A mix of extremes / by Ramani Fernando

Somasiri is a fa rme r 's son . He is 15 years old . He goes to school in the morning and spends his entire afternoon he lp ing his father in the fie ld. During harve st time he stays home from school to help with the harvesting. Latha is a 12-year-old daughte r of a laboure r. She has never gone to school. Since the age of seven, she has worked on construction sites carrying baske ts of sand for a meagre wage . Renuka is a teacher' s daughter who at 21 is a university unde rgraduate . She works part-time, in he r own time, to earn he r p ocket money. Ravi is 17 and a wealthy businessman 's son. Ravi attends one of the country's leading private schools and plays tennis and goes to discos during his leisure time . Bala is 14. His fathe r was a beggar who pushe d d rugs. Bala was once g iven a p ackage by his fathe r to carry , and today he is in remand prison . No one has p aid his bail and now it is Bala's third year in prison . An orphan in an adult jail. Who are they? They are the youth of my country, Sri Lanka, which r ates as a developing country with a g ross national product (GNP) of only US$ 354 . But desp ite this te rm "devel- oping '' , Sr i Lanka records a high literacy rate of 90 per cent , an infant mortality rate of 37 per 1000, and an immunization record of 70 pe r cent of young children fully immunized . So Sri Lanka' s social statistics are a mix of extremes. So are her young people. The age group 14 to 24 make up 60 per cent of the population of nearly 15 million, and as in any . other country they comprise the rich , the poor , the educated, the uneducated, the mod e l youth and the misguided . My grandmothe r remembers how in the 1920s people knew very little about health and how to stay healthy. They did not even know ab out safe water . Dispens- aries and clinics we re scarce. In my g randmothe r 's village in the south of Sri Lanka, the only way of obtaining me dicine or me dical attention was at the apothecary's house once a week. Only the d ying we re taken to hospital - the hop eless cases whose illnesses surpassed the apothecary's rem- e die s and the g ods ' benevolence. However , m y g r an d m other talks of incredib le things too. An old uncle who prescribed k udu to malnourished child ren . Malnu- trition was a still unknown word 14 A mix of extremes by Ramani Fernando from Sri Lanka, 21. She is a student of the University of Colombo, a freelance reporter for the Ceylon Observer, and copywriter to an advertising agency. Her main interests are in social issues and community service. but he detected its signs and insisted on kudu, the highly nu- tritious chaff of the r ice g rain which was till then fed to cattle or thrown away. My mothe r te lls me of killer d iarrhoea , where the patient was isolated and not g iven a d rop of wate r to stem the diarrhoea . The patient often d ied of what they later r ealised was dehydration. She also te lls me of the water- holes where the villagers bathed , washed clothes and drew water for drinking. These places are hard to recognise now , with sep- arate deep wells for washing and fo r d rinking . Every household boils its water. Now as I recall my childhood , I cannot remember any emphasis on the importance of immun- isation . The educated parents Sports offer a healthier outlet for youtMul boisterousness which might otherwise be channelled into alcohol or drug abuse. Photo WHOjL. Taylor who sought the advice of a doctor naturally immunised their child against d iseases like polio , teta- nus, diphtheria, tuberculosis and whooping cough . But the large number of mothers who gave birth to their babies at home in the care of a midwife, or those who failed to understand the importance of immunisation, saw their children sick, d isabled or dying. At the Children 's Homes where my work in the Guides movement takes me, the major ity of polio victims are youths like me and not child ren of eight years. This shows the importance of Sri Lank a ' s i m m u n is at ion p r a - gramme, which was non-existent in my childhood. Poverty and ignorance seem to be the reasons fo r the high rate of malnutrition in Sri Lanka . Mothers have to be educated on the importance of p roper nutr ition. On a Guide project in a remote village in the south, I q uestioned a mother about her 18-month-old child . The child was overweight, pale and slow. She did not say a word and walked with d ifficulty. The child had been fed only on breastmilk as the mother had been told that it was good for the baby. She d id not know that the child should be on solids from about six