Kasturi’s Progress: 1933 – 2017

W D K (Kasturiratne) Gunawardene as a young man (left) and at 80

Kasturi was born in another century in what now feels like an entirely different country. It was called Ceylon, a British colony, and the year was 1933.

Kasturi’s was a very ordinary life, which was mostly dedicated to education. But it was punctuated at various points by key events of his country and people. Tracing his life thus offers us some glimpses of his nation’s turbulent times.

At age two, he survived malaria during the major epidemic of 1933-35 which killed as estimated 80,000 to 100,000 Lankans. (He lived to see malaria being eradicated from Sri Lanka by 2016.)

At nine, he saw the Japanese air raid of Colombo and suburbs (1942), and lived through the various rations, restrictions and disruptions of World War II.

At 15, as a schoolboy he walked to Colombo’s Torrington square to personally bear witness to Ceylon becoming independent (1948). The following day, he wrote the best essay in class in which he outlined high hopes and dreams for his now self-governing nation.

At 20, he entered the University of Ceylon and was among the first students to experience the newly established Peradeniya campus where he studied history and Sinhala language. From the scenic hills, he would see the political transformation of 1956, as well as the cultural revival heralded by Maname (landmark Sinhala drama) and Rekava (landmark Sinhala movie).

At 25, as a fresh graduate entering the world, he witnessed the 1958 ethnic riots that foreshadowed the Sinhala-Tamil ethnic conflict that consumed his nation for the next half century. Among much else, it evaporated young Kasturi’s dreams of an inter-racial marriage.

At 50, as a teacher and father, he saw the far worse anti-Tamil pogrom of 1983. For the next quarter century, he would watch in horror — and guilt — as his generation’s collective blunders consumed the next generation’s future.

At 76, as a senior citizen still active in social work and literacy circles, he saw Sri Lanka’s civil war being ended brutally (2009). He had the audacity to hope once more, even if only cautiously. And yet again, his and many others’ hopes were dashed as political opportunism and corruption soon trumped over true healing and nation building. The nation was polarised beyond recognition.

At 82, he voted for a common opposition candidate (January 2015) and for political parties (Aug 2015) who pledged good governance (yaha-palanaya). That was his last public gesture, after having voted at all national elections during his time, and having spent 25 years as a public servant. He played by all the rules, but was let down by the system.

At 84, as he coped with a corroding cancer, Kasturi watched in dismay the much-touted promise of yaha-palana being squandered and betrayed. On 13 September 2017, he departed as a deeply disappointed man who remained highly apologetic for many wrong-turns taken by his generation.

Kasturi isn’t a figment of my imagination. Neither is he a composite character. Until yesterday, Kasturi was all too real. He was my father, whom we returned to the Earth today at a simple funeral. – Nalaka Gunawardene

Note: An earlier, and longer version of this was published in May 2014, and can be accessed at: http://groundviews.org/2014/05/07/kasturis-progress/


Nalaka Gunawardene (left) and his father Kasturiratne Gunawardene on the latter’s 83rd birthday, on 5 February 2016

සිවුමංසල කොලූගැටයා #269: ඓතිහාසික ජන සතුරා (මැලේරියාව) මර්දනය කළ මහා සංග්‍රාමය

Half a century after narrowly missing the opportunity to eliminate malaria in the mid 1960s, Sri Lanka seems to have reached this significant public health goal.

“With no indigenous malaria cases being reported since October 2012, Sri Lanka is currently in the malaria elimination and prevention of re-introduction phase,” says the website of the Sri Lanka Anti-Malaria Campaign.

In April 2016, Sri Lanka applied for World Health Organisation (WHO)’s certification on malaria-free status. Expected shortly, this is a key milestone in the history of health and development.

In this week’s Ravaya column (appearing in the print issue of 22 May 2016), I summarise how we reached here, and what challenges remain.

I point out that Malaria is an ancient enemy in Sri Lanka that has killed tens of thousands and affected millions over centuries. There is speculation that malaria contributed to the historical shifting of the seat of government (kingdom at the time) and majority of human settlements from the dry zone to the intermediate and wet zones.

A severe epidemic in 1934-35 led to an estimated 5.5 million cases and 80,000 reported deaths – around 2 per cent of the total population of 5.3 million in the 1931 census. My father, now 83, is one of its survivors.

In the mid 1940s, Ceylon became the first Asian country to develop a scheme of indoor industrial spraying using DDT. In 1946, when spraying commenced in earnest, the island still had around 3 million malaria cases, high for a population of 6.6 million (1946 census). With widespread use of DDT and other measures, there was a drastic reduction: down to 7,300 cases in 1956 and just 17 in 1963.

Then there was a resurgence, which took over two decades to bring under control. As Dr Risintha Premaratne, Director of Sri Lanka’s anti-malaria campaign, told WHO, “Key components in the elimination efforts included enhanced malaria parasite screening in high transmission areas through active case detection using mobile malaria clinics; early diagnosis and prompt treatment effectively reducing the parasite reservoir and the potential for transmission; and strengthening the malaria mosquito surveillance leading to evidence based vector control.”

Malaria elimination in Sri Lanka has been achieved through a period overlapping with a 30-year separatist war in areas that were endemic for malaria. The challenge now entails sustaining a malaria-free country and preventing the reintroduction of malaria to Sri Lanka…in the context of rapid postwar developments in the country, say three Lankan leaders in this struggle writing in WHO South East Asia Journal of Public Health in Jan-March 2014.

Image source: http://www.news.lk/fetures/item/7270-let-s-together-keep-sri-lanka-malaria-free
Image source: http://www.news.lk/fetures/item/7270-let-s-together-keep-sri-lanka-malaria-free

සිවිල් යුද්ධය නිමා වී වසර හතක් පිරුණේ ගෙවී ගිය සතියේයි. දකුණේ සමහරුන් මෙය තවමත් යුද ජයග්‍රහණයක් ලෙස හඳුන්වමින් සමරනවා. අපේම රටේ අපේම පුරවැසියන් අතර ඇති වූ කුරිරු යුද්ධයක ජය-පරාජයක් තිබිය හැකිද?

