What is this 'black fungus' infection? – The Island – The Island.lk

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By Dr. Kavindya Marapana
Sri Lanka is in the process of recovering from the most severe COVID-19 wave, dominated by the Delta strain. At the time of writing, 513,278 cases of COVID-19 had been confirmed from all parts of the country with 12,600 deaths. It has affected physical and mental health, the economy, education and the overall wellbeing of people across the globe.
The government and relevant authorities are fighting the pandemic effectively, utilising the relevant healthcare services and facilities to manage patients, aided by lockdowns and the ongoing COVID-19 vaccination programme. More than 50 percent of the population have received both doses of vaccines.
Meanwhile, several cases of ‘black fungus’ infections have been reported among COVID-19 patients in hospitals in Colombo, Kurunegala and Ratnapura. With the experience of our neighbouring country India, reporting more than 45,000 cases of black fungus infection among COVID-19 patients, causing more than 4,300 deaths, it is of utmost importance for us to be aware of this condition and to adopt preventive measures to avoid such a deleterious situation.
Consultant Mycologist of Medical Research Institute, Colombo, Dr. Primali Jayasekera, in a brief interview with The Island, answers some frequently asked questions about the black fungus infection.
Q: What is ‘black fungus’ infection?
It is a rare but life-threatening fungal infection, known as mucormycosis and colloquially as ‘black fungus’, caused by fungi belonging to the Mucorales group.
Q: Is this infection new to Sri Lanka?
Mucormycosis has been diagnosed among immunocompromised patients (patients with weakened immune systems) in Sri Lanka, over the years, and it is not an uncommon infection among Sri Lankans. It has a worldwide distribution. Found ubiquitous in soil and decomposing organic matter. It can be found indoors and outdoors, in rotten food and dust. In addition, being a temperate country, Sri Lanka has the optimum temperature for the fungi to grow.
Q: How would someone get infected by it?
Most infections occur following inhalation of fungal spores in the air. As a result, nasal sinuses and lungs are the commonest initial sites of infection. Skin infections have also been reported following traumatic inoculation and following injections. Cases have been reported following ingestion of contaminated food as well.
Q. Who is at risk of getting infected?
Patients with prolonged or profound neutropenia (low neutrophils in blood), diabetes mellitus (type I and II), metabolic acidosis, malnutrition, steroid users, bone-marrow transplant recipients, solid organ transplant recipients, patients with haematological malignancies (blood cancers), patients with burn injuries and injection drug users are at risk of developing this infection. It has also been detected among some patients with no apparent immunological defects.
Q. Are COVID-19 patients at a higher risk of getting infected?
Some COVID-19 patients are being treated for cytokine storm, and this is essential. But if such a patient has a weakened immune system, due to some other cause, he or she is more susceptible to mucormycosis infection, compared to a non-COVID-19 infected person with a weak immune system.
Q. What are the symptoms suggestive of the infection?
It depends on the site of infection. The commonest sites of infection are the nasal and adjacent sinuses (rhino cerebral mucormycosis) and lungs. Patients can present with fever, facial swelling (affecting one side of the face), unilateral headache, nasal or sinus congestion or pain and a blood-tinged nasal discharge.
Characteristic diagnostic signs include necrotic black ulceration on the hard palate or nasal turbinates, drooping eyelids, proptosis (protrusion of eyes), ophthalmoplegia (eye muscles not working properly), loss of vision and oozing of black pus from eyes.
Q. How is it treated? What complications can one develop?
Surgical excision and antifungal drugs are mandatory in treatment. Complications include infection spreading to the eye socket, swelling around the nose and eyes with progressive destruction of facial tissues. Infection can spread to the brain affecting the frontal lobe and form abscesses within the brain.
Q. How can one prevent infection?
It can be prevented by
• Adequate control of diabetes mellitus.
• In immunocompromised individuals, reducing the sources of environmental exposure (refraining from gardening, consumption of old and contaminated food, use of contaminated surgical dressing, syringes and such) and avoiding inhalation of spores during critical periods.
• Avoiding contact with COVID-19 patients or suspected individuals.
• Taking both doses of COVID-19 vaccine.
• Always using a clean face mask.
• If diagnosed with COVID-19, receiving treatment from a qualified doctor, as self-medicating with western medicine is very dangerous due to side effects which can make you more susceptible to mucormycosis.
