Foreign debt liabilities increased significantly by ‘six percentage points in Gross Domestic Product (GDP) terms’ to 41.2 per cent of the GDP last year (2018) led by a rapid depreciation of the Rupee and low GDP growth in the review period, the Finance Ministry, in a document released on 31 May, said.
Subsequently, interest payments, the single largest recurrent or current expenditure item in the Budget, increased by 0.4 percentage points to 5.9 per cent of GDP in 2018.
Overall economic growth fell to 3.2 per cent of the GDP in 2018, compared to 3.4 per cent in 2017 due to a deceleration of construction and mining and quarrying subsectors, the Ministry said.
Meanwhile, in GDP terms, total Central Government debt, both domestic and foreign, increased to 82.9 per cent of the GDP at end 2018 compared to 76.9 per cent at end 2017.
In related developments, domestic debt at end 2018 was marginally lower by ‘0.1 percentage point of GDP’ to 41.6 per cent of the GDP compared to end 2017, the Ministry said. Consequently, the share of domestic debt in the total outstanding debt decelerated to 50.2 per cent at the end 2018 from 54.2 per cent recorded at end 2017.
However, total debt service payments as a percentage of Government revenue increased to 108.8 per cent last year (2018) from 87.5 per cent in 2017, reflecting that total debt service payments outpaced the total revenue receipts of the Government in 2018, the Finance Ministry said.
Vis-à-vis, total Government expenditure, the ratio of total debt service payments to Government expenditure increased to 53.1 per cent in 2018 from 46.6 per cent in 2017, the Ministry said.
Meanwhile, Government debt service payments, including both amortisation (repayment of debt capital) and interest payments, increased by ‘2.6 GDP percentage points’ to 14.5 per cent of the GDP in 2018 from 11.9 per cent of the GDP in 2017.
Debt service payments in nominal terms increased by 30.3 per cent in 2018 with an increase in interest payments and amortisation payments by 15.9 per cent and 42.5 per cent, respectively. Amortisation payments on domestic debt increased to 6.4 per cent of the GDP, while it was 2.2 per cent of the GDP on foreign debt. Interest payments on domestic debt increased to 4.4 per cent of the GDP, while interest payments on foreign debt increased to 1.5 per cent of the GDP in 2018.
In related developments, the increase in recurrent or current expenditure by 8.4 per cent (Rs 162 billion) to Rs 2,090 billion, equivalent to 14.5 per cent GDP in 2018 over 14.4 per cent of the GDP 2017 was mainly driven by the rise in interest payments to 5.9 per cent of the GDP in 2018 from 5.5 per cent of the GDP in 2017, the Finance Ministry said.
C-section scars & secondary infertility at a glance
Women who have delivered by C-section can have scarring that causes infertility, as well as pain and abnormal bleeding.
This results when scar tissue does not heal properly and forms a pouch in the lower part of the uterine lining that fills with fluid and delays normal menstrual bleeding.
The inability to become pregnant again after already delivering a child is known as secondary infertility, which an estimated 3 million U.S. women experience.
Many women delay or do not seek treatment for secondary infertility.
Women who have C-section scars and experience secondary infertility should consult a reproductive specialist.
Laparoscopic surgery can correct the problem and cure infertility in about 75 percent of patients.
What is cesarean section scarring & secondary infertility?
The Centers for Disease Control and Prevention’s (CDC’s) latest figures report that 32.2 percent of all U.S. births are by cesarean section (C-section). While C-section has significantly reduced the infant and maternal death rates from childbirth, saving many lives, there are some associated problems with future fertility after a C-section.
These potential problems include an increased likelihood of needing a C-section in a subsequent pregnancy, potential rupture of the womb in a future pregnancy, and secondary infertility. Secondary infertility is the inability to become pregnant again after already having delivered one child. A British study has reported that 30 percent of women who had a C-section were not able to conceive another child.
Secondary infertility following a C-section is caused by improper healing of scar tissue in the uterus following the surgical incision in the uterine wall to allow birth. What can result is a defect that can become a fluid-filled pouch, or isthmocele, which forms in the lower uterine segment and causes an accumulation of blood. When old menstrual blood becomes trapped in the isthmocele and within the uterine cavity, it sets up an inflammatory response in the uterus that then impairs embryo implantation.
Symptoms of C-section scar tissue
The National Institutes of Health says that C-section scars that are clinically relevant or cause symptoms happens in 19-88 percent of C-section patients. Symptoms of such scarring include:
Pelvic pain
Abnormal bleeding
Vaginal discharge
Painful periods
Infertility
Difficulty with gynecologic procedures such as IUD insertion and uterine evacuation
Ectopic pregnancy in the C-section scar.
Women having a difficult time becoming pregnant following a C-section should seek medical consultation to evaluate the possibility of uterine scarring being the cause. It can often be corrected, yet women needlessly overlook this option.
That’s because many women and couples experiencing secondary infertility don’t talk about it. They are often surprised that they are having difficulty becoming pregnant again. OB/GYNs are becoming more proactive in following up on their C-section patients regarding fertility issues, and other complications, that may follow the surgery.
Diagnosis and treatment of C-section scars
We generally evaluate women having difficulty becoming pregnant after a C-section birth with diagnostic tests. These tests are best performed after a woman’s menstruation because the blood has likely collected in the pouch, rendering it more visible.
Transvaginal ultrasound involves an ultrasound probe inserted through the vagina to examine the uterus. The sound waves reflect off the uterine structure providing a computer image of the uterus, which can reveal scar tissue. Usually the uterine scar defect can be easily seen with the transvaginal ultrasound.
A saline infusion sonohysterography, or hysterosonography, may also be used for diagnosis and is more accurate in defining the degree or severity of the defect. The physician injects a saline solution into the uterus in conjunction with the vaginal ultrasound. The saline fills the uterine cavity and the C-section scar defect, providing a better delineation of the depth and width of the defect. The physician might also use an MRI, hysteroscopy (a tube with camera inserted in the uterus through the vagina providing a view) and 3-D ultrasonography (sound waves directed at angles produce a 3-D image).
Once the diagnosis confirms the presence of the abnormal uterine pouch, the patient and reproductive surgeon have options to correct the problem. Sometimes hormonal therapy can be tried, but it is generally not as effective as surgical treatments.
Surgical correction
Laparoscopic excision is recommended for women wishing to conceive again. It is a minimally invasive surgery to remove the C-section scar defects through the use of a laparoscope. The surgeon makes small incisions in the patient’s abdomen and inserts the laparoscope, a thin tube with a lighted camera that provides a video view. Special instruments are inserted through small incisions. The C-section scar tissue is cut away and the uterine muscle is sewn back together. With the new incisions and repair, the defect is markedly reduced or closed.
A major benefit of laparoscopic excision is that about 75 percent of patients do recover their fertility and become pregnant. Laparoscopic excision also restores the integrity of the affected uterine muscle tissue, thereby reducing the chance of uterine rupture during a subsequent pregnancy. General benefits of laparoscopic surgery include less scarring, bleeding and pain, shorter time in surgery, faster recovery and less risk of complications.
A hysteroscopic treatment involves placing an instrument with a camera through the cervix where the defect is visualized from the endocervical canal. Using an energy source, the tissue within the defect is cauterized, destroying the endometrial tissue in the defect that is the source of the trapped blood. Another option is to have a hysteroscopic endometrial ablation in which all the uterine lining tissue is destroyed, scarring the uterine cavity. This alleviates symptoms but requires follow-up for continued effectiveness. This technique reduces menstrual bleeding but endometrial ablation should only be considered if future pregnancy is not desired.
Risks of these surgeries are low but li any surgery include blood loss, infection, complications, damage to tissue, reaction to anesthesia and pain.
For a select few women, this could be the difference between a baby, and not. I’ll say it again: C-sections can cause infertility. Catherine Woulfe writes.
In October 2014 I had the kind of caesarean section where your bed gets whipped down to theatre by an orderly cursing fuck, fuck, fuck” as he runs for the lift. The kind where there is no talk of consent let alone risk, and the anaesthetist has time only to ask: are you allergic to any medication?” before slamming you under. The kind where you don’t see your little boy born.
I still cry when I talk about it. I’m crying now. But hey, as they say, we survived.
Our son was conceived the first month we tried. When he was nearly two we started trying again.
Very soon he will be four.
These last two years have been grim, numbing, month after month of nothing, nothing, nothing, bookended by very early miscarriages.
Various GPs were optimistic but by last summer, I was not: I referred myself to Fertility Associates. They carried out tests and asked lots of questions and put us in that catch-all category, unexplained infertility.
First I took clomiphene, a sledgehammer of a drug that prompts the ovaries to release more eggs. I miscarried a few days after the positive test. As the clots dropped out of me I dropped too, and spent weeks at the bottom of the sea.
We pulled out the big guns: IVF. At many times during that process an ultrasound wand gets stuck up inside you so the specialists can count eggs and measure follicles and things; one of those times, the doctor saw fluid in my uterus. The fluid most certainly should not have been there. Yet there it was again at my next ultrasound a few days later. On our specialist’s advice we decided to proceed with egg collection, but freeze any embryos until we could figure out what that fluid was, and deal with it.