මගේ මතය නම් වඩාත් සංවේදී වදන් භාවිතය වන්නේ එය යුද ස්මරණයක් ලෙස හැඳින්වීමයි. යුද්ධයකදී එයට සම්බන්ධිත හැම පාර්ශ්වයක්ම (නිරායුධ සිවිල් ජනයාද ඇතුළුව) බරපතළ හානි ලබනවා. එබඳු පසුබිමෙක එක් පාර්ශ්වයක් ජයග්‍රහණයක් ගැන දිගින් දිගටම කතා කිරීම යුද්ධය හරහා අපේ සමාජයේ හට ගත් අධික ධ්‍රැවීකරණය තව තවත් පුළුල් කිරීමක්.

සමරන්නට ඕනැම නම් ඓතිහාසික පොදු සතුරකුට එරෙහිව සමස්ත ලක් සමාජය ලත් දුෂ්කර ජයග්‍රහණයක් ද තිබෙනවා. වැඩ ප්‍රසිද්ධියකින් හෝ ජන අවධානයකින් තොරව ළඟා වී ඇති මේ ජයග්‍රහණය හරහා මර්දනය කර ඇත්තේ ඉතිහාසය පුරා දස ලක්ෂ ගණනක් අපේ ජනයාට මරු කැඳවූ සතුරෙක්.

කවුද මේ ජන සතුරා? මැලේරියාව.

මැලේරියාවට හේතු කාරක වන්නේ ප්‍රකෘති ඇසට නොපෙනෙන තරම් කුඩා ජීවියෙක්. සාමාන්‍යයෙන් මැලේරියා පරපෝෂිතයා නමින් හඳුන්වනවා. ප්ලාස්මෝඩියම් (Plasmodium) නම් ප්‍රොටොසේවාවන් කිහිපයක් මගින් තමයි මානවයන්ට මැලේරියාව ඇති කරන්නේ.

මේ පරපෝෂිතයාගේ ජීවන චක්‍රය නිශ්චිත මදුරු විශේෂ හා මිනිස් දේහය තුළ සිදු වනවා. මැලේරියා වාහකයා වන්නේ ඇනෝෆිලීස් Anopheles මදුරු විශේෂයේ ගැහැනු මදුරුවන්.

Anopheles mosquito
Anopheles mosquito

මැලේරියා රෝගය වසර දහස් ගණනක් තිස්සේ විවිධ රටවල ජනයාට බරපතළ ලෙස බලපා තිබෙනවා. කලක් බලසම්පන්න වූ රෝම අධිරාජ්‍යය ගරා වැටීමට මැලේරියාව ද හේතු වීයැ’යි සමහර  ඉතිහාසඥයන් අනුමාන කරනවා.

ශ්‍රී ලංකාවේද වියළි කලාපයේ සියවස් ගණනක් පැවති ජනාවාස හා රාජධානි ක්‍රමයෙන් අතරමැදි කලාපයට හා ඉනික්බිති තෙත් කලාපයට සංක්‍රමණය වීමට බලපෑ එක් හේතුවක් වූයේ මැලේරියා වසංගත බවට 1921දී එල්. නිකොල්ස් නම් විද්‍යාඥයා මතයක් ඉදිරිපත් කළා.

මේ මතය හැම පර්යේෂයකයාම පිළිගන්නේ නැහැ. මහාවංශය හා චූලවංශය මැලේරියා රෝග ලක්ෂණ සහිත රෝගයක් ගැන කිසිදු සඳහනක් කොට නැහැ. 1988දී ලංකා වෛද්‍ය සඟරාවට නිබන්ධයක් ලියූ ජේ. එස්. එදිරිසිංහ නම් පේරාදෙණිය වෛද්‍ය පීඨයේ ජ්‍යෙෂ්ඨ කථීකාචාර්යවරයා කීවේ පොළොන්නරුව රාජධානිය බිඳ වැටී පරිහානියට පත් වීමට මැලේරියාව මුල් වූ බවට සාක්ෂි නැතත්, යළිත් උතුරුමැද පළාතේ රාජධානි බිහි වීම වැළැක් වූ එක් සාධකයක් මැලේරියාව විය හැකි බවයි.

මේ ඓතිහාසික විවාද කෙසේ වෙතත්, 16 වන සියවසේ සිට මෙරට මැලේරියා වසංගත ගැන යම් වාර්තා හමු වනවා. එම නමින් හඳුන්වා නැතත් රෝග ලක්ෂණ සමානයි.

මැලේරියාව ගැන නිශ්චිත හා විස්තරාත්මක වාර්තාවක් මුල් වරට හමු වන්නේ 1867දී බ්‍රිතාන්‍ය පාලන සමයේ.

මැලේරියාව මදුරු විශේෂයක් හරහා බෝවන බව විද්‍යාත්මකව තහවුරු කළේ ඉන්දියාවේ කල්කටාවේ පර්යේෂණ කළ ස්කොට්ලන්ත ජාතික රොනල්ඩ් රොස් විසින් 1898දී. මේ සඳහා ඔහුට 1902 නොබෙල් වෛද්‍ය විද්‍යා ත්‍යාගය පිරිනමනු ලැබුවා.

රෝග කාරකයා හා රෝග වාහකයා නිසි ලෙස හඳුනාගත් පසු රෝග නිවාරණයට පියවර ගැනීම පහසු වුණා. ශ්‍රී ලංකාවේ මුල්ම මැලේරියා මර්දන කේන්ද්‍රය 1911දී පිහිටුවනු ලැබුවා. ඉන් පසු එළැඹි දශක දෙක තුළ මැලේරියා රෝගය වාර්තා කිරීම හා එයට ප්‍රතිකාර කිරීම වඩාත් ක්‍රමවත් වුණා.

