Wednesday, January 31, 2007


In today’s professional sports arena, victory means the ultimate objective of any team in a contest. The greatness is determined by the consistency of better results produced over a significant period of time. In this background, given the equality of skill and technique levels, mental component has come to the fore as the determining factor of the sporting success. It has acquired such an important level, Aussie cricket legend Steven Waugh believes that the skill level of cricket matters only 10% in the success while more importantly mental status comprises the rest 90%.

Many teams adopt multitude of tactics to boost their mental confidence while extreme measures such as sledging are used to disrupt the equilibrium of opponents. Any person who is a fan of All conquering All Blacks rugby team may be aware the use of a different tactic by ABs to intimidate their opponents even before the game is kicked off. The method used by all blacks to ensure their psychological dominance over opponents is the tribal war cry called HAKA

Haka is performed by hand, feet, legs , bodily voice and concluded by protruding tongue and mimicking the slashing of the throat. This blending of these parts convey their completeness, challenge, welcome, exultation, defiance or contempt of the word . Haka has been defined as a disciplined and emotional expression of the passion, vigour and identity of the race. It has been identified as a message of soul expressed by word and posture.

There are versions of haka performed in NZ. Familiar to rugby fans KAMATE version is believed to be the interpretation of the 19th century warrior chief TE RAUPARAHA who was famous for his ruthless slaughter of Maoris in the South island. Kamate of ngeri style is described as a short free form where dancers interpret as they feel. The other version, PERUPERU is a style for true war dance performed with weapons and high jump with legs folded under at the end. If you happen to be a tourist in the North island, definitely you may be able to witness the performance of this version by Maoris in their native costumes with painted or tattooed faces. It is a spectacular view that raises ones hair on seeing the performance.
Rangi pakia
Kamate Kamate
Ka Ora Ka OraKamate Kamate
Ka Ora Ka Ora
Tenei Te Tangata
Puhuru Huru
Nana E Tiki Mai
Whaka Whiti Te Ra
A Hupane A Hupane
A Hupane Kupane
Whiti Te Ra!

It is death It is death
It is life It is Life
It is death It is death
It is life It is life
This is the hairy man Who caused the sun to shine again for me
Up the ladder Up the Ladder
Up to the top
The sun Shines!

Wednesday, January 24, 2007


In a flourishing market economy, private providers have started to play a dominant role in Provision of pharmaceutical care. In such a scenario, the state’s objective of providing safe and Efficacious drugs to the consumer may loose to maximisation of profits by the private provider.The role of profit maximisation is more often associated with the risk of low quality of the practice at private pharmacies.

Policy analysts have identified mechanisms such as regulation, advocacy and monitoring as mechanisms to liaise with private providers. The state lays down rules, regulations and enforces such legislations through a legitimate body. In Sri Lanka, the relevant legislation is the Cosmetic Devices and Drugs (CDD) Act No27 of 1980, amendments No 38 of 1984, Act No27 of 1987 and Act No 12 of 1993. Cosmetic Drugs Devices Regulatory Authority (CDDA) exercises the enforcement of the act for the state. It is the duty of the authorised officers to ensure the provision of safe efficacious drugs to the consumers. In addition to the Food and Drug Inspectors (FDI), Deputy Provincial Director of Health Services (DPDHS) and divisional public health authorities such as the Medical officer of Health (MOH) have been specified by the CDD Act as authorised officers.

In order to provide safe and efficacious drugs to the consumers at the pharmacy level, it is imperative that these officers ensure the compliance with Good Pharmacy practices (GPP) by the pharmacy staff. GPP is defined as “the practice of pharmacy aimed at providing the best use of drugs and other health care services and products by patients and the members of the public”. It emphasises that the welfare of the consumer is the prime concern at all times.

The elements of GPP can be categorised in to seven broad groups: licensing, physical environment of the pharmacy, order in pharmacy, storage of drugs, and maintenance of cold chain, dispensing and documentation. A recent study carried out in urban areas of Gampha district and rural Polonnaruwa district has focussed on the status of compliance with the GPP at retail pharmacies.

A substantial floor area is a pre requisite for issuing recommendation for licensing of a pharmacy. Though a floor area of more than 120square feet is a pre requisite for recommendation for licensing, It has been highlighted that this has not been adhered in certain occasions. Inadequate floor area of pharmacies presents problems such as difficulty in movement, lack of space to fix a wash basin and for proper placement of refrigerators. Improper placement of a refrigerator may adversely affect the maintenance of the cold chain thereby perishing lifesaving drugs while inadequate space to move about may influence the efficiency of dispensing medicines.

Another pre requisite for issuing a licence for a retail pharmacy is the availability of a water supply with the requirement of a wash basin with its location in an easily accessible place. According to the study, this has been poorly adhered to in majority of pharmacies in the study areas. Some pharmacies did not have spacious premises to locate a wash basin while the reason for non availability of a wash basin in certain pharmacies which had adequate space was mere ignorance of this requirement. It was elicited that the reason for recommending license without fulfilling these pre conditional requirements was to improve the access to drugs. However, it is clear that such a move drastically reduces the quality of pharmaceutical services offered by the pharmacies.

