The diabetes time bomb is already upon us, and why is there so little information and community action to alleviate suffering?

I recently attended a free clinic, Dr Hemal Fernando has been running for over 21 years, every Saturday in Pamunugama, Sri Lanka, a coastal hamlet not 20km from Colombo.

What hit me hard was the reality that most of the patients have diabetes, (80%) and due to that are more prone to other illnesses, and make surgery and interventions more risky. Furthermore, I gathered that if this doctor does not provide the free medicines, which he purchases in the open market, (not medical representatives samples) these patients would forego treatment, as they will not purchase the needed medications averaging Rs1000 for a two week prescription fill!

Cause

The primary cause of this epidemic in Sri Lanka, is the increasingly sedentary lifestyle, where people still eat more than the requirement of starch, in the form primarily of polished rice three times a day, and the increasing consumption of flour, mainly in the form of bread, added to which the traditional sweet tooth results in unhealthy servings of sugar with their fluids, whether it is tea or fruit drinks, served sickly sweet.

No amount of pleading by the doctor seems to work on the patients, even though they are sick, to adopt a change to their dietary habits, in order to alleviate the symptoms and hopefully even reverse their condition.

In the doctor’s opinion, based on over 20 years of performing this service, the people are too poor to substitute starch for the needed protein of fish and meats, which is the alternative to over indulgence in rice, polished at that.

Before the patients are seen their fasting blood sugar is tested, so the doctor who has been treating most of them for a while will be able to gauge the level of medication required, after performing the other examinations himself, which include a modern gadget that checks the heart rate.

Among that sample of 80%, a quarter are under 50 years of age, and two of the cases, they had over 300 count, meaning they had to be referred for insulin injections, which they would have to purchase from outside, as the free healthcare system will not provide them that. He even had to negotiate with the pharmacists to try and give them the pens free of charge for them to purchase the units of insulin to inject themselves with in the stomach.

How can we take steps to reduce the incidence of Diabetes in the general population?

The doctor made an interesting observation to me, saying he had read that low birth weight babies are more prone to diabetes in older ages and so asked a mother who has many children the birth weight of her children to ascertain how one of them, who came today for treatment had such a high blood sugar count at his age of 42.

Of course the curse is the poor nutrition, the lack of education on nutrition at pre-school age, when one can be weaned into eating healthy, a lost cause once one is older. Every patient was asked to attempt to switch some carbs for proteins for a change to arrest the decent into Diabetes.

This is not to say that even the wealthy with access to the best medications, don’t get the disease, but they too are worried, but are hidebound in taking action, as they are educate and aware or older and none the wiser, further reinforcing my point that a more nutritious diet at an early age, something easier to do, is the need of the hour.

A less active lifestyle with many kitchen aides for work, leaves a disproportionate percentage of patients being women, who are more than likely to be overweight due to the over consumption of rice and the lack of awareness of the unnecessary level of food intake, when compared to their husbands, who are more active and therefore less obese, but for their alcohol intake, an issue I will not dwell on here.

Unless the state or the government take the moral high ground and give this war on Diabetes the importance it deserves, the problem will just get worse and have lasting effects on the population. The Easter Sunday bombings are a walk in the park compared to the thousands dying of complication arising from Diabetes. So why is this not given priority.

Politicians in Sri Lanka have not taken the steps to improve the health and wellness of our society. (building a hospital to get more votes is not a solution, just providing care) This, especially when they have to say to consume less rice, a staple grown in Sri Lanka. It is this signal priority that is not getting across to the people to change their food consumption habits away from starch, as they are more concerned about electoral fallout rather than the death of their patients.

For the record, Dr Fernando is a Board Certified Cardiologist of the USA & a FRCP from the UK, as well as being one of the youngest MDs (doctor of medicine as opposed to the MBBS which is the basic qualification of doctors in SL) when he passed that exam in Sri Lanka in 1966. He counts over 50 years of experience, in both Cardiology and Internal Medicine, and keeps his knowledge current by following the latest developments in the profession.

My Observations

What’s more, he is the old school doctor with the training of merely using the stethoscope to diagnose most ailments, where today’s newly qualified physicians require a battery of tests, before they venture a diagnosis. That ability is worth its weight in Gold in a clinic such as this, at a church hall in the Shadow of a Church, where patient numbers demand quick diagnosis with minimal aids.