Decolonisation, Development and Disease: A Social History of Malaria in Sri Lanka, by Kalinga Tudor Silva, Orient Black Swan 2014
Decolonisation, Development and Disease: A Social History of Malaria in Sri Lanka, by Kalinga Tudor Silva, Orient Black Swan 2014

1930 වන විට මැලේරියා මර්දන ඒකකයන් රටේ විවිධ ප්‍රදේශවල පිහිටුවා තිබුණා. එසේ වුවත් 1934/35දී පැතිර ගිය මැලේරියා වසංගතයේදී රෝග තත්ත්වයන් මිලියන් 5ක් වාර්තා වූ අතර 80,000කට අධික ජනතාවක් මියගියා. සමහර ඇස්තමේන්තුවලට අනුව මරණ ගණන ලක්ෂයක් වූවා. (එවකට සිටි ජනගහනයෙන් සියයට 2ක්).

මැලේරියා වසංගතය හා සාගතය අතර සබැඳියාවක් මතු කරමින් මේ ප්‍රශ්නයට දේශපාලන මට්ටමින් ප්‍රතිචාරයක් දැක් වූයේ මුල් යුගයේ මෙරට වාමාංශික නායකයෝයි.

1934-35 මැලේරියා වසංගතයේ එක් ප්‍රතිපත්තිමය ප්‍රතිඵලයක් වූයේ මෙරට සුබසාධක රාජ්‍යයක් (Welfare State) බිහි වීම යයි මැලේරියාව හා සංවර්ධනය ගැන 2014දී පොතක් ලියූ සමාජ විද්‍යාඥ ආචාර්ය කාලිංග ටියුඩර් සිල්වා තර්ක කරනවා. ඉංග්‍රීසියෙන් රචිත ඔහුගේ පොත (Decolonisation, Development and Disease: A Social History of Malaria in Sri Lanka, Kalinga Tudor Silva, Orient Black Swan 2014), මැලේරියාව මෙරට විසිවන සියවසේ සමාජයීය හා දේශපාලනික ප්‍රවාහයන්ට ඍජුව හා වක්‍රව දායක වූ සැටි ගැන කදිම විවරණයක්.

එක් දෙයක් පැහැදිලියි. මැලේරියාව නිදහසෙන් පෙරත්, ඉන් පසුවත් මෙරට ප්‍රධානතම මහජන සෞඛ්‍ය තර්ජනයක්ව පැවතුණා. මැලේරියා වාහක මදුරුවන් මර්දනයට ප්‍රසිද්ධ ස්ථානවලත්, නිවාස හා  DDT කෘමි නාශකය ඉසීම ආරම්භ කළ මුල්ම ආසියානු රට බවට 1945දී ශ්‍රී ලංකාව පත්වුණා.

The Royal Naval School of Malaria and Hygiene Control - War-time spraying of DDT near Colombo, Ceylon, December 1944 – Image Imperial War Museum, UK © IWM (A 28178)
The Royal Naval School of Malaria and Hygiene Control – War-time spraying of DDT near Colombo, Ceylon, December 1944 – Image Imperial War Museum, UK © IWM (A 28178)

DDT රසායනකය ඇති කරන පාරිසරික හානි ගැන පසුව අවබෝධ කොට ගත් නමුත් 1945-1960 වකවානුවේ DDT පුළුල් ලෙස භාවිත නොකළා නම් අපේ රටේ තවත් බොහෝ දෙනකු මැලේරියාව නිසා මියයාමට හෝ රෝගීවීමට හොඳටම ඉඩ තිබුණා. මේ නිසා නිදහසෙන් පසු දශක දෙකක පමණ කාලයේ මෙරට උපන් දරුවන්  “DDT පරම්පරාව” (Sri Lanka’s DDT Generation) ලෙස මා නම් කරනවා. මාත් එයට අයත්.

1946දී මිලියන් දෙක හමාරක් පමණ වූ වාර්ෂික මැලේරියා රෝග තත්ත්ව සංඛ්‍යාව (සමහර රෝගීන්ට යළි යළිත් වැළඳුණු නිසා රෝගීන් සංඛ්‍යාව මීට අඩුයි) 1953 වන විට 91,990ක් දක්වා ශීඝ්‍රයෙන් පහළ ගියා. 1950 දශකය පුරාම තවත් අඩු වූ රෝග තත්ත්ව සංඛ්‍යාව 1963දී 17ක් තරමට කුඩා වුණා.

තුරන් කිරීමේ මුවවිටට ආවත් එය සාර්ථක වූයේ නැහැ. රෝග ආවේක්ෂණය හා නිවාරණ පියවර ලිහිල් වීම නිසා මැලේරියාව යළිත් පැතිරෙන්නට පටන් ගත්තා. 1968 වන විට ලක්ෂ ගණනක් යළිත් රෝග තත්ත්ව වාර්තා වුණා. 1970 හා 1980 දශක මුළුල්ලේම විටින් විට උත්සන්නවීම් සහිතව මැලේරියාව ප්‍රබල සෞඛ්‍ය තර්ජනයක් ලෙස පැවතියා.

සිවිල් යුද්ධය නිසා දිස්ත්‍රික්ක ගණනාවක මැලේරියා මර්දන කටයුතු අඩාලවීම හෝ නතරවීම ද රෝග ව්‍යාප්තියට හේතු වුණා.

මේ තත්ත්වය වෙනස් වූයේ 1999න් පසුවයි. 1999දී තහවුරු කළ මැලේරියා රෝග තත්ත්වයන් 264,549ක් වාර්තා වූ අතර 2002 වන විට එය 41,411 දක්වා අඩු වුණා.

