perhaps, the humiliating defeat suffered by the Scottish National Party (SNP), which has its origins to the demand for Scottish independence, was even worse than that of the Conservatives. SNP once exercised virtually a dictatorship over Scotland, winning almost every parliamentary seat. It was humbled down to having only 9 seats, a loss of 39 seats, in spite of stoking the fire of nationalism by campaigning that this would be a vote for the demand of a second referendum for independence. The first independence referendum held in 2014 was lost, 55% voting against independence. Therefore, the most positive takeaway from the 2024 election is that it ensured the persistence of the union between England and Scotland. This clearly illustrates that a single-issue party like the SNP has a limited lifespan, a valuable lesson for some of the communal parties of Sri Lanka.

This election is remarkable in that, rather than being a Labour win, it was a Conservative defeat, as a detailed analysis of statistics clearly show. It had the second lowest turnout with only 59.9% of registered voters voting, the lowest with 59.4% being the 2001 election where the outcome, of re-electing Tony Blair’s government with a massive majority, was never in doubt leading to voter apathy.

In 2019, Labour got 32.1% of the vote, winning only 202 seats, which is considered Labour’s worst defeat. However, five years later, the share of the vote increased only to 33.8%, the increase being mostly due to a 19% increase in Scotland whereas there was hardly any change in England. Conservative share of the vote dropped from 45.6% to 25.7%. How can a mere increase of 1.7%, lead to a gain of 211 seats, Labour ending up with 412 of the 650 seats? The main reason for this is that Nigel Farage’s Reform party siphoned off a fair share of the Conservative vote in many electorates enabling Labour and Liberal Democrat candidates to win with small majorities. Reform got 14.3% share of the vote, a remarkable achievement for a new party. Farage, who started the chain of events that led to Brexit, took over the leadership of the right-wing Reform party immediately after the election was declared and threatened to take over the Conservative party ultimately. He may well do it unless Conservatives work out a robust strategy for revival! Wonder whether Farage got letters of thanks from the leaders of Labour and Liberal Democrat parties.

This is not the first time that the ‘First Past the Post’ (FPTP)electoral system, used in the UK, has produced paradoxical results. As Liberal Democrats were regularly getting fewer MPs compared to their share of the vote, one of the conditions for the formation of a coalition government in 2010 was a referendum to change the electoral system. However, the ‘Alternative Vote referendum’ held in 2011 ensured the continuation of FPTP as the Alternative Voting (AV) system was rejected by 67.9%.

Another big paradox of the 2024 election is Liberal Democrats gaining 64 seats, increasing their tally to 72 with only a 0.6% increase in the share of their vote from 11.6% to 12.2%. This probably will make them lose their enthusiasm for a change to a Proportional Representation (PR) system!

By far, the biggest paradox is Reform, which polled 14.3% got only 5 seats while Liberal Democrats, who got a smaller share, 12.2%, secured 74 seats! Reform is bound to clamour for change of the electoral system, with other minor parties, but the question is whether they would have a sufficient clout to bring about changes to the electoral system?

All parties in opposition clamour for a change but when they get power, completely forget about it, especially if they muster massive majorities. It is just like our Presidents, who promise to abolish the presidency during the campaign but, once elected and having savoured power, stick to it like leeches! Politicians, wherever they may be, behave the same way, subjugating everything to self-interest.

It looks very unlikely, in spite of all the anomalies, that the newly elected Labour government, which has a two-thirds majority in spite of having only minority support, would be interested in changing the electoral system, unless they start losing support quickly. This is not an impossibility, as they promised a lot which seemed almost impossible to deliver. They rejected Sunak’s Rwanda plan, which would have been a deterrent to illegal immigration and are now looking for a ‘Chief’ to solve the problem! PM Keir Starmer wants closer ties with the EU, which however is demanding free movement for the young but that would lead to an increasing number of immigrants; a very thorny issue. He has made some backers of his as ministers by appointing them to the House of Lords, in spite of having 412 elected members to choose from. The Lords is the chamber all parties never abolish despite their promises to do so as it is the place to accommodate cronies! I do hope, if a second chamber ever becomes a reality in Sri Lanka, it would not be like the Lords.

Even if politicians want to change the electoral system to PR or AV or even the French system of two-stage elections, which seems to have created a huge problem with the latest election, will the voters opt for change? Perhaps, not. After all, the best way to mercilessly punish politicians, in spite of all its disadvantages, is FPTP!

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Opinion

A different take on wind power projects in Sri Lanka

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A representational image

by Eng. Col. N. N. Wijeratne
(Retd)
Secretary General / CEO

Chamber of Construction Industry of Sri Lanka

Saudi Arabia aims to utilize her vast arid lands to harvest renewable energy resources and to increase her share of renewables to around 50% by the year 2030. This is similar to Sri Lanka’s stated goal of 70% renewable energy usage by 2030. However, sadly this is where the similarity ends.

Recently, the Saudi Power Procurement Company entered into two agreements with Marubeni Corporation of Japan to purchase wind power at a staggeringly low rate of 1.566 U.S. cents per kWh. Now compare this with Sri Lanka and the power purchase agreement with a foreign investor Adam Green Energy Ltd at 8.26 US cents per kWh. True, the government states that this will be the single most significant foreign investment in the country with a price of 1 billion US dollars and Sri Lanka will have uninterrupted electricity for the next 20 years, etc., and makes the convoluted argument that it is cheaper than thermal power which is 26.99 US cents per kWh and that the Ceylon Electricity Board purchases wind power from 9.67 to 13.99 US cents per kWh. Additionally, the power bought from Odamwadi solar project is higher in that it is 8.75 US cents per kWh unit. Be that as it may be, if competitive tenders were invited even in Sri Lanka a more competitive rate could have been possible keeping with the global norms. But this was an unsolicited bid negotiated by the Government high ups. Dr. Rohan Pethiyagoda has pointed out that for newly commissioned onshore wind projects, the global weighted average internationally for wind power is between 3.5 US cents per kWh to 3.3 US cents per kWh (2022 figures) and falling. In fact, in India the levelised tariff for wind power is 3.8 US cents per kWh. The very same investor is supplying wind power to the Indian power grid at this competitive rate.

This shrouded price has spurred Transparency International Sri Lanka to file no fewer than 11 Right to Information applications about this now cabinet-approved project that will come into fruition 2 years down the line and has questions regarding the legality, transparency, evaluation process, pricing, government involvement, and the environmental impact assessment related to 250 MW wind power plant in Mannar and the 234 MW wind power plant in Pooneryn. Additionally, it strongly raises an alarm about the ecological feasibility of these projects which are located in an ecologically sensitive zone and one in a Ramsar declared wetland sanctuary. The Right to Information has elicited a stony silence by the authorities and it is petitioned that the sovereignty of the people has been violated. If we take the pricing factor in isolation, it behooves the government to answer this call at least, keeping aside the energy policy and investor friendliness that the government talks about for this sector. Next question is do we need to buy wind energy in US$ for next 20 years? What justification is there to pay in US$ for our free wind. Capital investment by the developer could have been treated as a loan repayable at a reasonable interest rate.

Geopolitical considerations may have influenced India to be involved in our power sector in order to ward off Chinese intrusions, but there are questions both big and small that require answers for it appears that the people’s sovereignty is being trampled and they have a right to know.

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