I told many of the patients that they are so fortunate to have an internationally renowned diagnostician attending to their needs, and has without any doubt both maintained their quality of life and provided basic health care, extending their productive and active lifestyles, for no charge. In short a gem in their midst, whose value will only be felt when he is no longer available to be of service.

Some patients have been regularly treated and medicines doled out for over 20 years, and personally vouch that the doctor is the reason they are alive today and are able to have fulfilling lives, the main reason for a person to live surely!

I recently wrote an piece on my social media page on the impending “Diabetes Time Bomb” expected to hit Sri Lanka as sure as day follows night, along with the link to an US article about how even Americans are foregoing treatment and hastening their life expectancy due to financial hardship, see below.

https://www.cdc.gov/nchs/products/databriefs/db349.htm

It was therefore both a godsend to witness the social peril I was talking about, and to share with my readers a lay man’s observations that people with far better knowledge and access to decision making should have made a long time ago.

PS Below are some of the comments I made on my Facebook page just three days ago (22^nd August) about the subject I have covered.

Let this information be a salutary lesson to all. In the US approx 18% of diabetics are skipping medications, primarily because of cost, and inevitably their lifespan reduction is the price they pay.

Sri Lanka is currently faced with a NCD issue of diabetes of epic proportions, and there is little mass communication between the citizens and their government about how we can control this time bomb. There are many reasons, but one main cause is the over consumption of rice instead of only eating one rice meal as was done in history, when it was more nutritious, organic and partially milled, leaving the nutrients intact.

Lifestyle and nutrition after instilling discipline is the most important part of pre-school education, as it is difficult to convince those who have got used to bad habits. It is time we put MOST of our educational resources (instead of the present ZERO) to pre-school education for all, so we can build a new generation of healthy humans, instead of the increasingly sick nation.

Why are we ignoring the most important aspect of life, the basics of nutrition, of healthy eating, so we can be sick less, and be aware of everything good and bad that we consume, and the state redirect resources to ensure clean air, clean food and clean water all of which contribute to healthy living?

Frankly the people have been conditioned to waste their time on a totally meaningless Presidential Election, where no one of any value will lead us, in all honesty, and instead march against what is important, a healthy lifestyle so fewer people suffer. When anyone asks you who do you think is going to contest, or win the election? Just say who cares they will all kill us before our time anyway, and change the conversation to the real priority of the nation, WELLNESS!

Just go to the newly built grand wings of the Polonnaruwa Base Hospital, with much increased beds and facilities. The patients are spread in mattresses in corridors for lack of space, implying that no amount of increased beds is going to ease the bed shortage. We are simply becoming a nation of sick people, reducing productivity and going in reverse. Shortly the Chinese will finish the massive new hospital being built there also as a gift from China, only to cure illness not to prevent it! Don't wait for the whole nation to be bedridden before we take action, let’s begin now, and learn from history how to grow, eat and enjoy alternative nutritious food sources, while effectively DITCHING RICE as we know it, that is simply enriching the Paddy Mafia and destroying both the farmer who grows it and the people who eat it.

Why are the people of Sri Lanka not told the facts about their rice eating habits? Who are we afraid of? Aren't the overflowing hospitals proof of the impending cataclysm? Tell me if any of the potential presidential candidates even cares of about this issue which should be on the top of the list, not bull shit security or foreign domination, which will happen anyway if we are all sick! It is the wellness program that all our voters should be evaluating not the crap that is played out in the media by the prospective candidates, all of whom are playing to the ignorant gallery, instead of educating the gallery to the facts of life

Why are the rains that fall in the Western Province allowed to flow into the sea, when we have a desperate need for this water, especially for groundwater levels and agriculture?

The proof of a crisis is when the normal wells in the Gampaha District ran dry, with the falling water table and blame was laid on heavy water using Industries that are contributing to the economy and growth. For the purposes of argument, I will just concentrate on this area, and not the Country as a whole, but with the Tanks in other areas, there is better provision for stocking water, but even here, tanks must be rehabilitated to hold more water, then there is more available for agriculture and the incidence of drought conditions reduced.