Drug regulation 43(b) specifies that the premises shall have proper storage conditions for preserving the properties of drugs. In Sri Lanka, the average room temperature exceeded300C and this had been observed in majority of inspected pharmacies. Installing air conditioners was affordable only to a handful of owners of large-scale pharmacies. The High ambient temperatures of the pharmacy interior pose a problem for drugs that should be kept within 15-25 0C. The question of the efficacy of these medicines arises as a result of prolonged exposure to these temperatures exceeding 250C.Testing of these samples is thus essential to ascertain the quality failure.

Another issue that was highlighted in the pharmacy study was the inadequate coverage of an alternative power supply to be used in an event of prolonged power failure. Of the pharmacies which did not have an alternative power supply, almost all did not have an alternative arrangement to move vaccines and other drugs that needed a storage temperature between 2-8 C in an event of a prolonged power failure. This presents an inherent danger in terms of providing efficacious drugs to the consumers as Pharmaceuticals that need a storage temperature between 2-8 C are found in majority of pharmacies. Vaccines for human consumption were also available in more than two third of inspected urban and rural pharmacies while veterinary vaccines were available only in 1/3 of the pharmacies.

The commonest vaccine that was found in private pharmacies in both urban and rural district was the Tetanus Toxoid. Two thirds of the pharmacies had this vaccine. In rural pharmacies, other types of vaccines were not available. This reflects the low demand of vaccines in the private sector due to the better access to vaccination in the public sector. This was almost similar in the urban sector. However in a handful of pharmacies in the urban sector, Oral Polio, Measles Mumps & Rubella(MMR), Hepatitis A, Hepatitis B, and Haemophilus influenza
B (Hib) vaccines were available.

Though the maintenance of the temperature was an important aspect of ensuring the potency of vaccines and drugs, the temperatures inside the refrigerator exceed 2-8C in majority of pharmacies. Thermometers were not available. Recording of the temperature had been carried out only in exceptional cases. Since pharmacies are business premises, drugs, food and beverages are stored together in the refrigerator. As a result, the space of the drugs food and beverages took up more than50% of the total space in refrigerators in many pharmacies. Frequent opening of the refrigerator and the warmth of food and beverages cause the temperature to rise within the refrigerators affecting the potency of the drugs. Non availability of water bottles and icepacks also increase the temperature within the refrigerator. Additionally, practice of compact storage of vaccines, drugs, foods and beverages cause poor circulation of air between drugs and vaccines.

In majority of bigger pharmacies, the drugs had been stored even in doors of the refrigerator exposing them to the room temperature whenever the refrigerator was opened. However, smaller pharmacies do not stick to this due to the small numbers of vaccines and refrigerated drugs in their refrigerators.
All these observations suggest the questionable potency of drugs and vaccines available in pharmacies. In Contrast to this, in the public sector, there is a well established system of monitoring of Cold Chain. Cold Chain monitors indicate the need for quick use or discarding vaccines. There are hierarchical officers who monitor the cold chain ensuring the efficacy of the vaccine.

In Sri Lanka, as the majority of pharmacies are situated facing to motorable roads, dust is very common. However, the contamination with dust can be minimised by adhering to the practice of shutting down doors of shelves after transactions. In certain pharmacies, there were expired drugs contrary to the regulation 46 (b) of the CDD Act. The finding is suggestive of some deficiencies: inadequate or infrequent inspection by authorised officers, owners/staff not willing to have regular inspection of shelves and removal of expired drugs and non availability of a system to identify slow moving drugs when the expiry dates are close. The other danger is that the slow moving expired drugs especially when not dispensed in original pack can be sold to the clients.

The other biggest concern was the non availability of a proper mechanism to destroy expired drugs. The expired items are discarded to the rubbish collection in many pharmacies and subsequently removed by garbage disposal units of the local bodies as only a handful of drugcompanies collect expired items. This contravenes the Regulation No.72 of the CDD Act which specifies that any drug which fails to confirm to the specified standards or the storage life of which has expired shall be destroyed under the supervision of an officer authorised by the authority.

The CDD Act has clearly specified its objective of providing safe and `efficacious drug supply to consumers. The Sri Lankan experience demonstrates that there is a divergence of the service provider’s objective of profit maximisation from the objective of the CDD Act. As pointed out by health policy analysts, regulation and monitoring remain the core mechanisms to approximate these two objectives. Many of these deficiencies can be corrected within the current system. In order to effectively implement these regulatory mechanisms, routine monitory mechanism should be strengthened with introduction of targets for the officers involved.

