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Quitting smoking is as important as wearing a mask
World ‘No Tobacco Day’ falls tomorrow on the theme ‘Commit to Quit’
by Randima Attygalle
Chemicals found in nail polish, rat poison, battery acid, car exhaust fumes, paints, rubber cement and gasoline are just a handful of what you will find in a single cigarette. A lighted cigarette create more than 7,000 chemicals and nearly 70 of them are known to cause cancer; and many are toxic. While many of these chemicals found in consumer products carry warning package labels (eg. rat poison), there is no such warning about toxins in tobacco smoke, points out the American Lung Association.
While cigarette smoking is the most common form of tobacco use worldwide, all forms of tobacco including water pipe tobacco, smokeless tobacco products, cigars, pipe tobacco, bidis and kreteks (used in Indonesia) are all harmful. ‘The tobacco epidemic’, according to the WHO, is one of the biggest public health threats the world has ever faced, killing more than eight million people a year around the world. More than seven million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to tobacco smoke. ‘Over 80% of the 1.3 billion tobacco users worldwide live in low and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco,’ notes the WHO.
Cigarette smoke reduces the amount of oxygen carried to tissues and even in case of COVID patients, oxygen saturation (percentage of oxygenated hemoglobin returning to the right side of the heart) levels are low. Consultant Respiratory Physician and Senior Lecturer from the Department of Anatomy, Faculty of Medicine, University of Colombo, Dr. Yamuna Rajapakse points out that several studies have now confirmed that oxygen saturation is less in patients who smoke compared to non-smokers. “Smokers function in a low oxygen saturation environment, hence they are at greater risk than non-smokers during COVID lung involvement.”
Smoking causes thrombosis or blood clot formation. This could lead to stroke, heart disease and peripheral vascular disease. COVID too causes thrombotic effects and smoking may increase this risk she explains. Tobacco smoking is a significant risk factor for both viral and bacterial infections of the respiratory system. Smokers are five times as likely to develop influenza and twice as likely to have pneumonia. This, as many reputed medical journals including the British Medical Journal (BMJ) confirms, is an important factor worsening the impact of COVID-19. ‘There is evidence from case series that smoking is associated with more severe disease, a greater risk of intensive care need and excess mortality in people with COVID-19 admitted to hospital,’ notes the BMJ.
Smokers have more phlegm in their system and experience bouts of what is commonly known as the ‘smoker’s cough’. “Tobacco smoke burns the protective mechanism we have in our lungs which acts as a buffer against dust, viral and bacterial particles entering the respiratory system,” says the physician. She adds that smokers are more likely to develop pneumonia and this risk is aggravated in COVID patients who smoke.” Dr. Rajapakse also remarks that while the majority of COVID patients are asymptomatic, smokers show more COVID symptoms as research findings from China and UK also confirm.
New tobacco trends such as shisha smoking (smoking tobacco through a water bowl via a hose or tube) has also become an added problem notes Dr. Rajapakse who also warns that sharing of cigarettes and shisha tubes could increase the transmission of COVID and other respiratory infections.
Lung cancer which is the leading cause of cancer death the world over with smoking long established as a major cause, is now being diagnosed in a younger adult population. “Today we see advanced lung cancers in those in their 30s and 40s. Although genetic predominance is also present in lung cancer, a sizable percentage is attributed to second-hand or passive smoking (involuntary inhalation of other people’s smoke). Victims include women exposed to a smoking spouse.” Pregnancy is the worst time one could be around smoke, says the physician who warns that babies born to mothers exposed to passive smoking have lower lung reserves. Low birth weight is also common among such babies. Third-hand smoke where residual nicotine and other chemicals are left on indoor surfaces, clothing etc. is also bad for people who are exposed to them.
