Fundamentals Neglected

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Chronic Kidney Disease of Unknown Aetiology (CKDu) is one of the foremost challenges facing the country’s health sector. The disease, first identified in the early 1990s, is causing havoc in the country’s dry zone, killing dozens of victims every month while infecting just as many, according to researchers. However, the exact cause of the disease remains a mystery. The government of President Maithripala Sirisena has declared that fighting the disease was a priority. However, critics say much more needs to be done at ground level if there is to be notable success.

The main problem remains that the disease is still classified as being of ‘Unknown Aetiology’. Even the report issued by the World Health Organization (WHO) after its research on CKDu in Sri Lanka concludes that no single agent can be identified as being responsible. However, based on the available data, the study concludes a ‘triple threat’ to kidneys: Low levels of Cadmium through the food chain, coupled with deficiency of Selenium and concurrent exposure to Arsenic and pesticides. The WHO study has also found that 15% of people in the country’s North Central region are affected by CKDu. While water does not appear to be the source of exposure, improving water quality and supply will possibly reduce the body burden of heavy metals as well as possible role of Fluoride, Hardness, Calcium (Ca) and Sodium (Na), the WHO study concludes.

As part of the process of tackling the disease and aiding victims, President Sirisena has initiated a program where a monthly allowance of Rs.3000 is distributed to Kidney patients. The program was launched initially in Anuradhapura and Polonnaruwa, the districts most affected by the disease. The government has also formed a Cabinet Sub Committee under the chairmanship of the President to oversee efforts to combat the disease.   A unit is due to be established at the Presidential Secretariat to coordinate the activities of all these programs.

When contacted, Deputy Director General of Health Services, Dr. Sarath Amunugama said a special committee is also due to be appointed to advise authorities on the disease and measures to combat it. All parties are also due to be summoned by the President in the coming week for a meeting on further measures that need to be taken regarding CKDu.

Explaining the measures already in place, Dr. Amunugama stated screening activities were being conducted in the affected areas by the Health Ministry in order to identify those afflicted with the disease. “We screened about 500,000 persons last year and hope to screen a million more this year,” he said. Apparently, authorities were also working on adding more Kidney Dialysis machines that patients need for treatment.

“We have currently 12 vehicles that function as mobile clinics in the areas to screen people. Blood and urine samples are taken at these clinics and they are sent to the nearest hospital for laboratory testing,” Dr. Amunugama noted.

Lecturer, Faculty of Medicine at Rajarata University, Dr. Channa Jayasumana however painted a bleak picture regarding the situation.
“Although the government has changed, we are yet to see a noticeable difference in the situation. The problems still remain,” he said. He charged that no politician has so far taken the issue seriously enough beyond using it to further their own political agendas. “We are yet to see a politician who has fully grasped the medical science behind this issue,” he added.

He also alleged that some groups have started to profit from the general fear of agrochemicals by setting up ‘businesses’ that claim to offer organically grown paddy. While it is essential for Sri Lanka to move towards organic farming, the benefits from these business don’t flow down to the people at present, he pointed out.

In late December last year, the government of former President Mahinda Rajapaksa banned the use of pesticides containing five ingredients including Glyphosate, which had been blamed by some for the increased incidence in Kidney Disease in the North Central Province. With the 2015 Presidential Election only days away at the time, the move was widely seen as a political gimmick.

In a gazette notification, the Registrar of Pesticides, Dr. Anura Wijesekara stated that every license issued in respect of pesticides containing the active ingredients Glyphosate, Propanil, Carbaryl, Cholopyrifos and Carbofuran have been modified.
By this gazette notification pesticides containing the said active ingredients were prohibited from being used, offered for sale or sold within the Districts of Anuradhapura, Polonnaruwa, Kurunegala and within the Divisional Secretariat Divisions of Mahiyanganaya, Rideemaliyadda, Kandaketiya in the Badulla District.
However, Dr. Jayasumana alleged that the ban has never been properly enforced. “I’m in Anuradhapura right now and you can still find these so-called banned pesticides in town. Leave aside the farmers, even the traders don’t know these have been banned,” he observed.

The Nation attempted to contact Registrar of Pesticides, Dr. Anura Wijesekara to clarify these claims but he was unavailable.

Dr. Jayasumana was also sceptical of the steps being undertaken by the Health Ministry to screen for potential patients.

“The WHO guidelines for screening, also known as Wilson’s Screening Criteria for Tests states that in order for screening to be conducted, there should be a treatment for the condition. But there is no treatment for CKDu. Therefore, this screening procedure is not going to help resolve the issue”.

In order to exercise at least some degree of control over the situation, he suggested several measures that are urgently needed.

“Firstly, the ban on these particular pesticides needs to be enforced on the ground. The public and traders need to be properly educated on it. Second, there should be a proper testing mechanism to screen the agrochemicals coming to our country so that there is quality assurance. Thirdly, the drinking water issue needs to be addressed immediately. Too many people in the affected areas are still without safe drinking water, leaving them vulnerable to the disease. Fourth, we have to move faster on encouraging organic farming that’s free of agrochemicals”.

However, in the long term, the government needed to formulate a National Policy on Kidney Disease that would not change depending on who was in power, Dr. Jayasumana emphasized.

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