ඓතිහාසික මැලේරියා සතුරාට එරෙහිව ගෙන ගිය දශක ගණනක මහජන සෞඛ්‍ය සංග්‍රාමයේ පෙරමුණේම සිටියේ සෞඛ්‍ය අමාත්‍යාංශයේ මැලේරියා මර්දන ව්‍යාපාරයයි. ඔවුන්ගේ සහායට මෙරට සමස්ත රාජ්‍ය සෞඛ්‍ය සේවා පද්ධතියත්, වෛද්‍ය පර්යේෂකයනුත් පෙළ ගැසුණා.

මුලින්ම ලබා ගත් ජයග්‍රහණය වූයේ මැලේරියාවෙන් මිය යාම වැළැක්වීමයි. 1998දී මෙරට මැලේරියා මරණ 115ක් වාර්තා වූ අතර 2008 වන විට එය බින්දුවට බැස්සා. 2008න් පසු මෙරට දේශීය ජනයා මැලේරියාවෙන් මිය ගොස් නැහැ. ඉඳහිට වාර්තා වූ මැලේරියා මරණ විදේශිකයන්ගේයි.

මැලේරියා මර්දන ව්‍යාපාරයට අනුව 2012 ඔක්තෝබර් මාසයෙන් පසු මෙරට කිසිදු දේශීය මැලේරියා රෝගියෙක් වාර්තා වී නැහැ.

2015 ඔක්තෝබරයට දේශීය මැලේරියා රෝගියකු වාර්තා නොවී වසර තුනක් (මාස 36ක්) සම්පූර්ණ වුණා. ඒ අනුව මෙරටින් මැලේරියාව තුරන් කොට ඇතැයි සහතිකයක් ලබන්නට මේ වසර මුලදී රජය ලෝක සෞඛ්‍ය සංවිධානයට (WHO) නිල වශයෙන් අයදුම් කළා.

කෘමිනාශක රසායන ඉසීම, කෘමිනාශක ගල්වන ලද මදුරු දැල් ප්‍රචලිත කිරීම, නිරතුරු රෝග ආවේක්ෂණය හා කඩිනම් ප්‍රතිකාර නොමිලේ ලබා දීම මෙන්ම ප්‍රජා සහභාගිත්වය හරහා මදුරුවන් බෝවීම වැළැක්වීමද මේ සංග්‍රාමයේ ජයට හේතු වුණා.

මැලේරියා මර්දන ව්‍යාපාරය මීට දශක ගණනකට පෙර පිහිටුවන ලද්දේ මේ ඓතිහාසික ජන සතුරා මෙරටින් සදහටම අතුගා දමන්නයි. 2012 වන විට මෙය සාක්ෂාත් කර ගත්ත ද ලෝකයේ මැලේරියාව පවතින තුරු එය නැවතත් මෙහි පැමිණීමේ අවදානම තිබෙනවා.

Sri Lanka Anti Malaria Campaign is a public health triumph of our times
Sri Lanka Anti Malaria Campaign is a public health triumph of our times

මේ නිසා මැලේරියාව පිළිබඳ රෝග විනිශ්චය පරීක්ෂණ කිරීම හා සමාජ ආවේක්ෂණය පවත්වා ගැනීම වැදගත්.

මැලේරියාව යළිත් මෙරටට පැමිණීම හා පැතිර යාම ගැන තවත් වසර ගණනක් තිස්සේ අප මහත් විමසිල්ලෙන් හා සූදානමින් සිටිය යුතුයි. මැලේරියා මර්දන ව්‍යාපාරයේ අධ්‍යක්ෂ වෛද්‍ය හේමන්ත හේරත් මෑතදී මාධ්‍යවලට පවසා තිබුණේ මැලේරියා කාරක පරපෝෂිතයා මෙරටින් තුරන් කළත් මැලේරියා වාහක මදුරුවන් ඕනෑ තරම් තවමත් මෙරට සිටින බවයි.

‘විදේශයකදී මැලේරියා පරපෝෂිතයන් රුධිරගත වූ අයෙක් මෙරටට ආවිට ඔහු/ඇයගේ රුධිරය උරා බොන අදාළ මදුරුවකු හරහා නිරෝගී අයට යළිත් මැලේරියාව පැතිර යා හැකියි,’ ඔහු කියනවාග

යමකුට මැලේරියාව ශරීරගත වී ඇත්දැයි කඩිනමින් තහවුරු කර ගැනීමට ක්ෂණික රසායානාගාර පරීක්ෂාවන් කිරීමේ හැකියාව මැලේරියා මර්දන ව්‍යාපාරය සතුයි. එහෙත් මානව හිමිකම් ගරු කරන සමාජයක මේ පරීක්ෂාවන් කිරීමට යැයි බල කිරීමට සෞඛ්‍ය බලධාරීන්ට බැහැ. ඒ සඳහා පෞද්ගලික වගකීම හා ඉදිරිපත් වීම හැම පුරවැසියකුගෙන් හා රටට එන විදේශිකයන්ගෙන් බලාපොරොත්තු වීම පමණයි කළ හැක්කේ.

එසේ මැලේරියාව රුධිරගත වී සිටින ඕනෑම අයකු හඳුනා ගත් විට පුරවැසි හෝ විදේශික තරාතිරම නොබලා වහාම අවශ්‍ය ප්‍රතිකාර ලබා දීමට මැලේරියා මර්දන ව්‍යාපාරය සීරුවෙන් සිටිනවා.

නිසි ප්‍රතිකාර හරහා මැලේරියාව සුව කළ හැකියි. මදුරුවන්ගේ විදීමෙන් බේරී සිටියොත් මැලේරියාව බෝවීම වළක්වා ගන්නට ද හැකියි.