On the way home I googled some variation on fluid uterus fertility”. Holy shit, I said to my husband. Love, there’s a thing that happens where a caesarean scar heals in a weird way and makes you infertile.
Holy shit, I said, scrolling, scrolling, all that confusion and loss abruptly crystallising, clicking into place. It was the c-section.
MRI confirmed the diagnosis. I had a caesarean scar defect, also known as a niche, pouch, isthmocele, diverticulum or caesarean scar syndrome.
Picture a tiny cave, a pocket scooped out of the muscly inside wall of the uterus.
Now picture it filling up with period blood every month and holding onto that blood for a week or so, while also weeping its own inflammatory nasties into the mix.
It’s objectively gross. Medical professionals call the mixture cytotoxic” and that’s a word you don’t want anywhere near your uterus: it means toxic to living cells”. Sperm are living cells. So are embryos.Here’s the widely-accepted hypothesis of how that fluid affects fertility: every month my uterus would produce lots of the lovely stretchy mucus meant to keep sperm alive on their long swim to the fallopian tubes. And every month that cytotoxic fluid would get washed up by the mucus, and mix with it.
On top of that, the constant inflammation caused by the defect had likely changed the nature of my uterine lining, making implantation – the bit where the embryo burrows in and pregnancy technically occurs – much more difficult.
In short, this thing was comprehensively zapping our chances. And not just ours.
As I interviewed specialists and read through the medical literature I came to understand this is a condition on the cusp. Right now hardly anyone knows about it. Many of those who do are convinced – even in the absence of gold-standard randomised controlled trials – that it’s causing infertility, and that it’s time to start informing women.
Knowledge is power,” said Dr Farr Nezhat, a pioneering obstetric and gynaecological surgeon who heads a private clinic in New York City. I definitely think women should know, and I don’t believe you are going to scare anybody.” Wellington fertility specialist Dr Simon McDowell thinks I might, actually, but still comes down firmly on the side of informed consent. He works at Fertility Associates (he has not treated me) and spoke on behalf of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
I do think this is a cause of infertility, I do, and I think it’s one that is probably unrecognised in many situations,” he said. In other words: there are women out there who, like me, have no idea this thing is stopping them getting pregnant.
I think the College position is that women should be informed, absolutely.”
The trick is to convey information about risk and symptoms in a way that doesn’t cause undue anxiety and over-treatment, McDowell said.
Off we go.
THE AUTHOR AND HER BABY (SUPPLIED)
If you’ve had a caesarean section, there’s a good chance you have a defect. In one studyresearchers scanned 162 women after the procedure and found that after one c-section the risk of defect was as high as 61%. After three c-sections things got very black and white: a woman’s looking at a 100% risk.
We don’t know for sure what causes defects, although aside from multiple c-sections, we know that having a retroflexed (backwards-facing) uterus increases the risk. It’s thought that if a woman is well into labour when a c-section becomes necessary a defect is more likely to form, because the uterine wall thins during labour and is less able to knit back together properly.
Surgical techniques have also been red-flagged. Single closure – in which the delivering obstetrician uses one bite” of the needle to stitch closed the two layers of the uterine wall – saves time but has been repeatedly identified as possibly contributing to defects. It remains the norm in some countries. In New Zealand, McDowell assured me, obstetricians are trained to carry out double closure, where they stitch the layers closed one at a time.
He emphasised that defects are usually not a problem.
It’s thought that for about one in three women, a defect will cause abnormal bleeding. Some will have chronic pelvic pain, pain during sex or extraordinarily painful periods.
Dr Ceana Nezhat in Atlanta, Georgia stressed that these side effects, in themselves, can be significant. In the last year I have seen over 10 patients experiencing pain and irregular bleeding with various degrees of caesarean scar defect.”
(Nezhat is the medical director of training and education as well as director of minimally invasive surgery and robotics at Northside Hospital, which delivers more babies – 21,000 per year – than any other community hospital in the US. He is one of three Nezhat brothers who contributed to this story.)
None of those interviewed for this story would take a punt at how often defects cause infertility. It’s a hole in the data, perhaps the most significant one.
But they all point to the very big number hanging over the top of all this: the c-section rate.
Our most recent figures are from 2015 and that year in New Zealand, the rate hit 25%. That’s 14,859 women.
How many of those now have a defect? Let’s be optimistic and use the bottom of a sprawling 19-84% range often cited in the literature. Our best-case scenario, for that year, is 2,823 defects. Hundreds of those women are likely in pain, or experiencing strange bleeding. We don’t know how many of them are now infertile. But it can be fixed.
Surgeons have been successfully repairing caesarean scar defects for 17 years. One paper, published in January, put the number of reported cases – that is, repairs that doctors have written about in medical journals – at about 1,200 since 2005. Sometimes surgeons come at the defect with instruments inserted through the cervix. This is called hysteroscopy. The other option, which I had, is laparoscopy: basically, the surgeon attacks the defect – delicately, of course – from the smooth outside wall of the uterus. To find the defect, surgeons often insert a tiny torch through the cervix, shine it at the uterine wall, and look for the spot where it glows brightest.
Much of the recent literature about defects focuses on which type of fix is better. On the face of it they’re both astonishingly good, but McDowell warned that all we have to go on so far are case reports. We talk about five levels of evidence and that’s level five evidence.”
As in bad end?
Bad end.”
The crux of it is we don’t have the counterfactuals: how many women would have fallen pregnant without the surgery? McDowell said the numbers of suitable candidates for treatment are so low as to make it almost impossible to garner the statistical firepower necessary for a randomised controlled trial.
And, he agreed, no infertile woman is going to put her hand up for a trial that could see her drafted into the control (non-treatment) group.
So here’s where we are.
THE AUTHOR AND HER SON (SUPPLIED)
In a 2016 paper two Canadian experts examined data from 32 trials and found that after surgery to correct a defect, symptoms of spotting and bleeding resolved in upwards of 60% of women. As for fertility?
Laparoscopic repair carried a success rate – a pregnancy rate – of 86%. The hysteroscopic surgeries led to a pregnancy rate of 77.8% to 100%.
The authors couch these numbers in caution: Treatment should be reserved for selective cases,” they write – and only after eliminating other possible causes of bleeding or infertility. As I read this bit I picture McDowell nodding furiously.
He said he would have operated on me, but I’m a rarity – a textbook candidate for surgery. Young and healthy, spontaneous conception first time around; weird bleeding since c-section; secondary infertility with other causes ruled out; defect confirmed.
When we first spoke McDowell had never offered surgery to remove a defect – he’d not struck a case where he’d been convinced it would help. A few days later he emailed: This is a bit crazy, but I saw someone this morning who will need a repair … The most profound defect I’ve ever seen. She is having spotting almost daily for most of the month. We simply cannot put an embryo back until that is sorted!”
My gremlin was excised three weeks ago, leaving me with four tiny cross-shaped scars on my tummy (kisses on your tummy, Mummy!”) plus a bigger one through my belly button.
The defect had eaten so far into my uterine wall it was easy for my surgeon to see the light shining through from inside. The wall was just 2mm thick, which according to the literature makes my defect significant”. Membrane, my surgeon called it – not muscle.
At this point, I am obliged to mention two scary, but rare aspects of these defects.
First: defects provide another site (along with the fallopian tubes) for an ectopic pregnancy. Like those in the tubes, such a pregnancy is unviable and extremely dangerous for the woman. Susan Willman, a fertility specialist from California, explained: In this situation, the placenta implants on the defect, which does not have the normal layers of endometrium and muscle wall and the risk is that the pregnancy causes internal bleeding early in the pregnancy.”
Nightmare scenario: that bleeding is misdiagnosed as an ongoing miscarriage and surgeons unwittingly perform a D&C, scraping an already precariously thin uterine wall.
In New York, Dr Farr Nezhat is treating two women who have had caesarean scar pregnancies terminated and are awaiting surgical repair of the defect. It is better to repair and correct it before getting pregnant,” he said, firmly.
Second problem: defects – even those that are asymptomatic – can cause the uterine wall to be so thin that it ruptures during pregnancy or labour, causing internal bleeding that can threaten the life of both baby and mother. Willman said the incidence of this is thought to be about 1%. I was told if either of my pregnancies had made it to the third trimester I’d have been at severe risk of rupture.
Terrifying, I said. Right, Willman agreed. I had a patient who lost the baby. She was cleared for labour. And so when she went into labour, she took her time packing her bag to get to the hospital. [Her scar defect] ruptured at home and the baby delivered out of the rupture and was dead on arrival. It was horrible. Horrible.”
Unsurprisingly, Willman is adamant that this thinning of the uterine wall deserves more attention – perhaps pregnant women who have had a c section should be routinely scanned, she said, to help determine whether they are a good candidate for vaginal birth.
If a caesarean scar defect is a dark, confounding pocket, data on the condition in New Zealand is a black hole. A vacuum. It’s baffling. Here’s the best I can do: my surgeon, Sunil Pillay, has performed six other defect repairs since 2009. Five of these women went on to become pregnant. He seems to be the go-to defect guy – he has heard of only one other specialist who has performed the surgery, in Hamilton (our calls to confirm this, and to other fertility clinics, have not been returned).