It is imperative that more focus should be on the storage of drugs including cold chain items. At the district level, the services of the Regional Epidemiologists can be used by the Deputy Provincial Directors to improve maintenance of cold chain at private pharmacies. Regional Epidemiologists are specially trained by the Epidemiology Unit to supervise maintenance of cold chain in curative and preventive institutions in the public sector. As the CDD Act specifies the Medical Officer of Health as an authorised officer, he can also be utilised for this purpose. Independent monitoring of the elements of GPP by MOH in addition to the FDII will be an additional measure to improve the provision of efficacious drugs to consumers. As the disposal of bio waste remains a problem in relation to drugs, it is timely to consider a central low-cost model bio-waste plants at district levels. Mechanisms need to be worked out to collect and safely dispose of expired drugs under the supervision of authorised officers at the district level.

Tuesday, January 23, 2007


Knowledge or wisdom? just read this Red Indian verse and decide yourself.

Only after the last tree has been cutdown
only after the last river has been poisoned
only after the last fish has been caught
Only then will you find that money can be eaten


Sunday, January 21, 2007


They say it is a bad habit to read while one is eating. So said my strict mom and dad .From the earliest ages of my formative years of upbringing, I was stuck with this bad habit, sometimes it may seem useful though. Having persisted with the same still as an adult, I recently found some interesting facts about rice on the back of a packet of rice based breakfast( RICIES) . The facts are amazing and I reckon even for a second you will not imagine how interesting these facts are. In particular, if you are brought up in an environment where rice plays an integral part of your life, these facts may appear very thought provoking. My roots go back to rice cultivators and during our childhood, say three four decades back, as kids we were involved in rice farming to the maximum. We joined manual tillers in tilling the muddy, dark, sulphur smelling at times earth, harvest collectors in collecting plants with a sickle and the funny part of it was leading animals( Buffaloes) over the spread of collected, rice plants with the crop to separate seeds from the plant. This was the era well before tractors and harvesting machines were not in use. Many of the kids who grow up today do not know what these experiences were like. For us , it was sheer fun doing all these stuffs. Like elders, we loved simulating their acts of lying on discarded dried paddy plants after seeds had been separated. Even to a minute, we did not contemplate on the terrible itching that occurs in our skins. Today, whenever, I see paddy fields, my earliest nostalgic memories keep flowing to my mind.

Here are those interesting facts about rice:

In China they typically greet with “ Have you had your rice today”
Almost half of the world’s population eats rice (about three billion)
Ground boiled rice can be made into glue
Rice farming is older than the great grand mother of your great great grand father –
about 10000 years
After a framer plants rice, it takes 105 days before he can harvest it
Some time rice is planted by dropping from air
Rice is a source of carbohydrates to feed one’s brain
Did you know your favourite car Toyota means BOUNTIFUL RICE FIELD, and Honda
If a rice plant is cared for properly, it can live 20 years
It takes 5000 litres of water to produce one kilogram of rice
Rices are packed with B vitamins that help release energy from food intake

Tuesday, January 16, 2007


Maoris believe their settlement in Aotearoa ( THE LAND OF THE LONG WHITE CLOUD) occurred in 8 AD. According to a Maori legend, all life originated in a still night from primordial parents, RANGI NUI, the sky father and PAPA-TU- A NUKU , the earth mother. These were in a tight embrace and derived enormous joy from one another’s company .This tight embrace left their children to move violently and suffocate between their clasped their bodies for eternity Their eldest sun( TANE) the god of forest pulled himself free of the grip of their parents in the darkness . Over a long period of time he forcibly pulled their parents apart and separated them. He lifted RANGI in to the sky and covered his nakedness with the sun, moon and stars Tan created many trees and lakes strewed across the vast expanse to cover mother’ nakedness. She was covered with fauna and flora . However, the grief of separation from the mate caused RANGI to weep and tears started to flow from his eyes filling the surface of PAPA with oceans and lakes. As a result, the earth and sky remains separated today so that life can find it palace in between.
Another son, TIKE formed a figure of a human out of sacred and red sand and chanted a KARAKIA ( ritual incantation) to create MARIKORIKO the first woman. He consulted WAI MATU HIRANGI, the wise river. Their union produced great Maori people. Another son hauled up enormous fish out of sea that turned into the North Island .His boat and anchor weight became South and Stuart islands .


Rise from this grave
Release your anger and pain
As you soar the winds
Back to your homelands
There, find peace
With our spiritual mother, the land
Before drifting off into the dream time

(Quoted from the grave yard stone of Australian aborigines located in the Queen Victoria gardens in Melbourne)

Analytically, I admire the writer for identifying the pain and anger of the natives for the disruption of equilibrium that existed centuries. Their way of life was turned upside down, landscape was changed forever and some had to get rid of their lives so precious to their near and dear ones. Amazingly, though, the writer displays the elements of humanity in his blood by advising spirits to manage the uncontrollable anger and intolerable pain in the aftermath of a great injustice. Soothingly, he gives out the message to find everlasting peace in still untouched, harsh but virgin lap of the mother- Land. One of my favourites and no wonder I copied it from the moment it captured my eye.

