Nalaka Gunawardene - Mass Kidney Failure & Mass Media Failure in Sri Lanka - 17 Oct 2012


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Presentation to Science Communication Leadership Workshop during the First General Assembly of Association of Academies and Societies of Sciences in Asia (AASSA), held in Colombo, Sri Lanka, on 17 October 2012.

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Nalaka Gunawardene - Mass Kidney Failure & Mass Media Failure in Sri Lanka - 17 Oct 2012

  1. 1. Mass Kidney Failure & Mass Media Failure: Insights from Sri Lanka By Nalaka Gunawardene Independent Science Writer & Columnist, Sri Lanka Presentation to Science Communication Leadership Workshop At First General Assembly ofAssociation of Academies and Societies of Sciences in Asia (AASSA) Colombo, Sri Lanka: 17 October 2012
  2. 2. Contents: Chronic Kidney Disease ofUnknown aetiology (CKDu) CKDu: A Mysterious Disease in Sri Lanka Challenge to scientists & healthcare system Policy makers’ dilemma: best response? Mass media coverage critiqued:  Structural & professional problems  Advocacy journalism’s limits  Hazards of moderate journalism CKDu as prism of Lankan society: reveals issues, gaps & distortions All are my personal views!
  3. 3. CKDu: Reported in Sri Lanka’sDry Zone since early 1990s… CKDu: A Mysterious DiseaseInfographic courtesy: Centre for Public Integrity, USA
  4. 4. CKDu: A Brief History… Dry Zone: Heart of rice farming Mostly affected male farmers, 30-60 Started North- Central Prov but since spread Affected area: 17,000 sq km, home to 2.5m (1/8 of Sri Lanka pop)Map courtesy: BBC Online
  5. 5. CKD vs. CKDuInfographic courtesy: Centre for Public Integrity, USA
  6. 6. CKDu: A National Emergency Over 15,000+ kidney patients needing regular dialysis (2/week) Each dialysis session: ~USD 100 Care costs LKR 350m (~USD 2.6m) = 4.6% of annual public health budget How many deaths? No reliable figure; could be 100s/more Vast socio-psychological impacts
  7. 7. Part of a global trend? CKDu: Reported from Central America, India, Sri Lanka Is there a shared causative factor?
  8. 8. Contents…Photo courtesy Athula Bandara, IRIN News
  9. 9. Long search for causative factors… Genetic predisposition? Lifestyle-related exposure?  Locally brewed liquor  Ayurveda medicinal concoctions Environmental exposure?  Excessive Cadmium or Arsenic  High Fluoride in groundwater  Aluminium utensils + Fluoride water  Naturally occurring hard water  Cyanobacterial toxins in water  Bioaccumulation of pesticide residues Or something else?
  10. 10. WHO & Govt of Sri Lanka: Studying CKDu from many angles Multidisciplinary study: started 2008 Health Ministry’s Epidemiological Unit with WHO 10 teams: looking for curative & preventive responses Study report  Health Min mid 2012 NOT RELEASED TO PUBLIC: WHY??? In its absence  confusion, speculation, conspiracy theories Not good for PUBLIC TRUST in science or govt healthcare system
  11. 11. CKDu & Agrochemicals nexus: Suspected; on trial; or proven guilty? Mid 2011: Hypothesis: CKDu caused by excessive Arsenic in imported pesticides & chemical fertilizers, when combined with calcium in hard water. BEFORE peer-reviewed papers or scientific debate, info & opinions are released to mainstream & new media One scientist claims: Divine Intervention helped arrive at this hypothesis  Controversy!
  12. 12. ‘Miracle’Cartoon bySidney Harris
  13. 13. Divine-assisted Science?Some LK media scepticism… Cartoon by Awantha Artigala Daily Mirror (Sri Lanka): 20 June 2011
  14. 14. Dig Deeper & Probe Further… But proceed with CAUTION!Ceylon Medical Journal review article, Dec 2011: “It is timely that the available, credible, scientific evidence on CKDu (published in peer-reviewed journals) is collated and analysed, and the difficulties faced in establishing causality are discussed.” Cause of CKDu might be “multifactorial”. Caution: Mere associations “should not be considered to be of causal importance without documented evidence of proof” Full paper:
  15. 15. Policy makers’ Dilemma:What to do while scientists disagree?“Different groups have studied some aspects anddescribed it without giving a holistic picture. Thematter became complicated by some so-calledscientists referring to God’s assistance todiagnose the problem.“Commercial interests, lack of coordinationamong researchers, policy makers not willing todisclose findings and take appropriate action –all these have made the CKDu situation worse…”- Dr Janaka Ratnasiri, senior physicist & publicintellectual (not involved in CKDu research)
  16. 16. CKDu: Media’s Challenges CKDu: A powerful story for media  Mystery disease, suffering, fear, death  No scientific consensus: debate, intrigue  Activist allegations, speculation, conspiracy theories! CKDu: Also a difficult story to cover  Slow evolving tragedy: temporal  Impacts only humans but not landscape  No drama of a ‘contagion’  Needs effort & skill to ‘connect dots’
  17. 17. CKDu is NOT a Fleeting Story…Unsuitable for Breaking News! CKDu: A Mysterious Disease
  18. 18. CKDu media coverage in general:Highlights LK media limitations… Many journalists lack science background to critically examine issues or ask the right questions Uncritically peddling info fragments & opinions without clarity, context or coherence Many media outlets don’t assign sufficient resources for indepth or investigative coverage (lack of priority, not funds)
