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Internship training, is there a drop?

by Dr. Ananda Samarasekera

Dr. Ananda Samarasekera (Vice President of the Sri Lanka Medical Council) in an exclusive interview with the Health Watch on the standard of the internship training programme provided for young doctors who pass out from the six medical faculties in the country before they are given the full registration to practise the profession said compared to the internship training doctors had 20 years ago, today there could possibly be a drop in the standard as there is a considerable increase in the number of trainees now.

Dr. Samarasekera was responding to some grievances voiced to the Health Watch by some of the young doctors assigned to outstation hospitals for the internship where facilities are limited.

Dr. Samarasekera said he was not denying the possibility of inadequacies in this training programme for some doctors, as some of the approved hospitals in the outstations for training may not be having the required number of specialists today, owing to reasons of transfers to other hospitals.

The Health Department should bring such instances to the notice of the Medical Council, so that the Council could then discuss the issue with health officials and decide on how best the problem could be resolved.

Dr. Samarasekera continued, that the SLMC had given approval to a number of hospitals as training centres for the interns on the availability of specialists in those institutions.

The SLMC is not informed of any subsequent changes in the specialist staff in those hospitals, so an institution could still remain as a training centre even without a specialist in a particular field.

Dr. Samarasekera said even the intern doctors had the right to bring to the notice of the Medical Council any inadequacies in the hospitals to which they are attached, which they felt affects their training.

Dr. Samarasekera said the most important thing in this training programme is the direct supervision of the consultant on the trainees.

This supervision could be properly done only when a limited number of trainees are attached to a particular specialist. At present this could not be done due to the large number of doctors who are passing out and the shortage of specialists in the country.

He said 20 years ago a specialist had not more than 3 interns for training. Today the number exceeded 6, in addition PGIM trainees were also there in the same group.

The Medical Council had now drawn up a scheme to rectify this by the year 2005.

The problem also aggravated in the past few years owing to the universities having to postpone some of the exams.

Under normal circumstances the universities held only two final exams a year. But since of late, some universities had to increase this to three.

Dr. Samarasekera is of the view that to solve the problem of shortage of specialists and the reluctance on the part of specialists to serve in outstations, outstation service should be made more attractive to the specialists.

Today the situation in some of the outstation hospitals was very bad for the specialists.

Some hospitals lacked some of the facilities needed for the specialists to provide their service to the public properly. Besides there were no proper quarters for them. Most of the specialists were married and had children.

Doctors had to consider whether there were proper schools in the areas to which they are posted, for the schooling of their children.

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The Coconut Issue : 
Prof. Tissa Kappagoda is ready to reply

Prof. Kappagoda in an e-mail to the Health Watch says that he is ready to reply to any questions from the Health Watch readers on the coconut issue. Prof. Kappagoda states

"I am currently working at the medical faculty, Peradeniya as a visiting professor, and would be pleased to respond through your columns to any questions your readers may have on the coconut issue.

With reference to the article we carried in the Health Watch last week by Prof. Kappagoda on the coconut issue, under the title - 'Professor Tissa Kappagoda enters the coconut controversy', he states.

The relevance of my remarks on coconut relates solely to the fact that it contains a significant quantity of saturated fat. I have no opinion on whether coconut fat has other life sustaining properties. The question of whether recommendations for the U.S.

population are applicable to Sri Lankans also remains to be answered but in the absence of hard evidence based on clinical trials it would be a prudent course of action follow them.

By way of clarification, may I be permitted to add the following.

In the booklet I had emphasized the need to reduce the amount of saturated fat in the diet as a preventive measure for coronary artery disease. These recommendations were based upon the practice in the United States. However, since publication of the booklet, the National Cholesterol Education Program (NCEP) has revised its recommendations for dietary fat.

Readers can write to Professor Kappagoda at Prof. Tissa Kappagoda, Peradeniya Medical Faculty, Peradeniya.