Monday, January 15, 2007


Our journey, down south, went through the small southern city of Gore. On our way towards Invercargill, we did not make a stop over in Gore. It was intentional since the next day we were supposed to visit Jayantha’s home for the lunch. Directly we drove down to Invercargill, the southern most city of Aotearoa ( New Zealand). Invercargill is called the capital of MURIHIKU in Maori which means the tail end of the land.

Like Dunedin, IC has preserved its essentially Scottish heritage. Many of the streets bear names of Scottish rivers. The city has a lot of Victorian architecture if one is particularly concerned about architecture. From my professional point of view, IC hospital was an attractive site. I was told that there are numbers of Sri Lankan doctors working in the hospital as permanent staff as well as post graduate trainless from our very own Post Graduate Institute of Medicine. We met Dr. Viraj who happened to be a graduate from the medical academy in Moscow. It was a couple of years before I finished though. He was not known to me at that time though I had faint memories of Viraj. Just prior to his migration , he talked to one of my registrars about his impending visit to NZ when I was a trainee anaesthetist in the National Hospital of Colombo. He was a senior anaesthetist then at the NHSL. Who says world is a bigger place ? Technological revolution has made world a closer place to access than it was a decade or so ago. No wonder, I met him in the furthest corner of NZ closer to the South pole quite unexpectedly after a decade .

Ours was a busy schedule. We did not have enough time to skip from one site to another. Everything was made in a haste. This was not a sight seeing tour per se. Nor it was a planned trip. We started late from Dunedin and by the time we got to IC, it was too dark as it was the winter. We stayed at Raja’s place and next day, travelled to BLUFF , the furthest point of the South Island. We were able to climb up the hill to visit a look out point towards Stuart Island .This place was informative as it displayed a lot of historical information on IC , uniqueness of indigenous fauna and flora and the devastating effects of pests introduced by European settlers to the island. Some people who were with us had the slightest interest in these information . One has to bear it up when you acct collectively though, sub consciously I regretted the opportunity to store some information in my brain. I once again realised the importance of travelling with companions or peers having same sort of interests. We were able to spend only a couple of hours at Bluff since we were expected for lunch at Dr.Jayantha’s .In that way, we were pretty unfortunate to visit places of interest in IC. Though we missed, there are some places, any visitor to this peaceful city should visit.

The Art of Christopher Aubrey was in display when we were there. Christopher was a new generation of amateur artists who documented NZ country side in later part of the 19th century. His paintings are reported to reflect aspects of European colonisation of NZ. European settlers at work, deforestation, paintings of freshly constructed buildings are few of his areas of art works. Southland museum and art gallery is quoted in many travel guides as a place worth visiting in IC. The museum displays tuatara, the world’s only living relative of the dinosaurs that roamed the earth 220 million years ago. These living dinosaurs are a unique feature of the Southland museum. Closer to the museum, Queens Park is an ideal place for a retreat.

I have another interesting place in IC. That is the rugby stadium of the Southland rugby team. Invercargill is the birth place of one of my heroes, Jeffrey Wilson. Jeffrey was a double international. He first represented NZ in cricket. His greatest moment was scoring 44 runs to beat Aussies when all odds against Kiwis as a 19 year old cricketer. Later he realised the dream of any New Zealander of being an ALL BLACK. Jeffrey was one of the all time great ALL BLACKS and NZRFU should be grateful to him as he was instrumental in placing the full stop for WRC rugby.WRC rugby was a business manoeuvre similar to Kerry Packers division of the cricket world in 1970s. He played as a phenomenal winger with legendary Jonah Lomu. Jeff was a die hard Otago and Highlander player. Our common link is through the Otago university as I read in his autobiography that he pursued a course in UNI as an all black. Additionally, I am a highlander fan as well. After his retirement, he came back to represent cricket for NZ. In a match against the world XI, he captured 3 wickets for six runs. Jeffrey’s dream was short lived when he was sidelined from action in 2006, when a chronic ankle problem acquired as a result of rugby troubled him. Even visiting his birth place was a joy to me as a die hard rugby and cricket fan.

On the way to IC, another interesting place is the private house of a collector who has buried oyster shells brought from all over the globe in walls. A fascinating past time. Is not it?
On our way back, we made our stop over in Gore for the lunch. Gore is a small, rural city in New Zealand with the Hokonui hills in the backdrop. It is well known in the world as the capital of trout fishing, however smaller and rural the city may seem . From October to March, Gore district apparently becomes an international venue for anglers to pit their skills with the local brown trout. The last inter tribal wars were recorded to have occurred in Gore. Gold discovery and illicit whiskey industry were other aspects which have places in the history of Gore. Drive from Dunedin to Gore through stunning landscapes is amazing and spectacular. Peony roses, rhododendrons, roses, magnolias and bulbs are in abundance with brilliant colours due to the combination of richness of the soil, magnificence of the climate and the light. Among other things, Hokonui Moonshine museum, Eastern Southland art gallery, Gore fishing museum project are some offers to visitors which we were unable to visit during our brief stay in Gore.