CATHERINE’S SURGERY
Emeritus Professor Charlotte Paul, an epidemiologist at the University of Otago, sees two factors in play here.
First, newly recognised or suspected complications of surgery are not routinely reported,” she said in an email. Medicines are subject to a long-established national reporting system, linked in turn to the international oversight of the World Health Organisation (WHO).
For medical devices there are fewer safeguards in place, but Medsafe has set up a system to monitor adverse events. It has the power to recall products from the market.
Surgical complications take what could charitably be called a scenic route.
These are likely to be reported in the medical journals and, when there is sufficient evidence, bodies responsible for developing guidelines would incorporate information in their guidance.”
For caesarean section, that body would be the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
The college is yet to develop any guidelines around the defects, Simon McDowell confirmed. He suspects that will happen in the next few years, but due to what’s likely to be a continued lack of good evidence, they could be a bit waffly” – along the lines of be aware and seek help if you’re concerned”.
Back to Charlotte Paul and her second theory about the lack of awareness, let alone clinical clarity, around defects. Simple: perhaps the evidence is not yet strong enough.”
She put this to a contact at the WHO, Cape Town ob-gyn Dr Thabo Matsaseng.
There is some evidence that subfertility may be a secondary outcome of caesarean section uterine scars defects,” he responded. Before any recommendation could be made by WHO, a systematic review would need to be undertaken.” (We have sent questions direct to the WHO and await a response.)
In my head, McDowell’s nodding again.
He makes the point that if problematic defects were anything but very rare, we’d see that infertility coming through in the massive studies that scrutinise fertility rates after caesarean section.
This is a fraught, tangled area of research. Results – and interpretations – vary widely.
Late last year Edinburgh researchers crunched the data from 80 previous studies, giving them a sample of almost 30 million women. They concluded that a c-section makes subfertility 1.6 times more likely, and that for every 1,500 women who have a c-section, 166 will be left with subfertility.
French obstetrician Olivier Donnez and co-authors, in a well-regarded 2017 Fertility and Sterilitypaper, boil it down thus: The risk of infertility [after caesarean section is] estimated to be between 4% and 19%.” They echo other academics in stressing that even if the truth lies at the bottom end of that range, it nevertheless has a considerable impact in view of the large numbers of [caesarean sections] performed globally”.Susan Willman’s reading of the literature is that caesarean sections compromise fertility in 5-10% of women. She’s looking at massive studies that throw up correlations between c-sections and infertility – and at IVF studies that are able to zoom in more closely.
One such study, published in 2016, followed 975 women through two rounds of treatment. The first time, just over half of the women gave birth via c-section. When these women came back to try for another child – using embryos frozen during their first treatment – they were less likely to manage a viable pregnancy than those who had given birth vaginally. The difference was significant: 53% versus 62%.
Here’s the problem: the factors that prime a woman to have a caesarean section – age, in particular – also tend to prime her for infertility. These confounding factors” are not always accounted for in the studies (some are in the IVF one, as are many in the Edinburgh study) but McDowell believes they account for the gap in fertility between women who have c-sections and those who have vaginal births. If women like me are in that data, they’re huddled in a corner, out of sight.
His takeaway: There’s been no definitive causal link between caesarean section and subfertility, or trouble getting pregnant.”
INSIDE A BIRTHING SUITE. (GETTY IMAGES)
So. Should women be routinely checked for scar defects after c section? No. He’s sure on that. You’ll find a problem which doesn’t exist … You’ll end up trying to fix people who aren’t broken. The vast majority of people with a niche will get pregnant without any problem whatsoever so if you start checking them, you add anxiety and concern.”
Worse: we may wind up over-treating women. Corrective surgery carries its own risks and should be quite an uncommon procedure.”
Informing women, on the other hand, should be routine, but it should be done thoughtfully. He wouldn’t want women who need a caesarean section to avoid it because of defects. He would certainly inform them of the risk, though.
He would have a slightly different conversation, perhaps, with a woman wanting a caesarean purely for convenience, or to protect her pelvic floor. (Neither scenario happens often, he emphasised.)
I think it should be talked about there. It should be a reason [not to do a c-section]. You know: first do no harm. It’s conceivable that if someone has an unnecessary caesarean section they then unnecessarily have infertility. That’s possible.”
First do no harm. He keeps coming back to it. You only do something if you know it is necessary. Hence, we shouldn’t routinely treat niches and we shouldn’t routinely do a caesarean section. We should just make sure we make good decisions.”
What about women reading this story and thinking they may have a scar defect? My advice would be what I would say to all women: have kids early, and if you’re not having success seek help from a specialist. And don’t assume that you’re going to have problems getting pregnant because you had a caesarean section – but a well-trained fertility specialist will consider that as a possible cause.”
But most GPs don’t know about defects, McDowell believes, and even some fertility specialists don’t give the condition the consideration it deserves.
What I’ve gleaned from infertility forums is that my story is typical of women with a problematic scar defect. We tend to blunder around in the dark, clutching at clomiphene and IVF and acupuncture and organics, before finally – if we’re lucky – fluking a diagnosis.
My doc didn’t believe me, so I literally had to take to PubMed and print out literature for him, because it is not commonly known or understood,” wrote one woman in 2015.
Last year, another wrote this: After several years trying and [being] told I had unexplained secondary infertility the scar defect was only identified by a routine scan … after many invasive investigative surgeries. I too had constant brown bleeding and fluid in the c section pouch … I too am wondering why the the consequences of these defects are only now coming to light.”
In November, a mum called Michelle shared her long, harrowing story on the website of a US specialist known to be experienced with scar defects (I asked him for comment and haven’t heard back). She was initially told she was likely in menopause, or suffering from cancer. Even after a defect was finally diagnosed, finding a surgeon was a battle:
I went to six doctors here in Houston, after all, this is Houston with one the best medical centres in the world. Only one of the doctors had performed the surgery one time.” She ended up flying to Chicago for the op.
Susan Willman estimates only about a third of fertility specialists – fertility specialists – in the United States have heard of defects and what they can do to fertility. The website of the clinic she headed until recently is the only one I’ve found that gives patients good information about defects.
I think the actual numbers [of women with fertility compromised by a defect] are small,” she told me. But I do think it deserves increased awareness.”
THE AUTHOR AND HER SON TODAY (SUPPLIED)
Of all those interviewed for this story, Dr Camran Nezhat, a prominent surgeon based in Northern California and known for his work with endometriosis and minimally-invasive surgery, has by far the most experience with treating caesarean scar defects. He performed the first laparoscopic repair of a defect in 2001, and estimates he’s performed corrective surgery on more than 50 women since (Willman has had four patients with problematic defects and performed one surgery; Farr Nezhat has repaired six in the last two years; Ceana Nezhat, nine).
Nezhat has not stopped to formally collate his data but consistently the result has been very positive”, he said.
The majority of the patients get pregnant soon after the required three month healing period following surgery.”
How do all these women find Nezhat?
It’s mostly word of mouth, he said. Women telling their friends: women who are proactive and have the resources to do their own research.
We’re close to Silicon Valley. Patients here are highly educated and do their research prior to seeking out a specialist.”
He has never spoken to a reporter about caesarean scar defects, or seen them mentioned in mainstream media (nor have I, unless you count a perfunctory piece that ran in regional papers in India last week). He was eager to help with this story and with my defect. He offered to perform my surgery, to advise my surgeon. Women have come to him from Australia seeking his expertise, he said.
I asked him whether the science is strong enough at this point to really be relied on. Are we in a position that we can say: yes, this is causing infertility and it can be fixed?
There is no question. Definitely the science is there.”
Yet awareness is not.
The majority of reproductive endocrinologists and infertility specialists don’t even know about it. I have seen it over and over. They are not aware that this entity exists.
A lot of physicians don’t believe it causes problems and don’t refer their patients. And a lot of patients end up giving up. But some patients, when they try IVF they do not get pregnant, then their physicians refer them.” In recent years he’s noticed more referrals.
Still: all those women giving up; all those women, trying and trying. I asked Nezhat if he shares my frustration, my sense of urgency.
Absolutely.”
His feelings transcend even the constraints of academic writing. Here he is as lead author in a Fertility and Sterility paper published in praise of Donnez’s, heralding it as a critical rebirth” in the literature.
Caesarean scar defects have been described for 20 years, and laparoscopic repair has been performed for over 15 years; yet patients may have pain, bleeding, and infertility for years before they find a physician who is familiar with the diagnosis, let alone the treatment of a niche.”
The defects are currently underdiagnosed and may consequently be left untreated at a staggering rate,” he wrote.
There remains a paucity of quality literature on and attention given to the topic. In this day and age, the media spreads viral stories at an explosive pace, yet acceptance of medical and surgical treatments still lags decades behind their discoveries.”
Nezhat told me he saw the same lag when he pioneered minimally invasive surgery – a variety of which I had, with the tiny incisions and startlingly short recovery time.
There are many techniques that my team and I invented more than 30 years ago and they were associated with opposition for many years. Now, the whole world wants to do them.”
Likewise, Nezhat predicts the repair of defects is going to become a very common procedure. Just give it time, perhaps, 10 to 15 years.” That sounds like a long time.