Consequently, it is observed that some individuals are at higher risk of developing conditions such as black fungus infection during COVID-19 infection, and this can lead to severe disability and even death due to already existing comorbidities, as opposed to healthy individuals.
Therefore, it is our duty as responsible citizens to adhere to health guidelines, get fully vaccinated and help control and eventually eliminate this pandemic.

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Form-ation of Higher Education in Sri Lanka
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By Hasini Lecamwasam
Improving higher education in Sri Lanka is not only important, but essential and long overdue. However, seeking to achieve higher ‘quality’ by ‘form-ising’ the performance of teachers (or the practice of forcing the entire teaching-learning exercise into forms designed to communicate exactly what and what transpires in a classroom) may not be able to bring about the desired change. A new set of four forms introduced recently to this end requires, among other things, drawing up a minutely detailed plan of each and every lesson to be delivered in class, aligned with the Course Learning Outcomes (CLOs), in turn, to be aligned with the Programme Learning Outcomes (PLOs), which should all then be tied to the graduate profile, or the kind of graduate we seek to ‘produce’ at the end of it all. This may, on the surface of it, sound reasonable enough and not encourage serious debate or resistance because, after all, it is only some forms that need to be filled.
Form by tedious form, however, the teaching-learning process at state universities is becoming increasingly constricted, fragmented, monitored, controlled. In this piece, I wish to briefly ponder on the implications of these requirements and the larger trends they signal, while also attempting to reflect on what instead we may do to ensure ‘quality’ in the delivery of higher education.

The problem with form-ation
The larger ‘Quality Assurance’ (QA) landscape in which these developments take place was discussed in detail in an earlier Kuppi Talk by Kaushalya Perera. In a nutshell, QA seeks to standardise education such that study programmes can be assessed against each other, assigned numbers, and ranked accordingly. The deployment of overarching yardsticks for programmes with hugely varying mandates, methods, and content has been the subject of much critique lately the world over, not the least due to its rather warped understanding of ‘quality’ as something that can be objectively established through metrics and audits.
While I do not question the bona fide motives behind the initiative taken with the aforementioned forms, I do think serious reflection on where these developments push us in the longer term is needed. My primary reservation here has to do with the impact of this lesson-wise breakdown on the creative and democratic exercise that the teaching-learning process is supposed to entail. When each topic is broken down into such fine detail prior to the actual occurrence of the ‘lesson’ (for want of a better word), outcomes are foreclosed rather than collectively and organically evolving in the course of the ‘lesson’, which is particularly important to many of the subjects offered in the Arts Faculties. Exactly how many of us are actually quite so democratic in our classrooms is a valid question in this regard, and one I will return to. The point for me here, however, is that for those who do have a sincere commitment to such a democratic classroom environment, such forms and the limiting of the teaching-learning experience they constitute, may be tantamount to strangulation.
Even if the majority of us admit to being very controlling in our classrooms anyway, does that justify going one step further with these forms and institutionalising such control? Should not our commitment be to the emancipatory ideal, rather than simply what most are on board with? There should be meaningful space for creative, organic, and democratic teaching-learning processes to unfold for teachers who wish to make that choice, and for students to explore and think beyond the teacher’s frame of thinking. Micromanaging beyond the general content of a course (laid down in enough detail in the course syllabus) is inimical to even a possibility of democracy existing in the classroom and within the larger university space.
This complete subservience of the teaching-learning process to red tape signals a larger and troubling trend of corporatisation. Corporatisation may be defined as the restructuring of a publicly owned institution to be managed as a business place would be, with a view to privatising in the long term. In state universities, this shift is couched in the supposedly ‘progressive’ language of student-centered approaches and interactive classrooms, hijacked from the democratic pedagogy of the likes of Paulo Freire, but bereft of any of the emancipatory politics within which these methods assume meaning. Despite the use of these catch-phrases, however, such minutely detailed forms signal a return to an extremely teacher-centered model due to the absence of the possibility for students to meaningfully influence the outcome of a lesson, as it is predetermined for them.
The result, as the Kannangara report worried with remarkable foresight some 80 years ago, is students “with much knowledge and little understanding. They have not read books; they have “studied” texts. They cannot write, they produce essays after a set style. They can answer questions but not question answers … Their imagination has been stunted, their originality suppressed, their capacity for thought undeveloped, their emotions inhibited.”