E.mail address - [email protected]

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Listening to voices of the elderly

A couple of comments from the column Talking Point in the recent issue of "Ageing and Development", motivated me to write this article for the Health Watch.

The first of these comments was "Focusing on the views of older people provides insights into their situation that could not be gained in other ways". The second, "Participatory research involving older people is a key to developing sustainable policies".

As regards the first comment, I had a great opportunity recently to be invited as the facilitator to a well attended discussion on "Successful Ageing", by a group of elders coming from different backgrounds - professionals, non-professionals and housewives.

They were interested to hear about evidence based explanations to some of the ageing issues that concern them.

Evidence based approaches

Today's society is interested in evidence based approaches to practically every subject. The medical profession is concerned with evidence based medicine, and evidence based clinical management, although evidence alone can never be enough for most medical decisions. It was, therefore, not surprising for this group of elders, to focus on evidence based information on ageing issues at this discussion.

Anti-ageing treatment

Whilst on the subject of delaying of onset of disease and disability in the elderly, through health promotion and prevention, a retired teacher had this to say: "My family doctor prescribed some medicines for me that would help in slowing down ageing and promoting well-being.

I also read in several magazines, and in newspapers, that such products were commercially available. My problem is that my pay cheque does not last a week, but I get my pension only once a month!

Therefore, as I could ill-afford to pay for such medicines, do these anti-ageing medicines really work? Prior to responding to her question, I told her in lighter vein, that she has not been as fortunate as the lady referred to in a poem that appears in the recent "Searo News" - WHO newsletter to active and retired staff, which goes something like this:

"Today at the drugstore the clerk was a gent, From my purchase this chap took off ten percent, I asked for the cause of lesser amount; And he answered, because of the Senior's Discount".

At this discussion, to provide evidence based responses to the questions raised, I drew upon the findings of the McArthur Foundation Study in USA, which as far as I am aware, is the most extensive study on the elderly, so far.

This study was undertaken by the Mount Sinnai School of Medicine, New York, and the Michigan University. I also depended on data published by the National Institute of Ageing (NIA), USA, which is the apex body on ageing issues, and acts as the Federal Governments' watchdog on elders issues.

As regards anti-ageing treatment, therefore, there are a number of alleged anti-ageing treatment, including taking antioxidant vitamins, consuming DNA and RNA supplements, and other dietary interventions including caloric restriction.

The NIA has reviewed the scientific evidence for all such interventions, and has concluded that there is no definite proof to support claims on behalf of these products.

But the sale of health food products containing such substances is a brisk business.

Less liable to debate

Therefore, recommendations that are very much less liable to debate are presented.

These are: Avoiding smoking, drinking alcohol only in moderation; eating a balance diet and maintaining proper weight: keeping up regular exercise; to have regular health checkups to detect problems early; to observe good safety habits at home and when driving, to stay active and involved; allow time for rest and relaxation, and enough sleep.

At this stage of the discussion, a retired civil engineer in the group intervened, and said: "Perhaps the greatest anti-ageing 'potion' is good old fashioned clean living. Therefore, far more than is assumed, how well we age is in our own hands."

Social activities and health

A very fit looking housewife, encouraged by the comment on clean living and health, said that regular exercise was never uppermost in her mind, but she is certainly not a couch potato. She keeps herself busy by doing unpaid community work, in religious activities besides attending church on Sundays, going on trips and picnics, playing cards and bingo and attending to her small garden.

Her concern was this: "I feel that involvement in social activities, such as those mentioned, has kept me fit, but is there any scientific evidence to back up this feeling, so that I could confidently encourage others?

Research information, I said, was available on this issues of social activities and health in older people. A recent study done by the Harward University, School of Public Health, USA among the American elders, and published recently in the British Medical Journal, has shown that social and productive activities, on their own, are effective as physical exercise in lowering the risk of death, in older people. The exact mechanisms, however, how this is brought about is not clear.

In the recent study, it is assumed that physical activity prolonged life of the elderly through improved cardiopulmonary fitness, or improved muscular-skeletal strength, whereas non-physical social activities may influence health and survival through other path ways, such as psycho-social path ways.