This is the history of medicine: everything takes a long time.”
Here’s what I’d like to see happen right now. Every person quoted in this story backs me on it, albeit McDowell tentatively.
Add a sentence or two to the pamphlets women take home from hospital after having a c-section. Something informative but not too alarming. Along the lines of: For a minority of women defects in the caesarean scar can cause infertility. If you’re struggling to conceive, or if you have unusual pain, bleeding or spotting, tell your doctor.”
Too much? Consider the warnings directed at pregnant women and new parents, every step of the way. We are warned about drinking while pregnant, about sushi, sugar, weight gain, paracetamol, sleeping on one’s back, sleeping with baby. A heads-up on risk and symptoms of defects would be just one more for the list.
You’re right,” said McDowell. I think that’s a fair point.”
What he knows, and I now understand in my bones, is that in the infertility game, it all comes down to time. Time is two lines on a pregnancy test. Time is getting to haul the high chair out of the garage. Time is a little brother or sister.
Two months, now, before we’re cleared for launch. We plan to transfer one of the embryos frozen back in autumn.
For us, an early diagnosis could have saved two years, two miscarriages and a stack of cash. It could have changed the shape of our family. Even if everything proceeds at pace, our children will be waving at each other across a five-year age gap.
Of course, those two lost years could still prove to be the difference between one baby and two. I’m 35.
The journal references cited are linked throughout the text above.
One in three women cannot have a second baby after emergency operation, study claims
Almost half of all women who give birth to their first baby by emergency Caesarean section do not have another child – with nearly one in three suffering long-term infertility problems and one in five too traumatised to go through childbirth a second time.
In the first study of its kind, one of Britain’s most eminent obstetric experts found that three times more women had long-term infertility problems after undergoing a Caesarean section than those who had experienced a natural birth.
It also found that six times more first-time mothers who had a Caesarean section suffered trauma sufficient to prevent them having another child, than those who gave birth normally.
Caesarean birth has celebrity advocates including Victoria Beckham and Liz Hurley. Obstetricians admit it has become a lifestyle choice for those ‘too posh to push’.Advertisement
The research paper, published in the British Journal of Obstetrics and Gynaecology , followed 500 women who had given birth, some naturally and some by Caesarean, for five years after the delivery of their first child.
‘Neither the medical profession nor women themselves realise the extent of the long-term problems Caesarean sections can cause,’ said Professor James Walker, head of the academic unit of paediatric obstetrics and gynaecology at Leeds University and co-author of the study.
‘When doctors and mothers assess the risks of Caesareans, they generally only think about what the risks are at that time and ignore the impact they might have five years down the line,’ he said.
‘With other health issues, people think about the future but when they have Caesarean sections, which carry an even greater risk of losing a second baby than taking hormone replacement therapy or having breast cancer, they make the decision without knowing or thinking about the risks.’
Of the 165 women in the study who had a Caesarean section, 42.4 per cent did not have any more children- 30 per cent for reasons of infertility and 19 per cent because they could not bear to go through childbirth again. In contrast, just 29.1 per cent of the 148 women who underwent a normal birth failed to have further children. Serious injury as a result of Caesarean section is rare but damage can include major abdominal surgery, infections, haemorrhage, injury to other organs and anaesthesia complications.
Long-term complications in subsequent pregnancies include the risk of a ruptured womb and placental problems that can lead to infertility and increased respiratory problems in the baby.
According to the Royal College of Obstetricians and Gynaecologists, there has been a fall in the number of senior obstetricians in labour wards, resulting in increased reliance on unsupervised junior doctors.
‘Junior obstetricians simply do not know how to respond to complex labours except by performing Caesarean sections,’ said Dr Maggie Blott, a consultant obstetrician at King’s College Hospital, London. ‘The result is too many Caesareans are taking place, too many of which are performed by doctors who don’t necessarily have enough experience to guarantee their patients’ safety.’
Anna-Marie Bennett won damages from her local hospital last year after an emergency Caesarean by a junior obstetrician in 1997 left her in a coma for seven days. ‘I did not want a Caesarean and, if there had been a senior obstetrician on hand to advise, the hospital has admitted I would not have been given one,’ she said.
Ms Bennett lost 28 units of blood, an ovary and a fallopian tube, and suffered such extreme internal and external scarring that when she became pregnant a second time and underwent another Caesarean, the doctors perforated her bowel.
The findings have, however, been dismissed by Nicholas Fisk, professor of obstetrics and gynaecology at London’s Imperial College. ‘This survey is based on unreliable statistics taken from a group of women who were given emergency Caesareans,’ he said. ‘It is certainly true that the rates of Caesareans are going up but that is because doctors are now allowing women to choose, which is to be warmly welcomed.’
Over the past 20 years, the proportion of Caesareans has increased from 5 per cent to 21.5 per cent. This makes the UK the country with third-highest rate of Caesarean sections in the world.
Almost half of all obstetricians questioned in a recent Royal College of Obstetricians and Gynaecologists survey thought the rate too high and admitted that many operations were unnecessary. The college was so alarmed by its findings that it called for a clampdown – but already in many private hospitals the proportion of women opting for Caesarean births is estimated to be as high as 60 per cent.The rise in rates has continued despite the recent deaths of Tracey Sampson, 36, and Laura Touche, 31, at the Portland Hospital in London.
‘A Caesarean is an operation very similar in seriousness to a hysterectomy,’ said Dr Sharon Oates, a consultant in obstetrics and gynaecology at the Royal Shrewsbury Hospital which, at 10.4 per cent, has the lowest rate of Caesareans in the country.
‘The normalising of the operation throughout society has lulled women into a false sense of security. It’s only a matter of time before we have a sharp increase in maternal mortality because of Caesarean sections. We are beginning to see it happen already.’
Surveyed Women Had Harder Time Getting Pregnant After Surgery
Jan. 14, 2004 — Women who deliver their first child by C-section may have more trouble getting pregnant again, a new report from Scotland suggests.
When compared with moms who had difficult deliveries ending in vaginal birth, women in the study who had cesarean deliveries said they had more problems getting pregnant after the birth of their first child. Roughly 20% of the cesarean mothers reported difficulty conceiving a second child, compared with 5% of women who had vaginal deliveries aided by instruments like forceps.
But a childbirth expert who commented on the study for WebMD says fertility issues are way down the list of concerns regarding cesarean section.
“If there is an effect on fertility, it is certainly a very small one,” says California ob-gyn Bruce Flamm, MD, who has written two books on cesarean deliveries. “My concern is that this will divert attention from the much more significant issues surrounding C-section. Most women will not have any trouble getting pregnant again after having this operation, but there are other big risks they need to consider.”
Opposition MP Wimal Weerawansa today asked whether the statement made by Finance Minister Mangala Samaraweera that the Cardinal was engaged in fanning flames of hatred is the official stance of the government.
The minister had said Cardinal Malcolm Ranjith had done so by visiting Ven. Athuraliye Rathana Thera during his fast unto death. The Cardinal never did this. There would have been a backlash soon after the Easter Sunday attacks if it was so. Did the minister express the views of the government?,” he asked.
The MP was referring to the tweet sent by the minister urging Vatican to take action against the Cardinal.
House Leader Lakshman Kiriella in his response said the minister will make a statement on it later. We must respect all religious leaders including the most Ven. Mahanayaka Theras,” Minister Kiriella said. (Yohan Perera and Ajith Siriwardana)
Because of the hunger strike launched by Ven. Athuraliye Rathana Thera outside the Sri Dalada Maligawa in Kandy, the main issues that should be focused upon have been swept under the carpet, Bodu Bala Sena (BBS) General Secretary Ven. Galagoda Atte Gnanasara Thera said.
Speaking to the media at the BBS Headquarters today, the Venerable thera explained that Ven. Rathana Thera went to Kandy to launch the fast-unto-death campaign without even discussing the issue with them.
“Ven. Rathana Thera should not take the prevailing issues into his own hands merely because of his political bankruptcy. He should have sought a common solution after holding discussions with others. The solution should be found to the real issue,” he said.
The Karaka Maha Sangha Sabha was to meet and discuss the prevailing situation last Saturday (1). However, Venerable Rathana Thera had already started a fast by then, the prelate said.
“If I did not go to see Ven. Rathana Thera during the fast people might have blamed the BBS saying that I had been released by the President with conditions,” Ven. Gnanasara Thera said.
“I do not trust any politician but only the Buddha. We do not have any agenda or political motive. We would like to have an open debate with Muslim community leaders. My agitation is to control the people if those leaders cannot take control of their people. But not to assault or kill,” he said.
“The Jamiyyathul Ulama Council should come for an open debate. I do not have any conditions to defeat Muslim extremism. I would stand with anyone who has the capability of defeating extremism,” he said.
There was no need for several programmes to defeat extremism. Buddhist monks should have only one agenda, which is the national agenda at this time.
Therefore, we will not allow anybody to handle extremism in the country. This should be conducted under one leadership.
Because of Rathana Thera’s actions, the influence to control Muslim politicians has been concentrated in the Ulema Council. Earlier, there were many groups that controlled Muslim politicians,” the Thera said.
“But it is unfortunate that the main chapters are still unable to group all Sinhalese politicians into one camp.
