NCDs Continue to be the Leading Killer
By Dilanthi Jayamanne
It was a time when the Kings and their subjects in the isle of Serendib achieved great feats in construction of the many dagobas, temples, tanks and the grand palaces as seen in ancient citadels of Anuradhapura, Polonnaruwa, Sigiriya and Kandy. The country continues to thrive on showing off its ancient history to the many visiting tourists who arrive even in the midst of these troubled times of the COVID pandemic.
No word can be written with regard to disease without touching on the deadly communicable diseases which have claimed over 14,072 lives till date, and continue to top up its numbers, reaching a colossal 554,459 by 18 November 2021.
Has this nation forgotten or let go of its proud history or relegated it to the Grade 10 and 11 text books, where the students are expected to memorise the names of Sri Lankan Kings, their achievements, and their words of wisdom. “Do not let a single drop of water that falls to the earth go waste,” are words that have to be reminded to the people by a non-profit organisation. Oh how the tables have turned on the Pearl of the Indian Ocean which was once – during the time of the Kings referred to as the East Asian or Oriental Granary!
What about the gigantic, baffling architectural challenges that were constructed in the country’s past and what have the country’s leaders of present times constructed with aid received from foreign governments? In a nutshell, its leaders have been instrumental in plundering the sea, another major tourist attraction of the isle of Lanka, to extend the land area adequate for China to build on it. Not to forget the many road networks that have been constructed during the past ten years or so, which help travellers to reach even those ancient cities in record time, a theatre and a monumental edifice constructed also on a loan from China is probably a self-claimed tourist attraction.
Besides these loan-fed construction projects, the leaders of our time also have been responsible for constructing more and more treatment facilities for a greater plague than the current COVID pandemic. Non Communicable Diseases (NCDs) have been gradually, but steadfastly being rearing their ugly heads, so much so that it has come to pass that every Health Minister, has proudly claimed that a majority of hospital deaths were due to NCDs.
In a book co-authored by former Health Minister, Dr. Rajitha Senaratne and Prof. Shanthi Mendis on the Prevention and Control of Non Communicable Diseases, it is noted that in 2015 alone 1,136,000 deaths had been due to NCDs. “Ischemic heart disease, diabetes, cerebrovascular disease, asthma, chronic obstructive pulmonary disease, and chronic kidney disease are among the top 10 causes of death in Sri Lanka.”
Hence, the construction of the National Hospital of Nephrology in Polonnaruwa consisting of 200 beds, 100 haemodialysis beds, boasting five
state-of-the-art operating theatres, and two Intensive Care Units. Currently, the country’s Ministry of Health is in the process of constructing the second largest cancer treatment facility only second to ‘Apeksha’ Hospital Maharagama in the District of Kandy. The 12-story building will have a bed capacity of 600. The Linear Accelerator treatment facility had been commissioned in stage one of the Hospital’s construction process. According to the Deputy Director General of NHSL, Kandy, Dr. A. Jayasekera, the hospital caters to 2/3 of the cancer patients in the country. It hosts patients not only from the Central, but also North Central, Trincomalee in the East, Kegalle and Mawanella in Sabaragamuwa, and Northern Province.
According to statistics issued in 2017, the Oncology Unit of NHSL Kandy had 5,969 Direct Admissions made to its male ward and another 10,430 admissions to its female ward. That year, the male ward had 203 deaths and the female ward had 228 deaths due to cancer.
Statistics retrieved on New Patients Registration to Cancer Treatment Centres show that in 2020 the ‘Apeksha’ Maharagama has had 11,864, NHSL Kandy another 3,889, while Base Hospital, Thellipalai has had 2,595 new patients registered.
In 2020, a total of 35,863 new patients have been registered, while in 2019 the new registrations totalled 35,107.
Chronic kidney disease of unknown etiology
Better known now as Chronic Interstitial Nephritis in Agricultural Communities (CINAC) has been prevalent for the past 30 years, with several studies being conducted into the mysterious disease which suddenly reared its head among farming communities. According to statistics given by the International Journal of Occupational and Environmental Health (IJOEH), the Prevalence of CKDu in some Districts of Sri Lanka was between 15.1 to 22.9 per cent.
Most affected by this deadly disease is the North Central Province. In 2017, Anuradhapura District alone had 288.0 cases per 100,000 of its population, while Medawachchiya and Padaviya had 558.6 and 500 per 100,000 of their population respectively. In 2017, Polonnaruwa District had 414 cases per 100,000 of its population.
Although this article alone may be inadequate to enumerate the deadliness of this disease, which is an NCD, and has been responsible for claiming the lives of a large number of the population in this part of the island built from ancient history on an agricultural way of life, it also does not inadvertently attempt to shove the concept of organic fertiliser down the throats of those communities knowing that some things take time.
Chemical fertiliser and agrochemicals
The question however arises as to whether each government that assumes power is prepared to beg, borrow, or steal in order to build more treatment facilities for one of the many NCDs that assail the Nation.
The Government Medical Officers’ Association (GMOA), not so long ago, requested the Environmental and Occupational Health Unit (EOHU) of the Health Ministry to make known its recommendations on the health effects in using the Liquid Fertiliser and other agrochemicals. Mainly focusing on the stock of Nano nitrogen which had been imported to be distributed to farmers.
The Union at the time said with its many proposals based on the effects of NCDs burden in the country it was only fair that the EOHU declared recommendations on many of these issues surrounding the said nano nitrogen and chemical fertiliser. The Union called at the time for the Unit to voice its recommendations on the effects to human health and environment in using the liquid fertiliser.
Although major fertiliser manufacturers may argue that the root cause of diseases such as cancer, diabetes and chronic kidney disease were not the large quantities of fertiliser, pesticides, herbicides that are used in cultivation, but results of bad food habits and unhealthy lifestyles as has been harped on by many health experts time and time again.
However, the fact remains that nestled in a corner are these deadly poisons which add heavy metals that get added to the earth, the food and pollute the waterways. These may be just statistics and figures to the many experts who even after a lapse of 30 long years have been unable to come to count down to the very last person who suffers from CINAC.
With an entire Unit set up in the Health Ministry for NCD, no one seems to be able to give the latest figures of any of the said diseases which assail a large number of the young and elderly population and the breadwinners of the families that suffer along with them.
As so aptly pointed out by the GMOA, the EOHU too chooses to maintain silence in this regard and merely relegate this colossal issue to some forgotten research that has been randomly conducted.
Policies and hospitals
With the country’s leadership inadvertently threatening to collar the farmers into using organic fertiliser and the lack of data to assess the proportion of NCDs, Sri Lanka’s Health Ministers would most definitely find it tough to come up with policies and merely settle for the hand-me-downs of the World Health Organisation (WHO) and the World Bank, not to mention China, which seems to hold sway in the country. With not even an Act or regulation like the Quarantine and Prevention of Diseases Ordinance to safeguard this Nation against the ever-increasing NCD threat, let us hope that whichever government comes to power next, that its Health Minister would be able to convince China or some other country to loan Sri Lanka more money to build the next ‘largest treatment facility’ for yet another NCD.