Entailing symptoms similar to asthma with wheezing and coughing, Chronic Obstructive Pulmonary Disease (COPD) is another serious smoke-induced condition. A non-reversible condition, COPD does not respond very well to inhalers, explains Dr. Rajapakse. Smokers with a specific enzyme deficiency can end up with COPD prematurely, she warns. Besides noncommunicable diseases such as high blood pressure, heart disease and stroke, smokers are also at a higher risk of having intermittent claudication and vascular ulcers leading to amputation of limbs, she says.
Despite tobacco smoking being established as a real risk factor for COVID-19, seriously compromising immunity and structural functioning of the respiratory system, there is very little discourse on it, observes the Consultant Psychiatrist from the National Hospital of Sri Lanka and the Director, Centre for Combating Tobacco, Dr. Mahesh Rajasuriya.
“Not smoking is as important as wearing a mask, yet the tobacco industry has been careful in downplaying this,” says the Psychiatrist who adds that apart from developing very serious complications, tobacco smoking also directly violate COVID control measures. “Smokers are compelled to remove their masks to smoke and even if they are smoking outdoors, there is a tendency for them to interact with a few more people in a small enclosure inhaling and exhaling each other’s breath more sharply. Here the risk of contracting COVID is enormous. Secondly our health care system is already exhausted with COVID patients and if a smoker suffers a heart attack, a stroke or gets pneumonia to which they are more susceptible, it will add to the burden.”
While hardly anyone “pledges to smoke to the grave”, most smokers wish to quit at sometime but several factors prevent them from doing so, says Dr. Rajasuriya. “These can be broadly classified into demand and supply factors. While the former makes smokers want to smoke again, the latter keep the environment conducive to smoking such as making cigarettes cheaper and more accessible.” Although the price of a cigarette should be more than what it is now in the Sri Lankan market compared to other consumer goods, it has on the contrary become more affordable, driving those from lower socioeconomic levels and youngsters who are still dependent to become addicted, says Dr Rajasuriya. “The tax increases on cigarettes too has been fraudulent with less money going to government coffers and larger proportions to the tobacco industry.”
The non-availability of a local license system as in the case of many countries including several in the region such India and the Maldives, makes cigarettes freely available, he points out. The absence of a law banning single stick sales adds fuel to fire during the pandemic he says. “Added to the physical touch when selling single sticks, the smoker does not see the pictorial health warnings on cigarette packs.”
A large majority of smokers quit without any psychological help says the psychiatrist who observes that the tobacco industry has created a myth that quitting is an uphill task and only those with extraordinary willpower can do so. “It is imperative to see through this myth first if you want to quit smoking,” he reflects. Certain stereotypes ingrained in the brain such as the need for physical pharmaceutical support for quitting often discourages a smoker wanting to quit the habit. “Another myth which needs to be debunked is that cigarettes need to be replaced with another chemical to help one to quit.”
The benefits of quitting tobacco are almost immediate, confirms the WHO. ‘After just 20 minutes of quitting smoking, your heart rate drops. Within 12 hours, the carbon monoxide level in your blood drops to normal. Within two to 12 weeks, your circulation improves and lung function increases. Within one to nine months coughing and shortness of breath decreases. Within five to 15 years, your stroke risk is reduced to that of a non-smoker. Within 10 years, your lung cancer death rate is about half that of a smoker. Within 15 years, your risk of heart disease is that of a non-smoker.
While some can navigate the transitional phase after quitting, many experience ‘withdrawal symptoms’ such as irritation, anxiety for which medication may be required. Getting rid of not merely cigarettes but all smoking associated paraphernalia including lighters and ashtrays is vital when preparing to quit says Dr. Rajasuriya. The comprehensive course designed by the Centre for Combating Tobacco, Help Quit sponsored by the WHO country office helps those who aspire to quit smoking and other support personnel including doctors, nurses, psychotherapists, counselors etc. to assist others to quit.
“The image about smoking is negative today, although the tobacco industry is trying hard to project otherwise. In this exercise, social media is now heavily used to induce the smoking habit and also to target a locally untapped market of young girls and women. Hence it is important for the public to see the true picture and not be deceived by the tobacco industry’s marketing strategy,” concludes Dr. Rajasuriya.
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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