We urge politicians who do not agree with the national agenda to pack their baggage and go home. Because the country had been awakened and Buddhist monks are now united.
We urge the people not to fall prey to the trickery of politicians,” he said. (Chaturanga Samarawickrama)
The Archdiocese of Colombo today condemned the tweet posted by Minister Mangala Samaraweera saying, ‘Cardinal Malcolm Ranjith had fanned the flames of hatred and communalism by visiting Athuraliye Rathana Thera who was fasting in Kandy’.
In a statement, the Council of Priests of the Archdiocese of Colombo said the minister’s tweet has given a distorted interpretation of the Cardinal’s visit to Ven. Athuraliye Rathana Thera together with two other bishops and some Catholic clergy.
We strongly voice our opposition to Minister Samaraweera who criticized the efforts of religious harmony advocated by the Cardinal by his imprudent twitter message,” the letter signed by the Council’s Secretary Rev. Fr. Freely Muthukudarachchi said.
It said Rathana Thera was on a hunger strike on behalf of the victims of the Easter Sunday attacks demanding the expediting of the outcome of the investigations that are underway and the removal from office of two governors and a cabinet minister who are alleged to have had close ties with those responsible for extremist terrorist activities in Sri Lanka.
We also state that as Catholics we will continue to support the peace efforts among religions, especially among the Sinhalese, Tamils, Muslims, Burghers and others as a longstanding common heritage of the citizens of Sri Lanka and inform Minister Samaraweera and all others engaged in spreading erroneous and vengeful comments via social media of the same.
We highly commend the leadership given by the Cardinal in the aftermath of the Easter Sunday attacks on April 21 by his appeal to remain calm and ensured religious harmony in the country, especially appealing not to harm the Muslim Community. We salute the Cardinal for the great contribution he made during this crisis to maintain peace in Sri Lanka,” the letter said.
The Criminal Investigations Department (CID) today informed court that an investigation is in progress into alleged negligence by officials over the prior information received regarding the Easter Sunday attacks.
Police Spokesman SP Ruwan Gunasekara, speaking at a press briefing in Colombo, said that an investigation had been launched regarding allegations of negligence on the part of officials with regard to the prior information received on the 04/21 attacks.
He said that the investigation is being carried out based on the interim report of the special committee appointed by the President Maithripala Sirisena to investigate the terror attacks.
He said that CID informed the Colombo Chief Magistrate’s Court regarding this through a ‘B Report’.
Former Mayor of Colombo A.J.M. Muzammil has been appointed as the new Governor of the Western Province.
He was sworn in before President Maithripala Sirisena, a short while ago, at the presidential secretariat in Colombo, the President’s Media Division said.
Muzammil was most recently the Chairman of the Central Environment Authority (CEA) and prior to that served as Sri Lanka’s High Commissioner to Malaysia.
Muzammil takes over from Azath Salley who tendered his resignation yesterday along with Easter Province Governor M.L.A.M. Hizbullah.
A three-member committee comprising of three senior police officials has been set up at the Police Head Quarters to receive any complaints against former governors M.L.A.M. Hizbullah and Azath Salley and MP Rishad Bathiudeen.
The committee will be in effect until the 12th June, stated the Police Media Spokesperson.
Accordingly, the general public can submit their grievances from 8 am to 4 pm from today (04) onwards.
Anyone who wishes to submit complaints should hand over their written complaints to the Police Head Quarters in person.
The public is also requested to provide the evidence needed to support their claims.
Since the government changed in Sri Lanka in January 2015, the US has significantly” strengthened its military engagement with the island nation, particularly with the Sri Lankan Navy, says the latest US Department of Defense Indo-Pacific Strategy Report (IPSR).
The report, dated June 1, 2019, says that 2017 saw the first port visit in 30 years by a U.S. aircraft carrier – the USS NIMITZ Carrier Strike Group – and the first ever bilateral Cooperation Afloat Readiness and Training (CARAT) exercise.
In 2019, we increased cooperation on mutual logistics arrangements in support of Indian Ocean security and disaster response,” the report said.
The report does not mention the Access and Cross Services Agreement (ACSA) renewed in 2017. Of course the on-going negotiations on the controversial Status of Forces Agreement (SOFA) do not find a place.
India Gets Unique Designation
The report, which details US Department of Defense’s relations with several countries in the Indo-Pacific Region, is effusive on India.
It says that the US and India maintain a broad-based strategic partnership, underpinned by shared interests, democratic values, and strong people-to-people ties.”
The U.S.-India strategic partnership has strengthened significantly during the past two decades, based on a convergence of strategic interests.”
The United States and India continue to use their deepening relationship to build new partnerships within and beyond the Indo-Pacific,” the DoD report says.
In June 2016, the United States designated India a Major Defense Partner, a status unique to India”. The designation seeks to elevate the U.S. defense partnership with India to a level commensurate with that of the United States’ closest allies and partners.”
The establishment of the U.S.-India 2+2 Ministerial Dialogue in September 2018 also serves as a tangible demonstration of our commitment to promoting the shared principles of a free and open Indo-Pacific.”
The United States continues to pursue a range of initiatives with India to enable cooperation, strengthen our interoperability, and establish a strong foundation for defense trade, technology sharing, industrial collaboration, and broader cooperation on defense innovation,” the report says.
Indo-US Communications Pact
Hailing the Indo-US communication pact signed in 2018, the report said that the Communications, Compatibility and Security Agreement represents a significant development in our military-to-military relationship, facilitating greater interoperability and real-time secure information-sharing.”
The Department of Defense (DOD) and the Indian Ministry of Defense are increasing the scope, complexity, and frequency of our military exercises. Later this year, the United States and India will conduct our first tri-service exercise, and we continue to collaborate on maritime security and domain awareness, HA/DR, counter-piracy, counter-terrorism, and other transnational issues.”
US$ 16 billion Military Sales to India
Since 2008, the US had sold military equipment worth US$ 16 billion to India. But this is worded as bilateral defense trade”.
As the shared interests of the US and India and security cooperation have expanded, U.S.- India bilateral defense trade and technology cooperation have also grown, with approximately US$ 16 billion in defense trade since 2008.”
Through the Defense Technology and Trade Initiative, we are increasing cooperation in defense technology, building industry-to industry ties, and identifying opportunities for the co-development and co-production of defense systems for the sustainment and modernization of military forces,” the report said.
Military Aid For Maldives
The US expanded its military ties with the Maldives after the recent democratic transition in the Maldives,” giving it US$ 7 million in aid for the modernization of its security forces and for increasing domain awareness, the report says.
The United States has begun to explore avenues to expand security cooperation, with particular emphasis on providing capacity-building opportunities to the Maldives National Defense Forces and Maldivian Coast Guard. Key areas of focus include: maritime domain awareness (MDA), to enable Maldivian forces the ability to monitor and patrol its sovereign maritime area and contribute to regional efforts to protect sea lines of communication; HA/DR readiness; and counter-terrorism capability.
An additional $7 million in FY 2018 Foreign Military Financing (FMF) will support these efforts,” the report said.
Strong Relations With Bangladesh
The United States enjoys a strong” defense relationship with Bangladesh, an important partner” for regional stability and security, the report says.
Security cooperation focuses on key areas such as maritime security and domain awareness, counterterrorism, HA/DR, peacekeeping, and border security.
The annual Bilateral Defense Dialogue between USINDOPACOM and the Bangladesh Armed Forces Division sets the strategic direction of our defense relationship. In addition, recent increases in FMF, International Military Education and Training (IMET), and the inclusion of Bangladesh in the Maritime Security Initiative (MSI) underscore not only the value the United States places on its defense partnership with Bangladesh, but also Dhaka’s contributions towards regional stability in support of upholding a rules-based international order in South Asia and the Indian Ocean Region.”
Room For Expansion in Nepal
The United States seeks to expand its defense relationship with Nepal. Cooperation is not focused on HA/DR, peacekeeping operations, defense professionalization, ground force capacity, and counter-terrorism.
Our growing defense partnership can be seen in the establishment of the U.S. Army Pacific-led Land Forces Talks in June 2018, our senior-most military dialogue with Nepal. This year has already seen several senior-level visits to Nepal by the USINDOPACOM Commander and Deputy Assistant Secretary of Defense for South and Southeast Asia to further advance our defense relationship,” the report said.
China Castigated
Expectedly, China has come in for very harsh criticism in the US report.
Today, the Indo-Pacific increasingly is confronted with a more confident and assertive China that is willing to accept friction in the pursuit of a more expansive set of political, economic, and security interests,” the report says.
It pointed out that no country has benefited more from the free and open regional and international system than China, which has witnessed the rise of hundreds of millions from poverty to growing prosperity and security.
But while the Chinese people aspire to free markets, justice, and the rule of law, the People’s Republic of China (PRC), under the leadership of the Chinese Communist Party (CCP), undermines the international system from within by exploiting its benefits while simultaneously eroding the values and principles of the rules-based order,” the report charged.
It recalls that Chinese nationals acting in association with the Chinese Ministry of State Security were recently indicted for conducting global campaigns of cyber theft that targeted intellectual property and confidential business and technological information at managed service providers.”