What alternative can we propose?
A valid question countering what little resistance there is to form-ation asks how we can ensure the education we currently deliver is of an acceptable standard, and that everybody observes such. There seems to prevail tacit and widespread agreement that the ‘democratic nonsense’ within universities is what has allowed many to hide behind debates, deliberations, appeals to creative freedom, and so on, without actually doing their work.
In my view, this is an arbitrary causation to draw. Blaming internal democracy for negligence of duties fails to take into account the highly anti-democratic practices at universities that may better explain such behaviour.
Specifically, I think it is the rigidly entrenched hierarchy within universities that blocks the possibility of even dialogue, let alone debate, particularly when it comes to holding those higher-up in the ladder accountable for their actions (or the lack thereof, as the case may be). Hierarchy is why, among many other things, students cannot question the content or the methods chosen by their teachers. As previous Kuppi Talks have endeavoured to show, hierarchy is silently, and therefore very effectively, observed at every level, ensuring the trumping of students by teachers, juniors by seniors, women by men, minorities by the majority, and originality by tradition. It impedes questioning, stifles dissent, and smothers alternative thinking altogether. The problem, therefore, is not that we have too much democracy in universities, but too little of it.
We must make a sincere and sustained effort to radically democratise the university space by relaxing the classroom to allow open and honest exchange between students and teachers; changing the relations of power between seniors and juniors, starting with undoing the practice of deferential treatment; refusing to tolerate snide and not-so-subtle references to ways of dressing and similar gendered remarks; questioning the exclusive use of the majority language in official communications, as a starting point. In doing so, we would be subverting the crippling hierarchy that inhibits thought and practice within the university. Such a radical change geared towards improved quality through mutual accountability, for me, is the only acceptable way of introducing accountability to a space that, admittedly, sorely lacks it.

(Hasini Lecamwasam is attached to the Department of Political Science, University of Peradeniya)
Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.
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by Jehan Perera
The significance of President Gotabaya Rajapaksa’s speech at the UN General Assembly, in New York, last week, was his use of the time allocated to him to provide an outline of the government’s policies towards the main challenges besetting the country. The President covered the main issues that confront the world with his focus on Sri Lanka. These included measures to contain the Covid pandemic, the economic crisis, environmental degradation and violence. In the final section of his well-crafted speech, the President went into some depth regarding the government’s approach to national reconciliation. However, the response within the country, has been muted and for good reason. Those who voted for the government, on an entirely different platform, which emphasised ethnic majority nationalism and anti-international sentiments, are quite probably at a loss.
It is only recently that the government has started to speak in terms of reconciliation and obtaining international support for it. At the two elections that brought this government to power, the Easter Sunday bombing and the consequent threat to national security, took centre stage. The majority, who voted for the government, did so to protect it from a variety of security threats they were told of, both within and outside the country. The wretched failure of the previous government to prevent the bombing, the first terrorist act of any magnitude since the war ended a decade earlier, was attributed to the personal weakness of the then government leaders. It was also attributed to the 19th Amendment which sought to give state institutions protection from use for partisan reasons by government politicians and to consequent disintegration of the system of command and control.
A second theme, at the two elections, was depiction of ethnic and religious minorities as potential security threats. This stemmed from the country’s experience of three decades of internal warfare with the armed Tamil separatist movements. This was followed by the Easter bombings by extremists from the Muslim community, who were feared to be having a vast support base both internally within the country and also externally. In these circumstances, the re-centralisation of power within the government hierarchy and greater role given to the security forces, received public acceptance as being part of the government’s democratic mandate. At the same time, by denying the equally legitimate concerns of the ethnic and religious minorities, the electoral results demonstrated the existence of an acute polarisation, and wound, in the body politic that continues to fester to the point of bringing in involuntary and imposed international interventions.
EU MONITORING
The challenge for the government is to represent the interests of all communities and not only the majority who voted it into power. The problem is that the government’s mandate comes, by and large, from the vote of the ethnic and religious majority in a country that has been polarised on ethnic and religious lines, for many decades. An ugly part of this reality is that in the prisons are several hundreds of Tamils and Muslims for the most part who are in custody for periods ranging from a few months to many years without trial. They are being held under the Prevention of Terrorism Act, ostensibly until the security forces find adequate evidence to put them before the courts of law. This contradicts the rule of law and the presumption in our legal system that we are innocent until proven guilty can have negative consequences.