විදේශිකයන් මැලේරියාව ගෙනෙනවා යයි ජන භීතියක් ඇති කරන්නට සමහර වෛද්‍යවරුන් මෑතදී ප්‍රකාශයන් කළා. 2016 වසරේ අප්‍රේල් 20 දක්වා කාලයේ මැලේරියාව රුධිරගත වූ 16 දෙනකු හඳුනා ගෙන ප්‍රතිකාර කර තිබෙනවා. එහෙත් මෙයින් විදේශිකයන් වූයේ දෙදෙනකු පමණයි. අන් සියල්ලෝම ලාංකිකයෝ.

කැලණිය සරසවියේ වෛද්‍ය පීඨයේ ප්‍රජා වෛද්‍ය විද්‍යාව පිළිබඳ මහාචාර්ය රාජිත වික්‍රමසිංහ මේ ගැන හොඳ විග්‍රහයක් මෑතදී කළා. විදෙස් ගත වී යළි මවු රට පැමිණෙන ලාංකිකයන් හරහා නොදැනුවත්වම මැලේරියාව යළි මෙහි ඒමට ඇති අවදානම ඔහු සාකච්ඡා කළා.

එහිදී වඩාත්ම එම අවදානමට ලක් වන්නේ මැලේරියාව බහුල රටවලට යන ලාංකික ව්‍යාපාරිකයන්, මැණික් සොයා සමහර අප්‍රිකානු රටවලට යන අපේ මැණික් වෙළඳෙන්, එක්සත් ජාතීන්ගේ සාමසාධක කටයුතුවලට යන හමුදා නිලධාරීන් හා සොල්දාදුවන් හා කලක් රටින් පිට වාසය කොට නැවත මෙහි එන ලාංකික සරණාගතයන්. මීට අමතරව මෙරටට එන විදෙස් සංචාරකයන් හා ශ්‍රමිකයන් හරහාද මැලේරියාව ආ හැකියි.

Extracted from a May 2016 presentation by Prof Rajitha Wickremasinghe
Extracted from a May 2016 presentation by Prof Rajitha Wickremasinghe

‘මැලේරියාවට නිසි ප්‍රතිකාර තිබෙනවා. ඒවා මැලේරියා මර්දන ව්‍යාපාරය නොමිලයේ ලබාදෙනවා. විදෙස්ගතවී මෙහි පැමිණි පසු උණ ලක්ෂණ පහළ වුවොත් වහාම වෛද්‍යවරයකු හමුවී ඔබ කොහි සිට පැමිණියාද යන්නද හෙළිකරමින් ප්‍රතිකාර පතන්න. මැලේරියා ඖෂධ සියල්ල නියම කරන පරිදි දිගටම ගන්න. ඒ හරහා මේ රෝගය යළි පැතිරීමේ අවදානම අපට අවම කළ හැකියි.’ ඔහු කියනවා.

WHO දත්තවලට අනුව 2015දී ලෝකයේ මැලේරියා රෝග තත්ත්ව මිලියන් 214ක් වාර්තා වුණා. එයින් බහුතරයක් (88%) අප්‍රිකාවේ. ඊළඟට වැඩිම කලාප වන්නේ දකුණු ආසියාව හා අග්නිදග ආසියාවයි (10%). 2015දී ලොව පුරා මැලේරියාවෙන් අවම වශයෙන් 438,000ක් මිය ගියා. මේ නිසා මැලේරියාව තවමත් ලෝක සෞඛ්‍යයට තර්ජනයක්.

මහත් වෙර වෑයමින් මෙරට දේශීය මැලේරියා රෝග තත්ත්ව තුරන් කිරීමට සෞඛ්‍ය සේවාව කර ඇති සේවය ඉහළින් අගය කළ යුතුයි. දැන් අපට ඇති අභියෝගය ශ්‍රී ලංකාව දිගටම මැලේරියාවෙන් තොරව පවත්වා ගැනීමයි.

World Malaria Day poster
World Malaria Day poster

See for details:

Malaria elimination in Sri Lanka: what it would take to reach the goal By Risintha Premaratne,Leonard Ortega, Navaratnasingam Janakan, Kamini N Mendis. WHO South-East Asia Journal of Public Health, January-March 201

On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs, By Nadira D Karunaweera, Gawrie NL Galappaththy and Dyann F Wirth BioMed Journal, 14 Feb 2014

Malaria Control and Elimination in Sri Lanka: Documenting Progress and Success Factors in a Conflict Setting. By Rabindra R. Abeyasinghe, Gawrie N. L. Galappaththy, Cara Smith Gueye, James G. Kahn & Richard G. A. Feachem. PLOS One journal. Published: August 29, 2012


From MDGs to SDGs: Well done, Sri Lanka, but mind the gaps!

This op-ed appeared in Daily Mirror broadsheet newspaper in Sri Lanka on 1 October 2015.

From MDGs to SDGs:

Well done, Sri Lanka — but mind the gaps!

By Nalaka Gunawardene

Over the weekend of September 25 – 27, the United Nations headquarters in New York hosted the Sustainable Development Summit 2015. It was a high-level segment of the 70th UN General Assembly that was attended by many world leaders including Sri Lanka’s President Maithripala Sirisena.

Sustainable Development Summit 2015 Logo
Sustainable Development Summit 2015 Logo

The UN, which turns 70 this year, is once again rallying its member governments to a lofty vision and ambitious goal: to embark on new paths to improve the lives of people everywhere.

For this, the Summit adopted a new and improved global task-list called Sustainable Development Goals (SDGs). Prepared after two years of worldwide consultations, the SDGs offer a blueprint for development until 2030.

There are 17 SDGs tackling long-standing problems like ending poverty and reducing inequality to relatively newer challenges like creating more liveable cities and tackling climate change. These are broken down into 169 specific targets. Their implementation will formally begin on 1 January 2016.

SDGs in a nutshell - courtesy UN
SDGs in a nutshell – courtesy UN

The SDGs are to take over from the Millennium Development Goals, or MDGs, that have guided the development sector for 15 years. Sri Lanka was among the 189 countries that adopted the MDGs at the Millennium Summit the UN hosted in New York in September 2000. On that occasion, the country was represented by Lakshman Kadirgamar as Minister of Foreign Affairs.