Lifestyle and health - Health Watch Study

As regards the second comment, the Health Watch SPC Centenarian Study recently undertaken is one type of useful participatory research involving older people. This study should contribute a great deal in drawing up a profile on lifestyle behaviour relevant to our country that would help to move ahead towards successful ageing, as individuals and as a Society.

A byproduct of this new longevity is a remarkable increase in the number of centenarians. The McArthur Foundation Study has projected that by the middle of this century there will be over 600,000 individuals in the United States over the age of 100! I wonder what the numbers would be in Sri Lanka

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Health Watch Letter box

We had a long article sent to us by M. Mervyn Nanayakkara (Dhamma-Mitra, of the Western Buddhist Order in U.K) on "A way of transcending suffering" the article was very interesting however the material was not appropriate to this page. Hence we have forwarded it to the cultural page in the Daily News.

However we picked this paragraph from the article, which we thought should receive the attention of all of us in general.

Teaching out to others & Learning from the Worthless

"Reach out to others and do for them what we would expect them to do for us. Let us give to them materially if we can. But it is not only materially that we can give to others.

There is something more valuable that we can give. We can give of our time and energies.

There are people who are lonely and have no one to talk to. Find time to visit them and talk to them.

You will be amazed to discover the happiness it brings mutually, and also to discover how much we can learn from others who are seemingly worthless".

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Question Box

On curd and yoghurt

Mrs. Sigrid S. de Silva (consultant dietician replies to question on curd and yoghurt Q. Mrs. Motha from Mt. Lavinia likes to know:

1. How do curd and yoghurt differ nutritionally?

2. There is a common belief that sour plantains (ambul) should not be taken by those who get frequent cough. Is there any truth in this belief, that ambul plantains will cause phlegm?

A. 1. Curd is actually curdled milk (coagulated milk protein) The coagulation occurs when milk gets treated with rennet. The preparation often is obtained from the stomach of a calf.

Rennet contains the enzyme rennin, which induces the curdling process. Yoghurt on the other hand is fermented milk, due to the adding of certain bacteria.

Also flavour may be added if required. The nutritional difference therefore differs with the milk used in the preparation of either yoghurt or curd.

In Sri Lanka curd is usually prepared with buffalo milk, since it gives a firmer curd than prepared with cows milk.

The fat content of buffalo milk is more than that of cows milk, making it higher in calories as well as having a higher cholesterol content. 100g of curd contain approx. 100 calories.

Yoghurt is usually made from cows milk, either with a regular fat content or low-fat. 100 g of unsweetened yoghurt contain approx. 70 calories.

Fermented milk, such as yoghurt, is extremely well tolerated and easily digested, also by individuals with a lactose intolerance, since nearly all lactose is converted into lactic acid.

2. It is true that some individuals react unfavourably to the consumption of ambul banana/sour plantain. While some can eat any amount showing no effects, there are those who develop excess phlegm or even diarrhoea due to increased peristalsis.

Ambul banana contains a number of amines, such as serotonin, tyramine and tryptamine, which can lead to this kind of allergy.

Especially asthmatics and people suffering frequently from migraine, cold, cough and bronchitis should avoid foods containing higher amounts of amines.

Since there cannot be a general rule applicable to everyone, it is up to the individual to observe, learn and realize his/her tolerance to certain foods.

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Loss of Consciousness

Dr. D.P. Atukorale (Consultant Cardiologist) has sent the following reply to health watch reader L. Peiris from Ratnapura who wanted to know whether low blood pressure could cause attacks of fainting.

Reply: "Since you are getting recurrent attacks of loss of consciousness in spite of the present treatment, you should consult a neurologist as these attacks may be transient ischaemic attacks (T.I.A) and undergo a full neurological check up as some patients who get recurrent attacks of TIA are prone to get strokes.

Soluble aspirin is known to prevent strokes in patients who get attacks of TIA.

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