Militarization of Seas
The DoD said that China has continued to militarize the South China Sea by placing anti-ship cruise missiles and long-range surface-to-air missiles on the disputed Spratly Islands and employing paramilitary forces in maritime disputes vis-à-vis other claimants.
China additionally employs non-military tools coercively, including economic tools, during periods of political tensions with countries that China accuses of harming its national interests,” the report alleges.
As China continues its economic and military ascendance, it seeks Indo-Pacific regional hegemony in the near-term and, ultimately global preeminence in the long-term.”
China is investing in a broad range of military programs and weapons, including those designed to improve power projection; modernize its nuclear forces; and conduct increasingly complex operations in domains such as cyberspace, space, and electronic warfare operations.
China is also developing a wide array of anti-access/area denial (A2/AD) capabilities, which could be used to prevent countries from operating in areas near China’s periphery, including the maritime and air domains that are open to use by all countries,” the report says.
In the East China Sea, China patrols near the Japan-administered Senkaku Islands with maritime law enforcement ships and aircraft. These actions endanger the free flow of trade, threaten the sovereignty of other nations, and undermine regional stability.
Such activities are inconsistent with the principles of a free and open Indo-Pacific,” the report asserts.
Low Level Coercion
Simultaneously, China is engaged in a campaign of low-level coercion” to assert control of disputed spaces in the region, particularly in the maritime domain.
China is using a steady progression of small, incremental steps in the ‘gray zone’ between peaceful relations and overt hostilities to secure its aims, while remaining below the threshold of armed conflict,” the report alleges.
(The featured image at the top shows the USS Nimitz which visited Colombo)
Eight Muslim ministers in Sri Lanka resigned from their posts to stand on Monday in solidarity with Industry Minister Rishad Bathiudeen, who has been accused by the Opposition of supporting Islamist militants who killed 253 people in the Easter Sunday attacks in April, Reuters reported.
All Muslim Ministers – Cabinet, Non-Cabinet, State & Deputy – have decided to resign from their portfolios in the government.
Leader of the Sri Lanka Muslim Congress (SLMC) Minister Rauff Hakeem stated this at a press conference earlier today (03).
Accordingly, Minister of Industry & Commerce, Resettlement of Protracted Displaced Persons, Co-operative Development and Vocational Training & Skills Development Rishad Bathiudeen will also resign from his post.
Rishad Bathiudeen also resigned from the ministry on Monday, undercutting a planned no-confidence motion led by supporters of former President Mahinda Rajapaksa. Ten accusations were listed against the minister in the motion, including the allegation that he provided ammunition to a factory owned by one of the bombers, and pressured the Army to release suspects arrested in connection with the attacks. However, the accusers did not provide evidence against him. Bathiudeen has denied the charges.
Reportedly, the resigning Ministers will continue to serve as government parliamentarians. However, they would sit in the parliament as backbenchers.
A meeting of all Muslim Ministers representing the government was held at the Temple Trees at 3.30 pm this afternoon.
By Noor Nizam. Peace and Political Activist, Political Communication Researcher, SLFP Stalwart and Convener – The Muslim Voice – June 6th., 2019.
GOOD TIME FOR SRI LANKA MUSLIMS TO CREATE NEW POLITICAL LEADERSHIP WITHIN THE COMMUNITY IN PLACE OF DECEPTIVE POLITICIANS AND THOSE WHO RESIGNED.
The political happenings ( not the NTJ violence and the incidents
followed as a result) at present with regards to the Sri Lanka Muslim Community
has to be considered as God AllMighty Allah sent, Alhamdulillah, Insha Allah.
The resignation of all the Muslim Ministers, Deputy Ministers, Ministers
without portfolios (9 in all) and the 2 Muslim Governors has opened the way for
“NEW POLITICAL LEADERSHIP” within the Muslim political hierarchy of
Muslim political praties and the (so-called Yahapalana) coalition
government. This deceptive so-called SLMC Leader campaigns under the
SLMC Party banner, but contests under the UNP Elephant symbol. Wiping up
communal and religious themes. The ACMC does the same, but is accused of
being busy making money. These politicians finally do all they can to
become elected by the people hoodwinking the poor “PAMARAMAKKAL”, the
Muslim voters. Let the Muslims (PAMARAMAKKAL) who OWN the Muslim VOTE BANK NOT
get duped once again, Insha Allah. Muslims in Sri Lanka do NOT have a voice – a
POLITICAL VOICE for that purpose. The Muslim politicians stooging the UNP are
ONLY interested in their personal benefits. The ungrateful Muslim politicians
who benefited the most from Mahinda Rajapaksa, Basil Rajapaksa and Gotabaya
Rajapaksa are now stooging the Yahapalana government and enjoying their best
with their kith and kin and henchaiyas, by selling the VOTE BANK of the Muslims
who have been deceived lock-stock-and-barrel. The Muslim Civil Society and
Muslim Media organizations (excluding www.jaffanamuslim.com)
in Sri Lanka and their leaders will stage dramas by releasing “press
statements” because all of them have been well taken care by the
Yahapalana government and the foreign interests who are giving them large
amounts of funding to keep their mouth shut. THEY HAVE RESIGNED NOT ON BEHALF
OF THE WELFARE OF THE MUSLIM COMMUNITY, BUT TO SAVE THEIR SKIN AND TO HOODWINK
THE MUSLIM VOTERS, so that they can appeal for their votes as “SAVIOURS OF
THE COMMUNITY” in the situation we are placed.
Brother M.F.M.Fazaath – Southeastern University, Oluvil has written
a well explanatory article about the present plight of the Muslim Community in
Sri Lanka – Alhamdulillah. Fazaath makes the call that – The slumber
(sleeping) in which the Muslim Community has been should be over now. It is
time up that we should awake now”. This is the reality, Insha Allah – முஸ்லிம்கள் சிந்திக்க … – Jaffna Muslim www.jaffnamuslim.com/2016/07/blog-post_222.html
It is
true that we have allowed the affairs of our community to be taken control of
unscrupulous, dishonest, deceptive, self-motivated, selfish, corrupt and
manipulating Muslim politicians, Muslim political party leaders, traders,
businessmen, Ulema, Media personnel and government officials, that has led our
community to be considered as a 2nd., class community in Sri Lanka.
Look at a comment made by Brother Haseef
M says: 13
July 2016 at 15:41Replyhas
stated. “Our education and employment index is very low compared to
Tamil and Sinhalese .. Without employment people will do anything illegal to
make money… That is happening to our community … Most unemployed are from
our community,,. Most uneducated are from our commutiy.. So crime rate go up…
Do not we believe in next life and do not believe in Hell and Pradise we do..
We have weekly Friday reminder and yet crime is going up among us .why ??
On the eve of January 8, 2015 presidential elections, the SLMC
and the ACMC joined “Hansaya” camp as they found that the entire
Muslim Community had decided to take revenge on Mahinda Rajapaksa. The vote
that President Maithripala Sirisena (“Hansaya”) got was an
Anti-Mahinda vote, “enblock”. It was not a pro Maitripala vote,
neither was it a vote for Rishad Bathiudeen or Rauf Hakeem or Faizer Musthapa
or Mujeebu Rahuman or Marikkar or for the UNP. Even the 20% of Muslim voters
who voted Mahinda at the 2010 Presidential Elections and the general elections,
voted against Mahinda at the 2015 presidentail and general elections. The ACJU
willingly or unwillingly allows itself to be manipulated by the above Muslim
politicians and used as a front for Muslim as well as non-Muslim politicians
who seek to achieve their own ends through the ACJU. The incidents of Aluthgama
and Beruwela, blamed as violence instigated by the then government via the BBS
was to be probed by the “Yahapalana government” when it comes to
power – then 20014/2015. A presidential commission was to be set in motion.
THIS DID NOT HAPPEN UP TO NOW. The FRUSTATION and AGONY of the Muslims being
betrayed by the “Yahapalana Government”, followed by more incidents
against Muslims in Digana and other areas and attacks on a few Muslim mosques
which were smoke screened by Muslim politicians for their personal gains, may
have driven some of the the Muslim youth to gather around an EVIL force of
destruction that we saw let loose on April Good Friday in our recently
peacefull Island. Was there more to this, or was it the “THREACHERY”
that the Muslim politicians and Political leaders and ULEMA – failed of
politically serving the “ASPIRATIONS and INSPIRATIONS” of the Muslims,
especially the “YOUTH”, that drove these youth to what they have now
ended up with – that it was NOT wealth, position, elite way of living, be
politically successfull or the goodies of well-to-do-lives or “RELIGIOUS
DECEPTION” but NOT – politically serving the “ASPIRATIONS and
INSPIRATIONS” of the Muslim Community since the Muslim political leaders
started “TRADING” their vote banks with National Political
Parties/Alliances for their selfish needs since the advent of the Sri Lanka
Muslim Congress – SLMC in Kattankudy in 1981.
It is time up that a NEW POLITICAL FORCE that will be honest and
sincere that will produce “CLEAN” and diligent Muslim Politicians to
stand up and defend the Muslim Community politically and as responsible
citizens of our “MAATHRUBOOMIYA”, especially from among the YOUTH,
has to emerge from within the Sri Lanka Muslim Community to face any new
election in thecoming
future, Insha Allah.