Sunday, January 14, 2007


It has been almost one year since I set foot on this beautiful part of New Zealand to pursue my post doctoral training at the University of Otago. I was told that there was a holiday retreat just a few minutes away from the hustle bustle of Dunedin. However, commitments at the University and my spending winter vacation in Australia did not allow me to make a visit to these beautiful places in the Otago Peninsula. However, I set aside all my activities and spent a whole day in the charming beauty of the peninsula as soon I will be off New Zealand shores.

Otago peninsula stretches along the southern edge of the Otago harbour. The drive is a fascinating and scenic one along lush green pastures typical of New Zealand. Parallel to your drive on your left side is yet another similar drive on the other side of the lagoon leading to the port Chalmers. Countless numbers of small bays, rugged hills and volcanic landforms are luxuries so near to the City but yet so far removed from it. Once , Dunedin is gradually removed from your scene, the attractions which emerge before you are enormous.

The best description of Otago Peninsula has come from Sir. David Bellamy. He describes OP as the finest example of eco tourism in NZ. It has human dwellings but unlike in many places, it is still not polluted probably because of the low population density.

The biggest attraction of course is the remarkable range of wild life. Miles ahead of famous look out points for wild life, we managed to have a glimpse of a Zeal basking in the sunlight. As Dunedin weather is so unpredictable, just keep your eye on for the best forecast and a sunny day is just the sort of ideal day to experience the beauty of the OP.

If you are in Dunedin and need to spend the whole day in OP without the responsibility of leaving a vehicle behind, there is a bus in the morning which operates to the Harrington Point ( HP) which is nearly 2 KMs from the Furthest end of the OP. Walking from HP to Taiora Head (TH) is quite enjoyable. Royal Albatross centre is situated at the TH . Visitor centre has various guided tours to see Albatross and of course a souvenir shop to grab souvenirs. If you are lucky, you may be able to view huge Royal Albatrosses.

TH is the only inland natural habitat in the world. It is the only place where albatross breed in a mainland and still visible for human. These birds once paired, they pair for life unlike humans in some of whom the marriage lasts for days, months and sometimes a few years. Breeding takes place every second year and in between they take a year holiday at sea. Rearing takes 12 months and Royals breed only in NZ. Eggs are laid and changed over in November , guarded in March to June while near fledgling occurs in August. Chick are fed by slurry of regurgitated food .Food is transferred in CROSS BILL action. .A 30 minute quality time is spent with chicks. The brochure of the centre says these birds have been creatures of reverence , superstition and wonder for centuries. Earlier seafarers have believed the souls of their dead captains took the form of albatross to wander oceans forever.

You may visit Fort Taiaroa , where the underground fort houses the only completely restored Armstrong disappearing gun in the world. This has been in place since 1880s to pacify a possible onslaught from heavily armed Russians in the South Pacific. Just below the centre, sea lions can be seen in abundance. Some time these guys can be aggressive. One chased after me as a protest against the effect of flash when I attempted to take a photograph. There are other centres like NATURE’S WONDERS and Penguin colony where one can see wild life.

If one is interested in Maori Culture, a MARAE is situated in OTAKOU. It is just a few hundred meters inland from the coastal road. Marae and the church is very attractive but you may be disappointed to a certain degree if you have been to a better Marae in the North Island. There are lots of walking tracks if you want to take a stroll along pastoral lands . Many of these lands belong to individuals who have been kind enough to allow visitors to feel the beauty of the OP.

The other attraction is the Larnarch Castle which is situated closer to the Company bay. One has to climb up the hill by a vehicle or can stroll up a walking track of 3 KMs to the castle. It is supposed to be the only castle in NZ. My colleague, Stuart from UK was against using the term of Castle for this as he believes “Castle is a place built by royals and for defence purposes. However, I am not a linguistic specialist . Nor I am a historian. But, the garden of the castle is really nice to spend a day.

This castle was built in 1870 by William Larnach who was an Aussie banker who came to Dunedin lured by the wealth which followed the gold rush. He lived in the castle with 3 successive wives till 1898. His life has ended in a tragedy when he took his own life in the NZ house of parliament. His children sold his property which changed hands several times and was abandoned twice. It was purchased and restored by current owners, the Barker family in 1967.Castle and surrounding has a land area of 14 hectares. Garden has a cupola from the sailing ship “ZEALANDIA” installed in 1927.