The eight MDGs covered a broad spectrum of goals, from eradicating absolute poverty and hunger to combating HIV, and from ensuring all children attend primary school to saving mothers from dying during pregnancy and childbirth.

Much has happened in the nearly 5,500 days separating the adoption of the original MDGs and now, the successor SDGs. This month, as the world commits to ‘leaving no one behind’ (as UN Secretary General Ban Ki-moon has said), it is useful to look back, briefly.

Good ‘Report Card’

How has Sri Lanka pursued the MDGs while the country coped with a long drawn civil war, political change, and the fall-out of a global economic recession?

In fact, it has done reasonably well. In its human development efforts, Sri Lanka has quietly achieved a great deal. However, there are gaps that need attention, and some goals not yet met.

That is also the overall message in a recent report that took stock of Sri Lanka’s pursuit of Millennium Development Goals, or MDGs.

Sri Lanka MDG Country Report 2014
Sri Lanka MDG Country Report 2014

We might sum it up with a phrase that teachers are fond of using, even on good students: “You’re doing well – but can do better! Try harder!”

For the past 15 years, the MDGs have provided a framework for Sri Lanka’s national development programmes. Progress has been assessed every few years: the most recent ‘report card’ came out in March 2015.

The MDG Country Report 2014, prepared by the Institute of Policy Studies (IPS), is a joint publication by the Government of Sri Lanka and the United Nations in Sri Lanka. Data from the 2012 census and Household Income and Expenditure Survey 2012/13 have generated plenty of data to assess MDG situation across the country, including the war affected areas.

“Sri Lanka has already achieved the targets of 13 important MDG indicators out of 44 indicators relevant to Sri Lanka. Most of the other indicators are either ‘On Track’ or progressing well,” says IPS Executive Director Dr Saman Kelegama in his foreword to the report.


 The report offers insights into how Sri Lanka’s ‘soft infrastructure’ — all the systems and institutions required to maintain the economic, health, cultural and social standards of a country – are faring.

Consider these highlights:

  • Sri Lanka’s overall income poverty rates, when measured using accepted statistical benchmarks, have come down from 2% in 2006/7 to 6.7% in 2012.
  • Unemployment rate has declined from 8% in 1993 to 3.9% in 2012. However, unemployment rate among women is twice as high as among men.
  • While food production keeps up with population growth, malnutrition is a concern. A fifth of all children under five are underweight. And half of all people still consume less than the minimum requirement of daily dietary energy.
  • Nearly all (99%) school going children enter primary school. At that stage, the numbers of boys and girls are equal. In secondary school and beyond (university), in fact, there now are more girls than boys.
  • More babies now survive their first year of life than ever before: infant mortality rate has come down to 9.4 among 1,000 live births (from 17.7 in 1991). Deaths among children under five have also been nearly halved (down from 2 in 1991 to 11.3 in 2009).
  • Fewer women die needlessly of complications arising from pregnancy and childbirth. The maternal mortality rate, which stood at 92 deaths per 100,000 live births in 1990, plummeted to 33 by 2010. Doctors or skilled health workers are now present during almost all births.
  • Sri Lanka’s HIV infection levels have remained now, even though the number of cases is slowly increasing. Meanwhile, in a major public health triumph, the country has all but eradicated malaria: there have been no indigenous malaria cases since November 2012, and no malaria-related deaths since 2007.
  • More Lankans now have access to safe drinking water (up from 68% in 1990 to almost 90% in 2012-2013.)

These and other social development outcomes are the result of progressive policies that have been sustained for decades.

“Sri Lanka’s long history of investment in health, education and poverty alleviation programmes has translated into robust performance against the MDGs, and Sri Lanka has many lessons to share,” said Sri Lanka’s UN Resident Coordinator and UNDP Resident Representative, Subinay Nandy, at the report’s launch in March 2015.

Proportion of Lankans living below the poverty line - total head count and breakdown by district
Proportion of Lankans living below the poverty line – total head count and breakdown by district

Mind the Gaps!

Despite these results, many gaps and challenges remain that need closer attention and action in the coming years.

One key concern is how some impressive national level statistics can eclipse disparities at provincial and district levels. The MDG data analysis clearly shows that all parts of Sri Lanka have not progressed equally well.

For example, while most districts have already cut income poverty rates in half, there are some exceptions. These include eight districts in the Northern and Eastern provinces, for which reliable data are not available to compare with earlier years, and the Monaragala District in Uva Province – where poverty has, in fact, increased in the past few years.

Likewise, many human development indicators are lower in the plantation estate sector, where 4.4% of the population lives. An example: while at least 90% of people in urban and rural areas can access safe drinking water, the rate in the estate sector is 46.3%.

Another major concern: the gap between rich and poor remains despite economic growth. “Income inequality has not changed, although many poor people managed to move out of poverty and improve their living conditions,” the MDG Progress report says.

In Gender Equality, Sri Lanka’s performance is mixed. There is no male-female disparity in education, and in fact, there are more literate women in the 15 to 24 age than men. But “these achievements have not helped in increasing the share of women in wage employment in the non-agricultural sector,” notes the report.

Disappointingly, women’s political participation is also very low. The last Parliament had 13 women members out of 225. That was 5.8% compared to the South Asian rate of 17.8% and global rate of 21.1%. The report has urged for “measures to encourage a substantial increase in the number of women in political offices”.

Of course, MDGs and human development are not just a numbers game. While measurable progress is important, quality matters too.

The MDG report highlights the urgent need to improve the quality and relevance of our public education. Among the policy measures needed are increasing opportunities for tertiary education, bridging the gap between education and employment, and reducing the skills mismatch in the labour market.

