Books
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| Follies
and hope of a violent nation Not many of us, though, pause to ponder where this is all leading. Where and how the beautiful bubble of a united land burst and sent us on this deadly, downward spiral of violence. Gnana Moonesinghe has presented her own insights and written in the hope that from these stories drawn from the horrors of this country's destructive recent past, we may see our own follies and find new hope. Private Mohan, the first story finds a journalist stumble on an old woman living alone in a thatched hut in the Dry Zone jungle. Her grandson is in the Army and as she with typical village hospitality offers the unknown journalist a place for the night, he learns of her difficult life and how all her hopes centre around this young man whom she has brought up from childhood. When he marries it is to give his grandmother a companion. It is a story that touches many chords and Gnana's empathetic portrayals of the courageous old woman, the young soldier and the virginal bride all touch us deeply. The journalist is drawn to the family and finds his thoughts turning to them more and more. The ending is perhaps, inevitable but Gnana with her storyteller's instinct leads the reader gently through the young journalist's emotional dilemma. The other stories all are drawn from different periods in this country's recent past and are no less poignant. A Voice from the Carnage depicts the horror of 1983 through an elderly woman who from her hiding place watched the rampaging mob kill her family. Sudath the Rebel tells of a schoolteacher's discovery of the JVP presence closer home than she ever thought. Maya, My Daughter, Maya, the Heroine, is the tale of a young Tamil girl from a traditional background reared in a protective, loving atmosphere and her gradual journey down a path of no return. Is 'the cause' worth the sacrifice of even one young life? The final story In the Nick of Time is the only one in the book that is not dogged by tragedy and proves Gnana's understanding of the human mind and the times we live in where so often temptation intrudes to let the worm of discontent burrow in. Written in simple language with no artifice or unnecessary embellishments, these are stories that nevertheless strike at the heart of Sri Lanka's years of tension and torment; few could put this book down without being affected by their insights. Gnana Moonesinghe has lived in India for the past ten years with her diplomat husband. A graduate in Political Science from the Peradeniya University, her previous book was the non-fictional 'Thus Have I Heard' which linked Buddhist religious places of interest to the Buddha's discourses. This is her first attempt at fiction. THE
WORLD WITHIN COVERS Also,
why is so much of this violence directed towards the West? Only Turkey, among the 59 countries of the Organization of the Islamic Conference, has political institutions comparable to those found in the Western World. Elsewhere, we have - and this can never be denied - feudal monarchies and one-party dictatorships. As Lewis argues, the leaders of such governments have chosen to stoke up anti-western feelings, preferring to invoke old rivalries than meet the real needs of their own subjects. The book is more like an extended essay but it is also a marvel of informed and judicial analysis. The author shows how Muslim dictatorships have proved themselves to be "inequality, power and corruption" and tells us how Osama bin-Laden and other Islamic extremists have fashioned an ideology by demonising the West. The author finds this aspect of Islam particularly pernicious and gives vent to his exasperation to the indulgent attitude to 9/11 among Western Liberals. As he says: "Arab leaders who deflect their people's energies into religious extremism would be on par with Houston dynasts putting the oil revenues of Texas at the disposal of the Ku Klux Klan." Lewis writes clearly and elegantly and with a style refreshingly free from academic jargon. Even readers who have had it up to here with the Iraq war will find much to enlighten them. A
true Renaissance woman She represented her father in secret negotiations with the Queen of France, and, having married Gian Giardano Orsini, a rich widower, became an extremely wealthy widow in her own right. Murphy describes her as ruthless - she had no qualms about assassinating her enemies - and was never short of personal courage. When Spanish troops sacked Rome in 1527, she made a daring escape in disguise. Presenting her story in 65 thin chapters, Murphy presents "an intelligent, gutsy and powerful woman" involved in the intricacies of dynastic politics and yet knew when to step aside and assume the "frail creature" attitude. This is the story of a true Renaissance woman who achieved immense power and respect by the unusual means of working for it. The picture we have is both subtle and engaging - of an intelligent woman who overcame a difficult initial position to become, in effect, the First Lady of Rome. We are given a detailed account of her career as a successful businesswoman who proved herself more than equal to her male peers, negotiating property deals, organizing marriage mergers and obtaining lucrative Papal perks for those who did her favours.
