While a powerful Presidential Task Force is to be appointed to tackle the mysterious kidney disease that is felling farmers mainly in the North Central Province (NCP), all Secretaries of relevant ministries will meet on May 2 to discuss at length how to proceed with the tasks allocated to them under a wide-ranging Action Plan. [...]


Tackling kidney disease in NCP

Ministry Secs to go ahead with improved Action Plan

While a powerful Presidential Task Force is to be appointed to tackle the mysterious kidney disease that is felling farmers mainly in the North Central Province (NCP), all Secretaries of relevant ministries will meet on May 2 to discuss at length how to proceed with the tasks allocated to them under a wide-ranging Action Plan.

Karunawathi at Padaviya Hospital. Pic by M.A. Pushpa Kumara

The meeting comes in the wake of instructions by the Cabinet of Ministers in early April that the APction Plan be “reviewed and improved”, while also changing the composition of the 10-member Standing Cabinet Appointed Officials’ Committee headed by the President’s Secretary Lalith Weeratunga, and which put out the Action Plan, the Sunday Times learns.

The Lalith Weeratunga Committee, the Sunday Times understands, will now include the Prime Minister’s Secretary, the Cabinet Secretary and the Finance Ministry Secretary. The Action Plan with its 18 short-term recommendations and 10 long-term recommendations, detailed budgetary requirements of relevant lead ministries and the strategies that they should adopt for the implementation of actions had been coordinated by the Environment and Renewable Energy Ministry, the Sunday Times learns. Hereafter, the coordination is to be handled by the Special Projects Ministry. The estimated cost for the implementation of the Action Plan is around Rs. 4590 million.

For humble farmers such as V.G. Karunawathie of Padaviya whom the Sunday Times met at the Padaviya Hospital when she had come for dialysis, the Action Plan would hold out hope, where earlier there was only despair. Knowing that the Government is throwing its full force, not only to deal with Chronic Kidney Disease of Unidentified Aetiology (CKDu) but also to prevent it, while accelerating the search for the causes which have eluded the country, will help these beleaguered people to face their plight with courage.

Forty-year-old Karunawathie, a mother of three, has been suffering from CKDu for a decade. She had been diagnosed by Consultant Nephrologist Dr. Tilak Abeysekera (this Kandy-based Specialist was the first to indicate the emergence of CKDu) who used to hold outreach clinics in her area. Now Karunawathie is undergoing dialysis twice a week at the Padaviya Hospital.

Karunawathie who helps her husband in their paddy and vegetable cultivations, is not alone in facing the spectre of CKDu. Both her father and mother died of this dreaded disease, as also five of her brothers. Of the other five of her brothers, one has already undergone a kidney transplant and like her, another is being dialysed regularly at the Padaviya Hospital.

“The main tasks each relevant ministry will handle under the Action Plan will be discussed at the meeting next Friday,” explained Special Projects Ministry Secretary Wijeratne Sakalasuriya.The ‘Action Plan for the Mitigation of CKDu in the North Central Province’ is accompanied by an Addendum which prioritizes the actions to be implemented in the CKDu endemic areas immediately. Among them are:

n An integrated awareness programme — Agriculture and Health Ministries to undertake awareness programmes on the “safe use of agrochemicals” and “best practices for a healthy life”, with the Education Ministry identifying key staff members in schools in the CKDu endemic areas. These staff members would be educated to pass on the message to students who in turn would take that message home. Awareness material such as leaflets and video clips are to be prepared.
n Expedite the screening of CKDu patients — Screen CKDu patients in the endemic areas from the early stages to treat them before the disease reaches the chronic stage. It had been stressed under this priority that the need is to enhance preventive measures.

The Health Ministry has also been requested to prepare digital maps to indicate high CKDu prevalence areas. The discussions had also centred on the deployment of additional staff including medical officers, establishment of a special medical unit for CKDu patients, provision of necessary equipment and conducting of special clinics for CKDu patients in the endemic area.Referring to the intensive discussions and in-depth work which went into producing the Action Plan, the Environmental Ministry’s Natural Resources Management Director Sugath Dharmakeerthi — who handled the work under the instructions of Ministry Secretary B.M.U.D. Basnayake who was the coordinator of the Standing Cabinet Appointed Officials’ Committee — gave a detailed look into how it began.

It began with a Cabinet of Ministers’ decision on October 18, 2012, to appoint a Ministerial Committee chaired by Rural Affairs Senior Minister Athauda Seneviratne, assisted by a Committee of Government Officials to examine various issues relating to the ‘Indiscriminate Use of Fertilisers and Pesticides in the country with special reference to CKDu’. The Government Officials’ Committee had been convened by the Environmental Ministry.

Thereafter, four Technical Sub-committees had been appointed, each with its own mandate:

Fertiliser use in Sri Lanka with special reference to CKDu (FUSL) — Study and report on the types and amounts of fertilisers used in Sri Lanka, beneficial and adverse impacts of fertilisers on soils, water and human health with special reference to CKDu and identify measures to mitigate such effects.

Pesticide (including herbicide) ) use in Sri Lanka with special reference to CKDu (PUSL) — Study and report on the types, amounts and constituents of pesticides used in Sri Lanka and their impacts on physical, chemical and biological properties of soil, water quality, environment, human health and non-communicable diseases.

Organic Agriculture in Sri Lanka (OASL) — Advantages and disadvantages of alternate agriculture.

Research findings on the effects of soil, irrigation water, fertiliser and pesticide use on CKDu and any other related links from food and drinking water (RFSFP) — Findings of research studies on effects of fertilisers, pesticides and other identified risk factors on CKDu.

An important step in the direction of resolving the CKDu issues came with the Technical Sub-committees being able to get all the researchers who had done work on CKDu to the same table, it is learnt.

“Lengthy discussions and debates followed among the various groups who are engaged in research,” said Mr. Dharmakeerthi, adding that finally they were able to achieve common ground.

Then the Government Officials’ Committee integrated the technical outputs of the sub-committees and prepared a composite report, in concurrence with the Ministerial Committee, which included the short and long-term recommendations.

The Government Officials’ Committee had consulted more than 45 experts who had conducted research on CKDu and coordinated with relevant stakeholders in government and non-governmental organizations.

When this ‘Report on Indiscriminate Use of Chemical Fertiliser and Agrochemicals with Special Reference to CKDu’ was submitted to the Cabinet in August last year, a Standing Ministerial Committee and the 10-member Lalith Weeratunga Committee were appointed to prepare a comprehensive Action Plan.

While the Action Plan has taken into consideration the recommendations of the Government Officials’ Committee and the Expert Committee appointed by the Parliamentary Consultative Committee on Agriculture, it has observed that the recommendations submitted by the World Health Organisation in its final mission report of September 27, last year, “are almost similar to the recommendations made by the above committees”.

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