The central raised lawn with trees planted in 19th century has a marble fountain installed from Pisa, Italy in 1930. Flowers evoke the country garden era before the 1st world war. Scottish thistle , the national emblem of Scotland can be found in the castle . Vibrantly coloured perennials are planted in the Holly Hedge garden with NZ grasses and southern hemisphere shrubs. Marble bath was sold and used as a horse trough in a neighbouring garden but current owners have relocated it in the due place. ROCK GARDEN has been rediscovered after a visitor has informed the owners how he laid out it and was upset that his work has been obliterated by self-sown trees. Temperate rainforest, patterned garden Methane plant and south seas garden are other attractions in the garden. A days visit to this spectacular and magnificent garden is a rich experience and is worth for the entrance fee.

My retreat in the OP was really enjoyable. I feel like going there more often. Hectic schedule at university does not allow such luxury though. Soon, I will be off NZ shores to my sunny country. Memories of OP will definitely linger in my mind. The only other similar account that vividly describes a similar feeling that comes to my mind is John Denver’s COUNTRY ROADS. As the saying goes in Dunedin tourist circles, I WILL TAKE NOTHING BUT PHOTOGRAPHS, LEAVE NOTHING BUT FOOT PRINTS


Thursday, January 11, 2007


Among many traditional new year greeting cards recieved by me , this card sent by Anjana was the most fascinating one for me. It reflects the rich and ancient cultural heritage of Sri Lanka.


Sri Lanka has been in the fore front of the elimination of leprosy, which has been extant since ancient time, as a public health problem in the world. It reached the elimination target of less than one case for 10000 population, a half decade before the year targeted by the WHO. Though the country has achieved a significant progress in this regard, few more issues remain to be settled in the final phase of its elimination. Current strategies addressing these issues are consistent with the global strategy for further reducing the leprosy burden and sustaining leprosy control activities outlined by the WHO which aims at addressing the remaining challenges that endemic countries are likely to face in providing services to people affected by leprosy under conditions of low prevalence.

To overcome these challenges, Sri Lankan Ministry of Health took a bold decision to integrate leprosy services carried out by the vertical campaign to the hierarchical institutions in the General Health Structure( GHS) in 2001. This strategy was adopted with a view to detecting and managing still remaining leprosy cases in the population and providing a better and easy access to these services to patients in a low prevalence scenario in the country. Furthermore, this was seen as a cost-effective approach of providing services for the ministry in a changing epidemiological situation.

Global leprosy situation

Leprosy is no longer a public health problem in a vast majority of countries in the world.
The global registered prevalence of leprosy at the beginning of the year 2006 was 219826 cases. There were 296499 new cases detected during 2005. .According to the WHO, there was a 27% decline in newly detected cases in 2005 in comparison to the preceding year. However, our region, South East Asia was the biggest contributor to the global leprosy burden. Sixty eight percent (201635 new cases) of the global case load was reported in the South-East Asian region. The lowest number of 3133 new cases (0.01%) was reported in the Eastern Mediterranean region.

Worldwide, there has been a declining trend in newly detected cases during the period spanning from of 2001 to 2005. This decline was 38%. The percentage decrease for African, American , South East Asia, Eastern Mediterranean, Western Pacific regions were respectively 7.6%, 2.5%, 70%, 34.2%, 3.7%. The most notable decline in new cases is reported from the South East Asian region.

There were six major endemic countries namely Brazil, Congo, Mozambique, Madagascar, Nepal and Tanzania, which had not been able to reach the WHO elimination target by the end of 2005. Registered prevalence of Leprosy in Nepal was 1.8/10000 while New Case Detection Rate (NCDR) was 2.27/10000 population in 2005.

Seventeen countries had reported more than 1000 new cases during the year 2005.These countries accounted for 94% of the new cases detected globally. Though, Sri Lanka has reached the WHO‘s target of elimination, it occupied the 14th position in terms of the number of new cases detected during the year 2005. India’s contribution of 161457 (54.5%) new cases was phenomenal in this list.

One of the important parameters for a leprosy epidemiologist is the proportion of Multi Bacillary (MB) cases among newly detected cases .This varied from WHO regions to region. The highest proportion (94.3%) was reported from the Philippines while the lowest was from Comoros in the African region which was 22.6%. The other important parameter from the transmission point of view of the disease is the proportion of children less than 15 years among the newly detected cases (Child rate). Comoros in the African region had reported the highest child rate of 39.1% while Argentina had the lowest reported rate of 1%. Grade II disability rate which is the indicator of delayed detection of leprosy was reported to be the highest in Benin (21.7%) followed by China (21.3%). Federated state of Micronesia reported the lowest disability rate of 0.8%.

Sri Lankan situation.

Since integration of leprosy services into the GHS, diagnostic, treatment, MDT distribution and rehabilitative services have been fully taken over by the hierarchical institutions in the GHS. Organisation and implementation of the leprosy elimination activities at the field level are within the jurisdiction of the respective Provincial Health Ministries.