months . Today a large p rogramme of primary health care projects to educate the common man and woman on safe water , sanitation , nutr ition , clean environment and the use of clean toile ts is be ing carr ied out throughout the island. Having wr itten about health issues , I come to social issues that contribute to health problems of youth in Sri Lanka. The ethnic war that is ravaging the northe rn and WORLD HEALTH 3/89 eastern provinces of our country has given birth to a new and disturbing problem. Refugees . Reports record over 100,000 fam- ilies made homeless and living in refugee camps and makeshift shelters. Added to their needs of food and clothing are health prob- lems. Diarrhoea, typhoid and malaria surfaced almost as soon as the camps were formed. But the most recent and deadliest problem that has struck the refugee children is polio . In June 1987 four cases of polio were reported in Jaffna . In thre.e months the number had increased to 96 . The recurrence of this practically eradicated disease was due to the Jaffna mothers failing to complete the polio vaccination courses; some mothers were unable even to get their babies the first dose due to the disturbances. Then come the two deadly social issues that seem to envelop the young Sri Lanka faster than a spreading wildfire. Sex, and alco- hol and narcotic drug abuse. Sex in my grandmother 's youth was a word unheard of. Sex in marriage was not discussed , not even in the family or with the doctor , and sex outside marriage was non- existent. In common with the changing world in the West, Sri Lanka has also reformed in its traditions and beliefs. But even in my childhood a mere 20 years ago, sex was regarded as sacred and inside the bonds of marriage . Family planning and birth control were spoken of and discussed with married couples , and counselling was given only to those about to be married. We were not taught sex in school and we rarely spoke of the physical aspects of a boy-girl relationship. But today the world has changed so much and so have the young in Sri Lanka . Life moves faster and children grow up faster . Teenage sex has become almost a way of life . Children are exposed to sex in books , in films Young boy in Colombo. For many children in the developing world work starts early. Photo WHOjL. Taylor WORLD HEALTH 3/89 and in real life. But sex is not the problem. The problem is that the youth in Sri Lanka are not pre- pared for this role sex plays in the modern world . In the majority of households in Sri Lanka, young people do not speak about sex and parents do not discuss and advise children on issues like premarital sex and the possibility of pregnancy and birth control. Young men are not taught the gravity of getting a girl preg- nant and the importance of birth control. In this situation, it is natu- ral that illegal abortion clinics are being set up in Sri Lanka, and 90 per cent of those treated at these clinics are in the age group 16 to 24. Sri Lanka needs to pay much attention to sex and birth control especially among the pre-teens . Sex education has to be included in the school curriculum to give a deeper understanding to chil- dren , and birth control must be introduced alongside it. With sex comes the danger of sexually transmitted diseases. There is so much prostitution in Sri Lanka; men, women and children walk the streets of Colombo in the broad daylight hawking their bodies. Prostitution has lured school youths, especially boys . My interviews with young boys tell me that they indulge in sex with prostitutes at the expense of their school work, playing truant from school in the mornings. Such a boy tells me of seeing two young school girls in a brothel. All these youths are open to venereal diseases and now, in the modern world, to AIDS. Sri Lanka has seen eight AIDS patients in the short history of the syndrome , and it is no longer just the deadly disease of the West. Alcohol and drug abuse consti- tute another threat to youth. Last year 's reports say that one in 100 school students in the age group 13 to 18 tries hard drugs in Sri Lanka . In 1981 Sri Lanka recorded eight heroin addicts. Today there are over 40,000, of whom 90 per cent are youths . Even with the danger of a life imprisonment or death sentence for possessing two grams of heroin, last year 6,500 people were caught using and pushing drugs. A lot of preven- tion work is being done in Sri Lanka now. A number of organiz- ations, including the Girl Guides as well as special bodies set up to combat drug abuse, are working to prevent young people from indulging in drugs and alcohol. • 15