On the health front, too, there is unfinished – and never ending — business. Surveillance for infectious diseases cannot be relaxed. Even as malaria fades away, dengue has been spreading. Old diseases like tuberculosis (8,000 cases per year) stubbornly persist. A rise in non-communicable diseases – like heart attacks, stroke, cancers and asthma – poses a whole new set of public health challenges.

Sri Lanka offers the safest motherhood in South Asia
Sri Lanka offers the safest motherhood in South Asia

Open Development

So the ‘well-performing’ nation of Sri Lanka still has plenty to do. It is just as important to sustain progress already achieved.

The new and broader SDGs will provide guidance in this process, but each country must set its own priorities and have its own monitoring systems. The spread of information and communications technologies (ICTs) has created new sources of real-time data that can help keep track of progress, or lack of it, more easily and faster.

Whereas MDGs covered mostly “safe” themes like poverty, primary education and child deaths, the SDGs take on topics such as governance, institutions, human rights, inequality, ageing and peace. This reflects how much international debates have changed since the late 1990s when the MDGs were developed mostly by diplomats and technocrats.

This time around, not only governments and academics but advocacy groups and activists have also been involved in hundreds of physical and virtual consultations to agree on SDGs. In total, more than seven million people have contributed their views.

As the government of Sri Lanka pursues the SDGs that it has just committed to in New York, we the people expect a similar consultative process.

Goodbye, closed development. Welcome, Open Development!

Science writer Nalaka Gunawardene wrote an earlier version of this for UN Population Fund (UNFPA) Sri Lanka’s new blog Kiyanna.lk. The views are his own, based on 25 years of development communication experience.

Equal numbers of girls and boys go to school in Sri Lanka today, But women struggle harder to find employment.
Equal numbers of girls and boys go to school in Sri Lanka today, But women struggle harder to find employment.

All infographics courtesy: Millennium Development Goals: Sri Lanka’s Progress and Key Achivements, http://countryoffice.unfpa.org/srilanka/?reports=10872

Mosquito SPLAT: New Facebook game to support malaria research

I just killed a few dozen ‘girls’ before breakfast. It wasn’t always easy or pleasant, and after a while there was blood all over the place. But I feel good about getting them – and I saved an innocent baby in the process, and even helped a researcher doing good work!

The ‘girls’ are malaria carrying mosquitoes, and I was playing a new Facebook game called Mosquito SPLAT that was released this week to mark World Malaria Day 2009.

Now online: a game we have played over millennia against 'em blood suckers...
Now online: a game we have played over millennia against 'em blood suckers...

The aim of the game is to use the fly squatter to SPLAT mosquitoes before the baby gets malaria. For each mosquito you SPLAT, you score 10 points. For every 100 points scored, advertisers will make a donation to support malaria research projects at the National Institute for Medical Research in Tanzania. We also score 10 points for everyone we invite to play the game – plus there’s a link taking us to an online donation page in case we want to support the research directly.

“It’s quick, easy and fun, and a great way to do your part for one of the most serious global health problems in the developing world,” say the game’s promoters.

Indeed. Nearly 500 million cases of malaria occur each year, resulting in over one to three million deaths (figures online vary enormously on this). Malaria is particularly devastating in Africa where it is a leading killer of children. Every 30 seconds a child in Africa dies from malaria.

The fact is, malaria deaths are entirely preventable with modest investment and spread of knowledge that mosquitoes spread malaria (not everyone knows this, and as I wrote in another blog post, that’s a challenge that educators and broadcasters are now working on).

McLaughlin-Rotman Center for Global Health: Taking anti-malaria campaign online
McLaughlin-Rotman Center for Global Health: Taking anti-malaria campaign online
But more needs to be done to engage the Digital Natives in this global public health challenge. It’s not just the exposed people in malaria-prevalent parts of Africa, Asia and Latin America who are at risk. As development economist Jeffrey Sachs has been reminding us eloquently, malaria reduces productivity, increases poverty, weakens people’s bodies and makes them vulnerable to other diseases. In a globalised world, such massive suffering in some parts of the world would quickly manifest in different ways all over the planet.

Mosquito SPLAT is a partnership between the McLaughlin-Rotman Center for Global Health at the University Health Network and the University of Toronto and the UN Foundation’s Nothing But Nets campaign. The Mosquito SPLAT game is part of Malaria Engage, an initiative to enlist people directly in the anti-malaria battle by supporting malaria research projects in the developing world.

Click here to engage your Facebook friends to support malaria research.

Little biology lesson: Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria, and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken, which contains microscopic malaria parasites. About one week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Buzz and Bite: PSA campaign against relentless malaria

We tried DDT for half a century. Now try PSA...
We tried DDT for half a century. Now try PSA...

Today is World Malaria Day. It’s a day to reflect on an ancient disease that continues to kill and sicken so many people in the majority (developing) world.

Malaria accounts for one death every 30 seconds. Malaria kills more than 1 million people every year. Each year, between 350 million and 500 million people are infected with malaria.

Malaria plagued Europe and North America as recently as 60 years ago. Simple public health measures were crucial to eliminating the disease and helping those regions achieve growth, prosperity and stability. Many countries in Africa, Asia and Latin America have yet to achieve this level of control.

Public health officials have been trying to contain and control malaria for decades, most measures targeting the malaria vector mosquitoes. In recent years, educators have joined hands — for stopping malaria begins with awareness on how it spreads and what simple measures can be taken to prevent it.

The Buzz and Bite Campaign is one such awareness tool launched a year ago on World Malaria Day 2008. It consists of a series of 30 animated shorts and 5 audio shorts called Public Service Announcements (PSAs).

The Buzz and Bite Campaign is the creation of Canadian animation producer and director Firdaus Kharas, working with a team of skilled professionals. Firdaus earlier took on another public health challenge, HIV/AIDS, through his highly popular animation series The Three Amigos.