Recent analysis carried out by the ALC reveal that there is a statistically significant drop in the trend of newly detected cases at the Central Leprosy Clinic(CLC) indicating the effect of the integration. It reflects the gradual taking over of the case detection and treatment by the institutions in the GHS. Currently, the CLC caters mainly to the people residing in the Colombo Municipal area. Among the institutions in the GHS, institutions above Base Hospitals have been instrumental in detecting more than three quarter of cases every year since integration. This is consistent with the existing trend of bypassing minor health facilities for other disease in Sri Lanka. Another striking feature in pattern of detection of leprosy in the GHS following integration is the significantly increasing proportion of leprosy cases detected at hospitals with specialised dermatological services. However, in remote districts where specialised dermatological services were not available, the role of lower echelon institution such as Central dispensaries in detecting cases was noteworthy of mention. The comparatively higher proportion of Grade II deformities among patients detected in lower echelon institutions suggests the detection of cases hidden in the community mainly in rural areas until the services became more wide spread and accessible as a result of the integration.

Epidemiological situation

Prevalence of leprosy has been nearly unchanged in the five year period from 2000(0.68/10000) to 2005(0.65/10000). The absolute number of newly detected cases was 1924 in 2005 in comparison to 1700 in 2000. NCDR was 8.9/100000 and 9.6/100000 in 2000 and 2005 respectively. There has not been substantial decrease in the number of new cases detected during the five year period with the reported figure being around 2000 cases. Sri Lanka, despite its elimination of leprosy as a public health problem occupies the 14th position among the 17 countries which reported more than 1000 newly detected patients annually. Nearly half of the newly detected leprosy patients (44.5%) are reported from the Western province followed by 15% in Eastern and 12% in Southern province. Five districts (Colombo, Batticaloa, Polonnaruwa, Matara, Ampara) have consistently reported a prevalence above the WHO elimination target

There has been a clearly visible trend of a reduction in the deformity rates in comparison to 2000.The relevant rate was 5.7% in 2005 while it was 9.8% in 2000. This reflects the reduction of pool of previously undetected, hidden cases in the community and the relevance of shifting to NCDR (incidence) as a more appropriate epidemiological measure of quantifying the disease than the prevalence.

There were 803 (43%) multi bacillary (MB) patients in 2006. Increasing trend of the detection of MB rates augers well for the control of disease as early case detection and treatment with MDT remains the cornerstone of leprosy control. The child rate has been in the range of 10-12% during the five year period. Exceptionally higher rates in endemic Batticaloa (18%), Ampara(10%) and Colombo(14%) districts suggest the continuing transmission in these regions. However, one caution in interpreting these data is the possibility of over diagnosis of child cases.

Challenges for the future

Though Sri Lanka has achieved the elimination target at the country level, the sub national level elimination remains a high priority considering the consistent detection of nearly 2000 new patients annually with higher concentration in some districts. Integrated approach is the most cost effective approach to address the remaining problems and therefore, strengthening and sustaining the provision of quality leprosy services at institutional level in the GHS is essential. It ensures the easy access of services to patients closer to their homes.
Re-registration and recycling of previously detected patients still occur in certain areas. This has to be corrected as it may affect the quality of data. The other important problem is the over diagnosis of hypo pigmented patches in children. It is a known fact that sometimes diagnosis of leprosy may be difficult in children leading to over diagnosis. Validation of the diagnosis and support of the dermatologists to the medical officers in peripheral institutions in better diagnosis may prove to be handy in this situation.

Though many of the patients are cured without sequalae , some may not be so fortunate. Lepra-reactions occur in a few patients after the MDT and relapses may occur from time to time. These patients need timely intervention as negligence may lead to disabilities such as nerve impairment and permanent loss of the function of the nerve. These patients need the specialists support in referral centres. Neglecting such patients leading to permanent disabilities may impact negatively on the programme in a low prevalence situation. Improvement of the quality of life of these patients remain the biggest challenge to the ALC in a low prevalence scenario. Identification of mechanisms of counselling and provision of services to these long suffering patients stands out high priorities for district leprosy managers.

The global strategy for elimination of leprosy is based on further monitoring of MB rates, child rates and deformity rates even in a low prevalence setting. It is essential to estimate the hidden prevalence based on the delay in case detection to successfully launch programmes to detect possible remaining cases in the community. However, in Sri Lanka, the lack of the culture of local level data analysis and targeted intervention on the basis of evidence remain a big obstacle to further expand leprosy elimination activities. This lack of culture and non availability of REs have forced compulsory involvement of the ALC in planning and execution of leprosy elimination activities even after integration in certain areas.

Careful considerations of these challenges are essential to further consolidate gains achieved so far and to reach the goal of the campaign to achieve elimination of leprosy at the sub-national level.
1. W.H.O. Global leprosy situation-2006. Weekly Epidemiological Record, august 2006, August. Also available on URL: http:
Wijesinghe PR, Settinayake WAS. An analysis of the pattern of detection of leprosy patients by the General Health Services (GHS) in Sri Lanka after the integration of leprosy services into GHS. Leprosy Review. 2005; 76: 296-304.
3. World Health Organization. Report of the inter country meeting of the National Programme Managers of Leprosy Elimination at Kathmandu, Nepal on 6-8 January, 2005.WHO/ICP CPC 600.
4. Anti Leprosy campaign. Annual National and District Leprosy Statistics in Sri Lanka. Central Leprosy Clinic, NHSL, Colombo. 2000-2005.