Vaccination for prevention of diseases Small
pox According to Uragoda, "Thomas Christie was the first Britisher to have left his imprint on the medical scene in Sri Lanka. Christie will be best remembered for his work on vaccination in Sri Lanka". At first there was some resistance to small pox vaccination in England, India and Sri Lanka. But when its success was proven in the community it became accepted as the method to reduce the disease burden of small pox. As far back as 1886, nearly 120 years ago, the "Vaccination Ordinance" was enacted in Ceylon. The main objective of this was the provision for compulsory vaccination against small pox. This compulsory vaccination resulted in a decline in small pox in our country. The last definitive case of small pox in Sri Lanka occurred in 1967. However in 1972 there was a single case of doubtful etiology in a foreign national. Vaccination against small pox met with success in the countries where the disease was prevalent. Consequently small pox was eradicated worldwide in the seventies and in 1979, the WHO certified that this eradication was complete; a truly triumphant reward for a campaign tirelessly and relentlessly conducted. "SLMA Guidelines on Vaccines" is in fact the second edition of "Guidelines of the use of Non EPI Vaccines" which was also edited by Dr. Lucian Jayasuriya and Prof. Anura Weerasinghe and published by the Sri Lanka Medical Association in 2001. "EPI" is the acronym for "Expanded Programme on Immunization". When it was published "Guidelines for the use of Non EPI Vaccines" met with the same fate as Edward Jenner's small pox vaccine, namely resistance and strident criticism. Some of this was constructive but sadly some of it was transparently Philistine. Non-EPI
vaccines There were also some who even suggested that we should discourage those who could afford these non-EPI vaccines, from taking them and that we should even keep the public ignorant of the availability and effectiveness of these expensive immunizing agents. This however was difficult to justify. There should be informed decision-making by the patients or parents. This is a fundamental principle of ethical behaviour. One has to keep in mind the fact that over 50% of the outpatient health care is delivered in the private sector, with the recipient paying a fee. Until the state could provide the funding for the administration of the current non-EPI vaccines, it is important that the private sector undertook this task. Firstly, these vaccines protected those immunized and secondly, after administration they served to create a buffer group, albeit a small one, of immunized persons and helped to reduce the spread of the disease to those yet to be immunized. Clearly the diseases targeted by the EPI programme, from time to time, were selected not only for their indication, but also the availability of funding. This is why there was a delay in the introduction of those vaccines for which there was a need. For example, one could ask the question as to why the measles vaccine was introduced into the EPI as late as 1984, the rubella vaccine only 1996/1997 or why is mumps vaccine still excluded from the EPI. It was mainly because of the cost of the vaccination programme. To strike a personal note I was one who believed in the exclusiveness of vaccines for the EPI targeted diseases, consequently nearly two decades ago, I did not advise a very close female relative of mine to have the rubella vaccine, as it was not part of the EPI programme. This person unfortunately had rubella in the 10th week of pregnancy and delivered a baby with hearing impairment. The baby is happily normal today, thanks to surgery and rehabilitation. However it cost the parents and relatives a few years of anxious and troubled times. Like Jenner's small pox vaccine, the first edition of "Guidelines for the use of non-EPI vaccines" overcame the problems and actually became a widely used reference book by the health care providers in the private sector who began to administer or recommend vaccines for prevention of several bacterial and viral diseases not covered by the EPI programme. Examining the copies of "Guidelines for the use of non-EPI vaccines" on the bookshelves of health carers provides obvious evidence of their constant use - the wrinkles, dog ears, tatters, stains and annotations are visible. Prior to "Guidelines for the use of non-EPI vaccines" there was no book for Sri Lankan healthcare providers on the use of Non EPI vaccines. Effect
of vaccines Sri Lanka earned a worldwide reputation for a high uptake of immunizing agents by its populace and also for the successful results that followed. Credit for this should rightly go to the Expanded Programme on Immunization (EPI). This programme was actively promoted by doctors in the state sector especially those in the preventive health sector and the paediatricians. Doctors in the private sector such as the family physicians played a very significant role in this exercise. As a result there has been a dramatic decline in the incidence of vaccine-preventable diseases in our country. It is interesting to note that even before WHO inaugurated the Expanded Programme on Immunization, the Sri Lankan Health Services had started routine immunization of infants against tuberculosis, diphtheria, whooping cough, tetanus and poliomyelitis. The Expanded Programme on Immunization (EPI) was inaugurated in Sri Lanka in 1977 and in the early stage diseases such as tuberculosis, diphtheria, whooping cough, tetanus and poliomyelitis were targeted. The immunizing agents used at that time included the following:
The
private sector had begun to use b)
Reduced antigen diphtheria, tetanus and cellular petussis vaccine
(DTPA). This is a booster vaccine for diphtheria, tetanus and pertussis.
It is indicated for children over 4 years of age, adolescents and
adults. c)
combined diphtheria, tetanus and pertussis and haemophilus influenzae
type b (Hib) vaccine. Every chapter in Guidelines for the use of non-EPI vaccines has been revised by the authors and reviewed by the committee. These chapters deal with vaccines for cholera, haemophilus influenzae type b, hepatitis A, hepatitis B, Japanese encephalitis, rabies, tetanus, typhoid, varicella, yellow fever, measles, mumps and rubella. In addition they cover general information on vaccines, meningococcal and pneumococcal vaccines, BCG, immunization of HIV infected persons, passive immunization, management of anaphylaxis following immunization and immunization for international travel. Rabies The guidelines have been written by specialists and reviewed by the SLMA Commitee on Communicable Diseases. The specialist writers include Prof. Jennifer Perera, Prof. Anura Weerasinghe, Prof. Srimalee Fernando, Drs. Sudath Peiris, Omala Wimalaratne, Sinha Wickramasekera, Iyanthi Abeywickreme, Paba Palihawadana, Desmond Fernando and Nihal Abeysinghe. The book provides authoritative and comprehensive information on vaccines currently available for use in Sri Lanka. "SLMA Guidelines on Vaccines" will be like its predecessor an informative reference book for several categories of those involved in providing health care such as family physicians, pediatricians and preventive health officers. Every medical and university library in the country and every family physician and paediatrician should have it readily available for reference. |
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