The citizens ire should instead have been directed at the poor harvesting of rain water, and the state not sufficiently proactive in raising groundwater sources by directing rainwater to holding tanks to fill aquifers, instead of building more and more canals and drains to quickly send all rain run off to the rivers and ultimately to the sea, and prevent flooding.

My contention is we have to use the low lying lands, much of which are uncultivated paddy lands that are not economic to cultivate without assured water, as water holding basins with some intelligent planning, and to direct this excess water to increase ground water supplies, instead of the current fastest route to the seas.

It is apparent that in the world water stress index, Sri Lanka which should be at the bottom, meaning the best placed, is in fact only in the middle, despite all the rainfall.

We must also remember, that due to climate change, there is short sharp heavy bursts of rain today as compared with the past, necessitating a storage mechanism, whereas in the past slow drizzles did not result in water flows, instead would be sucked into the ground in home gardens, grasslands and plantation sectors. Increasing urbanization, more concrete and less space for absorption have also exacerbated the problem.

Water Stress – What is it? And why is it so important for Sri Lanka?

https://www.wri.org/blog/2019/08/17-countries-home-one-quarter-world-population-face-extremely-high-water-stress

Water Stress – The ability or lack thereof to meet human and ecological demand for fresh water; compared to scarcity, water stress is a more inclusive and broader concept.

Water Scarcity – The volumetric abundance or the lack thereof, of freshwater resources

Water Risk – the possibility of an entity experiencing water related challenge (scarcity, stress, flooding, infrastructure decay and drought)

In the report of the link above, Sri Lanka ranks 77 out of 164 Countries, with 1 being the most water stressed Country being Qatar and least water stressed at 164 Suriname in South America.

To summarize, despite however much rainfall we have, if we are unable to harness that and store it for use when we need it, and instead just let it go all the way to the sea, we could have high water stress, if our requirements/needs are not met.

IT IS THIS POINT that I wish to highlight and in this context relate it to the absurdity of drought conditions for the Western Province that has high rainfall and the state to take immediate steps to alleviate this stress, with better water management techniques.

We are being told daily that water is becoming more and more scarce, and so we as a nation must be cognizant of this, take elementary steps now to minimize the future shocks, and be prepared for ever worsening conditions of rainfall and flooding and drought conditions too.

It is often that we now see some parts of this small island having to deal with heavy rainfall, whereas other parts are suffering drought conditions, a very incongruous situation!

Summary

Why do we have a Government? The responsibility of the state is to look into the welfare of its citizens, and the access to water for our daily needs is of paramount importance in this regard, as a fundamental duty of the state. However, despite all the prognostications and pontifications that take place, no one in power, or seeking power has even picked up on this right and promised the citizenry that this will be a priority over others, as without water, nothing else matters, SURELY!

I simply fail to understand why in prioritizing what is critical, water does not come right up there as it is synonymous with environmental preservation as well a key component for the survival of the human race, that is we care!

You see what you want to see - It is worth realizing there is more to it than first impressions

The clicks below (in this journal it is above) are two parts of the same photograph. When I posted the original photo, my eyes were on the larger Tusker, so the elephants all around did not get a look in. I stumbled upon this again, and on a second look, got three for the price of one!

If you look closely, there is a baby tusker in the photo with the big one. Seeing them is just as important to seeing the big one. The little fellows are part of the herd. In ten or more years he will venture out on his own if he is lucky.

The second photo is also very interesting seeing the little baby elephants who had just come out of the water, still enjoying their time without a worry in the world, as they are closely watched over by the elders for protection

The moral of the story here is that, often we see only what we want, and miss out on the big picture. This is so common, we need to always reflect a while and consider a double take, wondering if we have either come to the wrong conclusion, or we have missed out on the big picture.

We are so used to coming to instant beliefs based on limited facts, unable, or not wanting to accept that, either our conclusions are wrong, or at the least warped, because we wish to only reinforce our prejudices.

In fact we must also be aware that social media such as Facebook, also attempt to reinforce perceived prejudices, by presenting, targeted adverts in the guise of news, that they believe we are more likely to be happy with, thereby giving value to the organization, person, or political angle that is paying for that privilege, In short we are being duped, and our initial beliefs further confirmed, because we are presented with even more evidence to justify our point of view, further strengthening our resolve, instead of giving us a chance to question them, mind manipulation for short.