Wednesday, January 10, 2007


Currently, it has been debated as to why Black caps have performed pathetically in the recently concluded series against Sri Lanka. In hindsight, SL deserved a lot more than what results reflected at the conclusion of the tour. For, statistical purposes, records go as drawn test, twenty twenty and ODI series. But, in all three formats, SL were well ahead of BC in their own den.

One of the excuses that touring teams, bar all conquering Aussies, make is the home advantage of the home conditions to the hosts in the face of a defeat. It is extremely heartbreaking that BC were not able to manipulate extreme cold conditions prevailed in NZ and consequent movement off the seam. It is a well known fact that SL are poor tourists in terms of results achieved off their shores. Only other occasion that they fared well was against one off test victory against Kiwis and coming from behind victory in a 3 test series against Rammez raja’s Pakistan by Arjuna Ranatunge’s team just prior to historic world cup win. To their credit, SL performed creditably well in England and now in NZ. Mahela must be a happy man with the results so far.

In the first test , SL have to blame themselves for being 50 runs short. Had they have these runs on the board, the outcome would have been 2-0 in favour of SL . In 20-20, had they not rested Vaasy and Murali , the result would have been 2-0 . Much anticipated ODIs exposed the inefficient, fragile middle order of BCs. Two games that they won went down to the wire. Had not it been for Trevor Franklin heroics and last ball four of Mason, SL would have gone home as not sharers but outright winners of the trophy. I felt sorry for Auckland crowd. Aucklanders always come to the Park and support cricket in this fanatically Rugby Union crazy country. Their passion is matchable to the vociferous crowds of other EDEN the EDEN GARDEN in cricket obsessed India. They deserved more than the meagre total put together by 11 kiwis.

There will be lot of excuses as POMS and BC are well known for those. But, for the longevity of the summer game in NZ, administrators need to learn from mistakes like their counterparts in Rugby did in 1990s when they continually lost to Wallabies. Quality of batting is apparently a big headache for them. This aspect has been highlighted by Allan Donald in his Autobiography. According to him, Kiwis and POMS are reluctant to move away from their comfort zones and as a result, have performed miserably. This is quite contrary to Aussies and proteas who quickly acclimatise to conditions which may be strange to them. As Aussies point out, they take all positives out of negatives. Reluctance of Kiwis and POMS to tour subcontinent and WI while happily touring AUS and SA has been quoted as their soft corners. Australia , on the other hand, keep raising the bars, adopte fresh approaches like conditioning programmes of the nature of boot camps in Queensland etc.

Having come to the conditioning policy, I reckon one area that went wrong for Kiwis is the blindly acceptance or copying lessons from Graham Henry’s book. I have got to blame the rotation policy for the poor performance of BC. The move may be wise and rational for a contact sport like rugby where injuries do tend to occur every now and then. Cricket though a team game, it’s success depends on individual performance of a collective. In rugby, you need 15 people to make a ball move. In cricket, collective efforts of individual brilliances make the difference. Under such circumstance, how wise is the decision to rest your number one batter and number one fiery bowler against who SL have displayed their fragility? .

Even if rotation policy is the panacea, Graham Henry can do it as he has got a very talented and ruthless army. Even if the top 36 are left out of competition, he will have another 36 to crack opponents . Such is the player base and the passion rugby has in NZ. The question that comes to my mind is “ Is Bracewell be able to find such luxury in NZ at the moment ? The great majority of star players of the current crop BC ( perhaps except Flem and Bond) are just ordinary players who are no where near the rest of the players in the best league. This prompts Bracewll to use his handful of important resources wisely. He shold have used his limited troops to condition them for the World Cup, against SL in the current series. Hopefully, sane counsel may prevail and BC will fare better against their arch rivals “ Aussies. It is no wonder that some Aussies are already interested in not the winner, but the team that will qualify for the finals. It is our belief that BC will fight it out for the pride of the nation and the dying interest for cricket in NZ

It is sad that the summer game is dying in NZ. The era of Hadlees, Cooneys, Chatfields and Crowes are just nostalgic memories and cricket fans miss 1980s (golden era of the game in NZ)a lot. Like in Rugby union and league, the future of the game lies in South Asian Kiwis, Islanders and Maoris with greatest respect to Pakehas. Administrators need to popularise the game among non pakeha population as well if NZ desires to be a potent force like trans Tasmen neighbours,Australia. Victory has so many fathers while defeat is an orphan. The only way to save cricket dying in NZ is success at consistent basis and it will be the only remedy for NZ cricket.
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