  19. 19. Mass Kidney Failure + Mass Media Failure? Healthy kidney: filters waste & excess water Healthy, vibrant media: separates fact from fiction; provides clarity and context What causes mass MEDIA failure in LKA? Is there a cure? Where?
  20. 20. Advocacy Journalism on Health &Environment OK – but within reason!“Journalists -- environmental or not-- must be rigorous in their fact-checking and field investigations.They must provide balancedanalysis of issues, impacts, choicesand alternatives. They must also becommitted to sticking withunfolding and evolving stories...”- Nalaka Gunawardene, inSciDev.Net Editorial, 20 April 2007Full text:
  21. 21. Advocacy Journalism:around for decades,went mainstreamcirca 1989
  22. 22. CKDu coverage in LK Media:Advocacy or Activist Journalism?Advocacy Journalism Activist Journalism: Supportive of a public  Supportive of a public interest cause Sustained coverage (story interest cause is kept alive)  Sporadic media coverage Journalists ask critical  Journalists become questions, verify info ‘embedded’ & uncritical Accommodates diverse &  Selective amplification of dissenting views; no one is blocked out by media info & opinions Creates an inclusive  Dissenting/divergent views platform for debate, ignored/attacked seeking solutions  Solutions???
  23. 23. 2012 Aug controversy: “WHO says” it found “the cause” of kidney failure Aug 15: Activist group releases 3-page document allegedly by WHO official (named) BUT document is an unsigned, unverified pdf: No logo, reference or contact details Many mainstream newspapers rush to print: “WHO says farm chemicals found guilty!” WHO in Colombo & Geneva: No reaction at all LK Ministry of Health: No comment of any kind Silence fuels suspicions; activist media claim case is closed (“so banish the guilty party…”)
  24. 24. Too much finger pointing, Too little reflection! TOO MUCH time & energy spent looking for a ‘Villain’ TOO LITTLE media attention on:  Healthcare needs of those already living with CKDu  Economic, social & emotional needs of affected families  How to prevent more people falling sick: need for safe drinking water NOT ENOUGH questions on overall agro policies that heavily favour high external inputs
  25. 25. LK Chemical Fertilizer Subsidy: How did we became so addicted? State subsidy for chemical fertilizer: started 1962 (Green Rev) Continued for much of past 50 yrs Since 2005: 90% subsidy for N,P, K My column 26 Aug 2012: Costs ~ LKR 50b (USD 380m)/year Watch out: Everybody Lives 2009 subsidy cost = 3% of total Downstream! govt budget = 0.6% of LK GDP How Lanka became Too political to rationalise! addicted to cheap V. cheap fertilizer = farmers not chemical fertilizer & why it’s hard to kick the habit thrifty  massive runoffs Organics just can’t compete!
  26. 26. So are agrochemicals causing CKDu? We’re still waiting for firm evidence…Photo courtesy: Amantha Perera, IPS
  27. 27. Public Communication of Risk: CAUTION: Handle with care! CKDu: Emotions run high: anxiety, suspicion, fear, anger, distrust… Affected & others looking for empathy + support + solutions Need authoritative & trustworthy persons to give clarity, assurance Media doesn’t have all the answers What media can do: ask right questions; admit to gaps in knowledge; seek short term relief; advocate more study
  28. 28. Lankan public’s info sources on currenttopics: Heavy reliance on media Outdoor billboards, banners, etc 27% Educational institutions 7% Friends, neighbors, colleagues 52% Public exhibitions, seminars,etc 13% Mobile phone/SMS alerts 13% Internet 9% TV 94% Radio 74% Newspapers and magazines 70%2010 survey covering 1,000 persons from all over Sri Lanka
  29. 29. Media as a Mirror: But what KIND of mirror do our eco-activists want? Media as mirror of society: show things as they are: black, white & grey… Media cannot be a ‘Funny Mirror’ distorting images to impress a few Some SL activists seem to expect public media to reflect/amplify exactly & ONLY what they want. Or else…!!!
  30. 30. Summing up 1: CKDu as a ‘prism’ of Lankan society Applicability of indigenous knowledge Need for full disclosure in public science Lack of public TRUST in govt/official sources Loss of public respect for scientists & medical profession due to public spats Policy paralysis from single-issue activism Too few public intellectuals Even fewer NEUTRAL platforms for debate
  31. 31. Summing up 2: Headline Thoughts… CKDu: unfolding human tragedy Need for restraint, focus, compassion: More than just a ‘good story’ for media or ‘agitation point’ for activists Journalists: reassess their role: limits of advocacy; need for balance Eco Activists: go beyond conspiracies, villains & finger pointing Both: link ‘micro’ with ‘macro’; connect the dots; keep an open-mind
  32. 32. Advice to scientist-activists…“Scientists should firstestablish themselves asscientists, with a solid recordof peer-reviewedachievement, THEN speak outin their area of expertise--loudly, if necessary.”- Edward O WilsonHarvard biologist, author
  33. 33. Thank You! Blog: Twitter: Opinions expressed are entirely mine. These do notrepresent those of any entities I am associated with. I welcomeopen & dispassionate debate in the public interest.