Cardinal Malcolm Ranjith who visited MP Ven. Athuraliye Ratana Thera during his fast unto death said the problem would not have blown out of proportion today if President Maithripala Sirisena and Prime Minister Ranil Wickremesinghe had acted against those who discreetly aided and abetted the terrorist attacks.
People have given a mandate to the President, the Prime Minister and the Cabinet to govern the country for five years. They had not been given a lifetime right to be in office. They have not been given the country on freehold basis. The country belongs to people, not to its rulers. The rulers should be mindful of it. The time has come to take a decision on the President and the Prime Minister,” he said.
He said if it were the President and the Prime Minister who could appoint Minister Rishad Bathiudeen, then it was they who had the authority to remove him.
The Cardinal also said that there were no proper investigations into the Eastern Sunday attacks so far.
No one is investigating to find out about those indirectly involved in this attack. Because of that, there should be immediate investigations to find out who were behind this attack. So we call on the President and the Prime Minister to launch a proper inquiry into the attack immediately,” the Cardinal told the media.
I urged the President and the government find out the persons who were creating hatred among the communities and take necessary action against them. I believe that Ven. Rathana Thera too conducting this fast because the government had failed to do what the people want in this context,” the Cardinal said.(
Pulasthini Rajasinghe
or Sara was one of the Jihadists who blew herself in a Sri Lanka Church on Easter
Sunday. There is no valid reason for her
to have exploded that bomb and herself along with it. One does not know whether she wanted to be a
suicide bomber It may be she was forced into doing it.
Like Ahimsa who may
not even know why she should destroy the political future of a fellow Sri Lankan without even knowing
whether he was actually responsible for the death of her father.
What did Sara the
Jehadist gain from that terrible act ? She was not even there to see the
aftermath of the bloody buchery she caused to innocent men women and children doing nothing else
but celebrating the rising of Jesus from
the dead ?
Ahimsa
Wickramathunga is also to a certain extent like Sara the Jihadist who exploded the
suicide bomb. But it may be Ahimsa too
has been forced to do so, as no one
knows what Ahimsa with such a meaningful name wants .
What does Ahimso stand
to gain from filing a civil case against
Gotabhaya Rajapakse in a US District
Court in California, which in my opinion is a bomb to shatter the reputation of
an innocent man loved by a greater majority of the people in Sri Lanka ?
As Sara the Jehadist
will go down history as a murderer of innocent men and women, Ahimsa Wickramaratne will go down history as a woman who tries to murder” the hopes of lakhs of
people of Sri Lanka her motherland , or if she denies it, that of her father.
It could be called a
suicide bomb even though Ahimsa is not
physically blowing herself up, she nevertheless will have to live as a person
with a meaningless name thereafter (because Ahimsa means not harming any one)
hated by a majority of the people in Sri Lanka, and her children too will
continue here after to live with that scar of a mother’s betrayal of the Sinhala people or if she denies they
are not her people , they were at east he people of her father.
Those interesed- Ahimsa’s handlers and brain washers like
those of the Towheed Jamat are
determined to vindicate the assassination of her father ten years ago when
Ahimsa was only 16 years of age. They are certainly not doing it for any love
for Ahimsa or her father Lasantha , but for the compensation money they have
been promised by anti Sri Lanka group-the Tamil diaspora , or a political party
in Sri Lanka to who are bent on
depriving the hopes of the
majority of the people of Sri Lanka to recover the peace and security and rapid
development of their country before the 8th January,2015, under President Mahinda Rajapakse and the Defence Secretary Gotabhaya
Rajapakse.
Of course in the
latter case Ahimsa the terrorist-( to my
mind any one who without a valid reason attempts to kill the good name and reputation of an innocent man is also a
terrorist) may not blow herself, but yet she blows off her own feminity and
what she may have learnt of altruism, as a child hailing from a respected and
an educated family.
One may of course argue
that Ahimsa even if what she is preparing to do is equivalent to an action of a
terrorist suicide bomber, she may not
cause a carnage as it had been at the
Church where the Jehadist exploded herself.
But then Gotabhaya
Rajapaksa is a man loved by a large majority of the people in Sri Lanka who are
lamenting the calamity that is being
done by the present government of Ranil Wickramasinhe.
Under the Premiership
of Ranil Wickramasinghe; Sri Lanka has
lost its peace and security and is being gradually handed over to USA , the
West and the terrorist sympathising Tamil Diaspora. It is worst than the carnage on the Easter Sunday, as it is an attempt to
massacre the hopes of the suffering people of a politically mismanaged
Sri Lanka.
The other Tamil man
who has filed another action against Gotabhaya Rajapakse-the former terrorist Manojkumar Samathanan who
claims to have been tortured and claims compensation from Gotabhaya Rajapakse
is doing so for the sake of money he may gain if he wins the case.
But Ahimsa
Wickramathunga may have enough money and her interest may not be the financial
gains she has been promised, but she is nevertheless just attempting to blow up a suicide bomb to get some relief for her suffering as a daughter
whose father had been murdered by some unknown persons whom she thinks or her
handlers think was carrying out the
orders of Gotabhaya Rajapakse.
The poor girl Sara
who had joined the Jehadists did not know she was dying in vain, as she was
brain washed by Towheed Jamat. And she was obeying her handler to blow herself
in a Church. She had no alternative once
the bomb was attached to her and
commandeered to enter the Church, she had to die in blowing up the bomb,
or if she abandoned she would have been killed by her handler who was certainly
prowling behind her.
Ahimsa Wikramatunga
has also been brain washed and she obeys her handler to assassinate the
popularity of Gotabhaya Rajapakse ten years after the assassination of her
father. She was only 16 years old at the
time and her handlers write as if it is her confession that she was only 16
years of age at the time.
Ahimsa may now be
about 26 years, and forgotten all about that
sad episode or trying to forget it, but
it is her brainwashers –the handlers who
are using the fact of Ahimsa being the daughter of Lasantha Wickramatunga to
realise their dirty object of destroying Gotabhaya Rajapaakse’s political
future and thus assassinate the hope of a nation, and in adition hope to get
financial compensation.
Ahimsa you have still
time to think, whether you will be obedient to your handlers and set off the
bomb or just refuse to detonate the bomb and thus be the heroine of the countless number of people in
Sri Lanka looking for redemption from calamitous situation Sri Lanka has been
brought into by Ranil Wickramasinghe and
his government, and allow Gotabhaya
Rajapakse to be the President of Sri Lanka to bring it back to what it had been before Ranil Wickramasinghe was sworn in as
the Prime Minister on the 9th January,2015.
The number of complaints lodged against Dr. Mohamed Shafi from Kurunegala Teaching Hospital has, reportedly, exceeded 630.
Sixty-six mothers who had undergone a Caesarian surgery under Dr. Shafi had filed their complaints at Kurunegala Hospital today (03).
Accordingly, the total number of complaints received by the Kurunegala Teaching Hospital itself is 544.
Additionally, another 21 mothers had filed their grievances at the Dambulla Hospital, today; which brings up the total number of complaints received by the particular hospital to 86.
Meanwhile, the interim report of the committee appointed by the Health Ministry to inquire into activities of Dr. Shafi was handed over to the Ministry Secretary today.
It contained 04 pointers including a recommendation to broaden the 6-member investigative committee by expanding the composition and the number of members in the committee.
CCTV footage of the Easter Province Governor M. L. A. M. Hizbullah meeting several persons who could be identified as Saudi Arabian nationals at a hotel in Pasikudah has been uncovered.
The CCTV footage shows Governor Hizbullah arriving at the particular hotel on the 22nd April 2019, a day after the Easter Sunday bombings which killed nearly 350 persons.
Footage has also captured several persons coming out of the hotel building to meet the governor and him entering the hotel with them.
Subsequently, the governor comes out of the hotel with several persons who could be identified as Saudi Arabians.
Later, a van arrives at the hotel and a parcel which arrived on the van is taken towards the hotel.
At a time when leading Sinhalese politicians were not prepared
to identify themselves as Sinhala Buddhists, when the Sinhalese were divided on
party lines, when leaders were behaving like Ostriches with their heads buried
in the sands, promoting multi – culturalism and reconciliation both of which
have collapsed like a pack of cards, and when Sinhalese have realized that they
have been taken for a ride and deceived by empty slogans and were waiting for a
true leader with a back bone to call the shots in the country, you arrived at
the right moment to give voice to the Sinhalese and the people all around the
country rallied around you saying ‘ At last we have a leader with a moral back
bone’.
The result was the resignation of two of the most despised men
in the country.
This is a huge milestone in the life of the nation and in your
personal life.
You have used non – violence as a weapon and like Mahatma Gandhi
have shown its high potential to cleanse and purify society.
Go Forward O Monk.
Teach moral cowards to take pride in our ‘ Rata, Jathiya, Agama’
Never a dull moment in Sri Lankan politics! Someone or something keeps it really exciting. The unfolding political situation is like an edge-of-your-seat thriller.