In June this year, the EU parliament passed a resolution that the GSP Plus tariff privileges, made available to Sri Lanka should be withdrawn unless the government fulfilled its obligations in regard to the upholding of human rights. The resolution, expressing “deep concern over Sri Lanka’s alarming path towards the recurrence of grave human rights violations”, and makes specific reference to the use of the Prevention of Terrorism Act (PTA). The resolution notes the “continuing discrimination” against and violence towards religious and ethnic minorities, while voicing “serious concern” about the 20th Amendment passed in 2020, and the “resulting decline in judiciary independence, the reduction of parliamentary control, and the excessive accumulation of power with the presidency”. It also highlights “accelerating militarisation” of civilian government functions in Sri Lanka.
A delegation from the EU is currently in Sri Lanka to meet with members of the government, Opposition and civil society, to ascertain whether the country is fulfilling its obligations to be a beneficiary of EU trade benefits. It is likely that the delegation will be provided with evidence of human rights violations and acts of impunity. There are hundreds of persons languishing in prisons without being put on trial, many of whom are Tamils, suspected to be LTTE members, and more of them are Muslims, suspected of having links with the Easter bombings. When questioned in parliament about the latter, the minister in charge justified those detentions on the grounds that Muslim youth, including the Muslim parliamentarian who had questioned him, could contain Islamic State ideology in their heads and therefore be security threats.
NEW DIRECTION
At the last elections, the most potent theme was the failure of the then government to act effectively to protect the country from the Easter suicide bombings and the pressures from human rights actors in Geneva. Among the issues that loomed large at the last election was also the charge that the previous government was giving in too much to the Muslim community within the country. The fact that the Easter attacks were by Muslim suicide bombers added force to this charge. The prioritisation of national security in the election campaign had popular support. The influential religious clergy, associations of professionals and mass media also joined the battle in earnest and their messages reinforced one another. The recent debate in Parliament suggests the government’s thinking continues to be in sync with the mandate it received at those elections.
However, in his speech in New York, President Gotabaya Rajapaksa has shown signs of diverging from the politics of the past. The President said “Fostering greater accountability, restorative justice, and meaningful reconciliation through domestic institutions is essential to achieve lasting peace. So too is ensuring more equitable participation in the fruits of economic development. It is my Government’s firm intention to build a prosperous, stable and secure future for all Sri Lankans, regardless of ethnicity, religion, or gender. We are ready to engage with all domestic stakeholders, and to obtain the support of our international partners and the United Nations, in this process.” However, the President’s speech continues to be at variance with the ground realities at the present time and the general manner of governance since the President took office in November 2019.
So far the pledge of a new direction is articulated in words. The time for the government to make the President’s words real and act accordingly is now. This will help to overcome the deep and dark cynicism that has enveloped the country regarding promises made by politicians. The first step would be to apply the logic of the Justice Minister in Parliament. Replying to an Opposition Parliamentarian who called for the arrest of Minister Lohan Ratwatte who stands accused of entering a prison and threatening prisoners with his gun, the justice minister said that everyone is entitled to the presumption of innocence until proven guilty. This also applies to the hundreds of Tamils and Muslims in jail without evidence to charge them in a court of law. The better way to deal with the threats to national security is to win the confidence of all the communities in the Sri Lanka by treating them without discrimination, as children of one mother, as our national anthem proclaims.
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Covid-19 has claimed many lives, in our part of the world. Quite a few musicians, too, have had to face the music, where this deadly virus is concerned.
However, one is perturbed with the setup seen on some of our TV shows, especially where musicians are concerned.
The Covid-19 guidelines are never adhered to – no masks, no social distancing, etc.
There were reality shows held, post pandemic, where judges were seen even hugging their favourite contestants – with no masks.
With the virus turning deadly, some of the judges took to only wearing face shields. And, we now know the results of their stupidity.
By their irresponsible behaviour (wearing only face shields), they seem to be setting a trend for others to follow.
The question being asked is what are the health authorities doing? Why haven’t such folks been taken to task!
If the man on the street is arrested for not wearing a mask, how come these law-breakers go scot-free!
If wearing a mask is a hassle in an air conditioned setup, then such shows should be put on hold, or held virtual…live stream, zoom, from home, etc., and not with the participation of several artistes, in a studio.


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