Just something to think about I guess! 

Gun control in the USA and Second Amendment Rights – an opinion

To Americans brought up under the Second Amendment Rights, that permit citizens to bear arms, guns are part and parcel of the culture, where one can even purchase guns with minimal screening in places like Walmart, with 5,000 stores that sells almost everything everywhere in the USA.

WHICH CAMP ARE YOU IN?

There are three distinct actors in this debate. ONE –Those advocating strict gun control, even the abolition of the second amendment, on the grounds that this amendment is anachronistic, and almost unique to the Constitution of the USA and not to any other country on the face of the earth. TWO –Those who will hear of nothing, and don’t wish to change this right of the individual, and are vociferously represented by the NRA (National Rifle Association) that is well funded and lobbies in the US Congress, where lawmakers fear their strength in the heartland of rural USA. THREE – The Supreme Court that interprets the Constitutional Rights, when it comes up for debate, and where those advocating control have been singularly unsuccessful in getting an interpretation of the Constitution favourable to the abolition, or substantial restriction.

THE TROUBLE WITH MASS SHOOTINGS

Each time there is a mass shooting this question comes up for debate up and down the country, and the people have strongly held views on the subject. However in the 250 year history of the Country, the second amendment is seemingly unshakable!

So how do you shake it without upsetting the majority? Two thirds majority of Congress is required I believe to change the Constitution and there is no chance of that every happening. So given the ground realities and taking a practical stance, let us take the security of the person as paramount, and look at how fire arms have changed in 250 years.

IF you take protection of the person, then I should have the right to protect myself from harm, and permitted to carry a weapon, concealed upon my person or openly in plain sight, to both deter the aggressor, or provide security in case of attack. Given the fact that the right to bear arms is sacrosanct and there is nothing you or I can do about it there are just two avenues we can start by forcing a COMPROMISE that is partially acceptable to the citizenry. Then the debate should concentrate on what kind of weapon will give me this level of protection, and be compatible with the second amendment rights at the same time.

PROPOSAL FOR CONSIDERATION

It is quite obvious that many if not all the of the mass shooters, and remember gun crime is not restricted to mass shootings, though it is them that hits the headlines and starts the debate amongst the public, are carried out by people with certain personal issues, of anger against some group, or some past betrayal leading to some need for revenge, etc. The common denominator is that these people have some kind of mental instability. One must also remember that suicides are also gun related, when guns are freely available, however with Sri Lanka high on the suicide statistics, it is carried out by other means, negating this argument for gun control.

The second common factor is that these unstable individuals, seem to be able acquire high velocity, repeater assault rifles that can kill and maim numbers of people in a very short span, something that only armies or terrorist prevention militia need, and should not IN ANY CIRCUMSTANCE be freely available to anyone who wishes to buy them. The mere fact that any person who wants to can amass an arsenal in a short space of time is a frightening prospect, especially if this person is mentally unstable, and no one can predict when and where that person is liable to use it. That means NO ONE IS SAFE.

If that latter statement isn’t enough for a normal human being to say, enough is enough, we must control the types of weapons people can purchase, what is?

Of course there is a looming Presidential Election in 2020 in the USA, and if a candidate comes up with a compromise that they wish to enact that is legally likely to pass, then that must be a platform that would obtain majority support. People are not in extreme camps and it is time we test it out.

Of course in a Presidential campaign there are other issues that may be paramount relegating this depending when this matter is on the front or back burner as a result of a new shooting or mass killing.

Republican President Trump being from the rural red neck backing, ironically has the best chance of bringing this about, and be remembered for posterity, if he wants to leave a legacy, advocating moderate control that minimizes the likelihood of the unstable population getting their hands on lethal weapons. After all it is he, who says these people doing it are nut cases, without admitting that the Country does in fact have more than a fair share of nut cases, growing daily, and his off the cuff remarks, that are meant for his political base, further empowers the nutters to act, citing the President as a source of their inspiration! It is worth a stab, and there is nothing to lose, DON’T YOU THINK?

Do you even know that the Indians are pouring in tens of thousands of troops into Kashmir today?