Watch a sample Buzz and Bite Spot (in English, British Accent)

According to the Buzz and Bite website, PSAs have so far been produced in 22 languages, and are being adapted into more. “The goal is to enable a potential reach of 80% of the world’s malaria at-risk population or over 5 billion people in their own language.”

See all language versions on Buzz and Bite channel on YouTube

The PSAs are available to any television broadcaster, radio station, NGO, hospital, doctor, community group, university, school, educator or other user, free of charge, anywhere in the world.

The campaign is strongly supported by Nobel Laureate Archbishop Desmond M. Tutu.

Malaria has been eradicated in many parts of the world but continues to thrive and even grow in other parts, especially in tropical areas. “This anti-malaria campaign focuses on sub-Saharan Africa (where up to 90 per cent of all malaria fatalities occur), on South America, and on South and South-East Asia, where the rates of malaria are alarmingly high,” says the website, adding: “Malaria is preventable. The easiest and cheapest way to prevent malaria infection is through the use of long-lasting insecticide-treated bed-nets (LLINs) which can last up to 5 years. This campaign promotes the use of nets.”

You heard the buzz...Now get ready for bite!
You heard the buzz...Now get ready for bite!

Images and video courtesy Buzz and Bite campaign

Bill Gates and mosquitoes: World’s top geek now works for its meek

More bugs from Gates...
More bugs from Gates...
Bill Gates can’t seem to get enough of bugs.

On 4 February 2009, he let loose a swarm of mosquitoes at the TED 2009 technology, entertainment and design conference in California to highlight the dangers of malaria.

“Malaria is spread by mosquitoes,” he reminded his audience of leading scientists, designers, researchers and entrepreneurs. Turning to an upturned jar on stage, he announced: “I brought some. Here…I’ll let them roam around. There is no reason only poor people should be infected.”

Luckily, the mosquitoes were not carrying the disease. But it had the intended effect. Wired editor Chris Anderson, curator of the show, suggested a headline: “Gates releases more bugs into the world”.

Watch Bill Gates’s mosquito moment:

Watch the full 20-minute video of Bill Gates at TED 2009

As stunts go, this one was pretty mild and harmless. There are many shocking ways in which the harsh daily realities of the world’s poor can be brought into gatherings of the rich and famous. They could be served glasses of the contaminated, sludgy (and often smelly) water that tens of millions drink everyday. Or all the toilets could be locked up and the keys thrown away – for good. Or electricity supply could be cut off, or frequent ‘black-outs’ or ‘brown-outs’ could be staged. You get the idea…

Of course, few event organisers would dare try any of these, if only for health and safety considerations. Reminds me of a rare exception: when he was director of information with the UN’s population agency (UNFPA), journalist-turned-UN official Tarzie Vittachi once hosted delegates of a high level meeting to lunch which consisted soley of a bread roll and a glass water. He told his guests: the meal was better more than what most poor people in the global South on any given day.

Bill to the rescue...
Bill to the rescue...
Meanwhile, billions of poor and needy – and not just those in the majority world – are glad that Bill Gates caught the ‘development bug’ and has switched his formidable creative energies (not to mention his billions) to address their survival issues. The Bill & Melinda Gates Foundation – which carefully manages the giving away of Gates wealth – operates on the belief that all lives have equal value. “We think all people deserve the chance to have healthy, productive lives”.

They have set priorities such as improving health and reducing extreme poverty in the developing world, and improving high school education in the United States.

The New York Times columnist Nicholas Kristof recently described it as a paradox: “In these brutal economic times, one of the leading advocates for the world’s poorest people is one of the richest.”

He noted: “Mr. Gates ended his full-time presence at Microsoft last July and since then has thrown himself into work at his foundation. He is now trying to do to malaria, AIDS, polio and lethal childhood diarrhea what he did to Netscape, and he just may succeed.”

In his TED talk, Bill Gates addressed two questions that occupy much of his time these days: How do we stop Malaria? How do you make a teacher great?

Look, no computers!
Look, no computers!
He said: “The market does not drive scientists, thinkers, or governments to do the right things. Only by paying attention and making people care can we make as much progress as we need to.”

He called for greater distribution of insect nets and other protective gear, and revealed that an anti-malaria vaccine funded by his foundation and currently in development would enter a more advanced testing phase in the coming months.

“I am an optimist; I think any tough problem can be solved,” he said. That’s the geek in him talking: marshall all information, analyse problems, respond strategically — and keep at it.

A friend who now works with the Gates Foundation confirms how the charity seeks evidence and rigour in all its social investments. This is no bleeding-heart do-gooding or ‘social work’ for its CSR value. The new wave of geeks lining up to serve the meek bring business acumen to the development sector long under-served by unimaginative aid agencies and self-serving UN organisations.

As Kristof wrote: “Gates ended his full-time presence at Microsoft last July and since then has thrown himself into work at his foundation. He is now trying to do to malaria, AIDS, polio and lethal childhood diarrhea what he did to Netscape, and he just may succeed.”

Gates has announced that despite the economic crisis the Gates Foundation will increase spending by US$500 million this year.

In late January 2009, the billionaire philanthropist released the first ‘Annual Letter from Bill Gates‘ where he discussed his work at the foundation and spoke candidly about what has gone well, what hasn’t.

He compared his earlier work at Microsoft with the challenges he now tackles at the charitable foundation. “What I’ve found now is that really those same key elements are there. The opportunity for big breakthroughs is absolutely just as great–now it’s vaccines, it’s seeds that have better yield, it’s ways of sharing teaching practices…they will take the same kind of patience that we had for software breakthroughs.”

Just ahead of the letter’s release, Nicholas Kristof talked with Bill Gates about why aid to developing countries is more important during the economic downturn and vaccine breakthroughs on the horizon. Watch the interview:

Read: Bill Gates’s Next Big Thing by Nicholas D Kristoff, published in the New York Times on 24 January 2009