The yahapalana government is afflicted with a serious autoimmune disease, so to speak. It has become its own enemy. President Maithripala Sirisena and Prime Minister Ranil Wickremesinghe are at daggers drawn. Others who helped cobble up the yahapalana coalition and bring it to power have turned against it. Its chief architect, Ven. Maduluwawe Sobitha Thera, was one of its bitterest critics at the time of his untimely demise. His successor Prof. Sarath Wijesuriya cursed himself, the other day, for having backed it.
Now, MP Rathana Thera, who led the yahapalana campaign against the Rajapaksa government, from the front, is on the warpath. He launched a fast last week, demanding the removal of Minister Rishad Bathiudeen and Governors Azath Salley and M. L. A. M. Hizbulla. The government had to give in. Salley and Hizbulla resigned, yesterday. Rathana Thera ended his fast after being given an assurance that Bathiudeen would follow suit.
If the government had refused to grant Rathana Thera’s demand, his fast would have continued and the deterioration of his health would have made the public furious. Above all, his hunger strike would have snowballed into a mass protest campaign against the government. Kandy traders closed their shops as a mark of solidarity with the fasting monk, and bus unions threatened a strike; in fact, buses stopped operating on some routes yesterday. A TNA MP also staged a fast in solidarity with Ven. Rathana, and the families with the victims of the Easter Sunday bombings travelled to Kandy in support of the Thera. Archbishop of Colombo Malcolm Cardinal Ranjith visited the rebel monk and held the latter’s hands. The message was loud and clear!
The government may have been able to prevent the people from taking to the streets, but the political storm has not blown over. It would not have been in the current predicament if it had faced the no-faith motion against Minister Rishad Bathiudeen instead of trying to open an escape route for him through a parliamentary probe into the very serious allegations against him. It may have thought that it could do anything in Parliament. Thanks to its arrogance, an issue which could have been confined to Parliament has got out of hand; even if the no-confidence motion had been taken up and the Opposition had secured its passage with some UNF MPs voting for it, Bathiudeen would have resigned himself to losing the vote. But, now, all Muslim ministers in the government have had to resign because of him.
It is reported that the Muslim MPs in the ruling coalition have decided to continue to support the government without holding ministerial and other portfolios. They have helped the government wriggle out of a difficult situation, albeit temporarily, but they are politicians thirsting for power like their counterparts in other communities. This is certainly not a situation they can come to terms with so easily. There was absolutely no need for them to resign en masse from the Cabinet because the allegations at issue were not against the Muslim ministers; they were against only Bathiudeen, and they were never under pressure to step down.
In fact, some of the Muslim ministers are known to have courageously stood up to the dangerous extremists in their community. Why they decided to get bracketed with their beleaguered ministerial colleague defies comprehension. Their resignation might prove to be counterproductive in that it can be misconstrued as an act of pledging solidarity with Bathiudeen, who stands accused of having had links to the National Thowheed Jamaath, which carried out the Easter Bombings.
We can only hope that an equal number of Sinhala ministers will also resign from the Cabinet so that a lot of public funds spent on their maintenance could be saved.
Venerable Athuraliye Rathana Thero has concluded his protest fast upon learning that Governors Azath Salley and M.L.A.M. Hizbullah had resigned from their respective posts.
Athuraliye Rathana Thero launched a protest fast in front of Sri Dalada Maligawa in Kandy on 31st May demanding the removal of Minister Rishad Bathiudeen, Eastern Province Governor M.L.A.M Hizbullah and Western Province Governor Azath Salley from their respective posts.
Rathana Thero claimed that he was prepared to sacrifice his life if need be in order to achieve his demands.
Meanwhile, Governors Azath Salley and M.L.A.M. Hizbullah handed their letter of resignation to President Maithripala Sirisena earlier today (03).
Accordingly, Central Province Governor Maithri Gunaratne informed Rathana Thero of the resignations.
Accordingly, the Thero broke fast and was taken to the hospital for treatment.
Rathana Thero stated that the President cannot remove Minister Rishad Bathiudeen from his post and that he believes that Prime Minister Ranil Wickremesinghe would take an action regarding this.
Parliamentarian Ven. Athuraliye Rathana Thero, who commenced a protest fast on Friday, has been informed that Governors Azath Salley and M.L.A.M. Hizbullah have tendered their resignations.
The Central Province Governor Maithri Gunaratne arrived at Sri Dalada Maligawa in Kandy, where Rathana Thero had been leading the protest fast, to inform him in this regard.
Eastern Province Governor M.L.A.M. Hizbullah and Western Province Governor Azath Salley had submitted their resignations to President Maithripala Sirisena a short while ago, the President’s Media Division said in a tweet.
A discussion was held at the Presidential Secretariat this morning between President Sirisena, MPs of Sri Lanka Freedom Party (SLFP) and Governors Hizbullah and Salley regarding the titles of the governors.
MP Rathana Thero stated that the protest fast would proceed until he is informed of this in writing.
Attempts to conquer
heights, be it a mountain or any other carry their own perils and risks.
Generally, glory and peril walk side by side in such endeavors, until the
former or the latter wins, in the end”.
Already eleven or twelve
climbers have perished on the slopes of the Mount Everest, in this year alone
and that is only so far. This sad news made me ponder on ‘the diverse nature of
adventure and that craving for a bit of it present in almost every human being
and the question how much or less of it in each one of us is there, longing for
those quests, some of which are unbelievably dangerous?’
Now at one end of the
scale are the minimal risk takers with hardly any love for or sense of
adventure at all, who cannot even be persuaded to climb anything higher than an
anthill or dare venture out further than to a depth around knee level in any
water body, be it a pool, a lake, a river or even the mighty ocean. They live
lives governed by the principle that as long as you keep away from everything
that has even the slightest chance of going wrong, you are safe. However, the
question is can you find such absolute and guaranteed safety in this world of
ours, where your safety depends as much on numerous external factors that are
beyond your control?
Yet our minimal risk
takers don’t get deterred or disturbed by such arguments. They would as best as
they can try to avoid anything and everything that they think may put them in
danger. And they are also firm believers in superstition so much so that they
will truly think that the little house gecko, who is going after a mosquito on
a wall suddenly abandons its stalking and decides to come up with its usual
chattering call ‘chuck, chuck, chuck’, is actually telling them that it’s a
foreboding. And one of them might even hurriedly start looking for that
handbook of ‘Huunu Sasthare’, if it happens to be at his/her home. Or what
about that innocuous looking black cat that happens to be crossing the same
patch of the road that our superstitious friend is walking along? Would his
casual thoughts as regards it be limited in extent to ‘oh a poor stray cat on
the prowl’: I doubt it.
Now at the other end of
the scale are sitting the exact opposite, who enjoy risk-taking and relish it,
going for adventures of all sorts, mostly very dangerous and doing it for the
sake of glory, sheer thrill, sense of achievement and so on and so forth.
And apart from those
extremely challenging and dangerous adventures such as mountain-climbing, there
are other equally dangerous and at the same time immensely foolish ones too
that some of our friends at the other extreme end of the scale tend to go for.
To keep it short, I will site only a couple here. But then before going any
further; ‘isn’t there a degree of foolishness attached to all extreme types of
adventure and sport, anyway?’
Poking one’s head into
the cavernous mouth lined with razor-sharp, sawtooth-like dental armour of a
fifteen-foot alligator is one, for example. This present-day descendant of
the dinosaurs that roamed the earth millions of years ago, is said to have only
a tiny brain even after all those eons that have passed by, and it’s more like
a chancy game of Russian roulette, when or whether the creature decides to shut
its snout with a human neck inside it for chewing at leisure.
And then we have some,
who, adequately emboldened by alcohol and apparently empowered by those ‘Ali
manthara’ dare challenge a wild elephant that is peacefully chomping away on a
leafy branch in a patch of jungle. In spite of being called gentle giants and
quite correctly so, they too like us the humans don’t take it lightly, when
someone tries to invade their personal space. And unfortunately, those who
dared to do so, didn’t live to tell the rest of the tale, as far as I
know.
Now, this particular form
of adventure could be more or less limited and quite unique to, Sri Lanka only.
And then I am not sure whether this kind of sheer stupidity should be
called an adventure at all, other than that it is plain suicide. However,
according to the ‘Oxford English Dictionary’ an adventure is; ‘An unusual and
exciting or daring experience, Excitement associated with danger or taking of
risks, A reckless or potentially hazardous action or enterprise’ etc. So, it,
nevertheless, is adventure too, of some kind.
Anyway, engaging in true
adventure is no doubt challenging and once accomplished, can be very
exhilarating too. To the person, who wins in the end beating all odds, I am
sure it brings a great sense of achievement and fulfillment, a magical
sensation of unburdening a weight that he/she had carried so long.
And before I leave, must
I say for myself that I am somewhere in the middle of that scale or should I
honestly admit that actually it is now far more to the left than to the right?
Yes. Years have taken their toll and they did teach me a few lessons too!
Now this brief article
wouldn’t be complete without a mention of a very special kind of an adventure,
which is the political adventure. And particularly, in our land like no other,
it is one adventure that still guarantees a victory in the end, if not glory.
Isn’t a hefty pension after just five years of idling in Diyawanna environs
along with ample real estate and other forms of wealth acquired and accumulated
during that state-paid vacation, enough, whether one wins or loses, at the end
of one’s adventurous tenure, so to speak?