There is trouble brewing in Kashmir and India has asked all tourists to vamoose, as their security cannot be guaranteed and they are pouring in troops to this disputed region, in order to quell a potential uprising.

The world is silent as they don’t want to get involved and have their own problems and even the well-known rather unbiased international media are keeping mum! Such is the power of power, Indian style.

So make no bones about it, little Sri Lanka is not and never will be in that situation and cannot call the shots. Our foreign and domestic policy must be such that we know how to balance competing interests and do whatever it takes to benefit the Country, its strategic interests and take from whomever it gets, not be frightened to tell the opposition goons who have no clue about diplomacy nor understand sovereignty of a nation that is not powerful.

The Indian Govt. with Modi’s new found moral authority, is willing to go the whole hog and change the dynamics of how Kashmir is ruled. Read the links below for further information.

I am sure Pakistan is contemplating what moves they can make, but don’t want to interfere, as they have their own issues internally and the Afghanistan issues to contend with the Taliban, allowing India to effectively dictate terms.

Of course poor Sri Lanka will not dare even squeal as the Indian tiger will just Roar and our frightened leaders will just cower in fear, their words of bravado reserved for the local dimwits who believe any crap that is laid on them.

https://www.theguardian.com/world/2019/aug/05/india-revoke-disputed-kashmir-special-status

https://www.theguardian.com/world/2019/aug/05/kashmir-leaders-placed-under-arrest-amid-security-crackdown

This action of India is a salutary reminder of the possible, if we try to embrace Chinese too much into our bosom. It is just was well that potential power seekers understand the ground reality, of the delicate game that has to be played.

Narendra Modi is a fierce counterbalance to Xi Jinping of China, our jokers need to know how to play the game of balance, keeping both super powers happy with Sri Lanka. We need to warn the politicians who do otherwise, to keep their traps firmly shut, if they call themselves patriots, as nationalists we don’t want anything to do with that moniker in the present environment.

In the context of two mass killings in the USA – and how it does not draw IRE! When compared to the travel advisory issued by the US Embassy.

Sri Lankans are left wondering about the incomprehensibility with which the US Embassy issues a travel advisory for Sri Lanka on 2^nd August warning people to avoid public places, just in case, where as in the US packed store was open season for a homegrown terrorist to commit mayhem, or a restaurant where normal people also gather as another place that is unsafe.

It is fair therefore to feel slighted and perturbed by the actions of the US Govt. (the embassy after all is an adjunct of their State Department) which affect tourism adversely, where one asks doesn’t US mass shootings affect their security, or the security of a visitor.

The flip side of this argument is that the SL Government can issue a travel advisory IN THE USA via its embassy warning Sri Lankan citizens there about the dangers of home grown terrorism that could appear anywhere, and where one least expects it. The fact that the shooter in Ohio who killed 9 did so within the 30 seconds available to him, before he was shot dead speaks volumes for the deadly arms that are effectively freely available to the citizens, and could have if there were no cops nearby, have left even more people dead and injured.

I am sure the US govt. will not complain about an advisory, unlike the SL govt. which is complaining now, as being unfair. Only potential threats have necessitated the advisory. The real issue is a travel advisory from the US affects the SL economy, and the vice versa situation does not affect the US economy at all, and therein lies the inability to counterbalance the argument itself.

For the appreciation of the argument the homicide rate in the US is 4.9per 100k while in SL it is 2.9per 100k, so the US is a distinctly more dangerous place. However people don’t come to SL because our homicide rate is lower and not go to the US because its rate his higher!

http://worldpopulationreview.com/countries/murder-rate-by-country/?fbclid=IwAR3Kt_ooW3JOeTjoiN3S6sjP8Co8QWrGXwv0hUgFRKZWHa7Yk1kp9eVVJS8

Put it another way, the US has 100 people die from road accidents each day on average, while SL has 10 people dying. However the US population is 16.5 times that of SL. SO it is clearly more dangerous being on a SL road. The US really should point this out as being a hazard to their citizens, but they don’t, as it is difficult to explain. If they do, the SL authorities will shout saying it is not comparing apples with apples.

This whole argument boils down to chance and being at the wrong place at the wrong time and the probability of anyone being affected by a terrorist attack bei it in SL or USA is less than being affected by a motor accident in either country.