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During the past few weeks Health Watch has focused on the very insidious nature of noise pollution. Health Watch should be congratulated for facilitating this timely dialogue. But, where do we go from here?

At present noise is experienced in great abundance everywhere - both during day and night - more so in the urban areas - but has also spread to the once peaceful rural interior of the country through the advent of the loudspeaker. It appears that people cannot do without the public address system for even a gathering of a few people, or to advertise their wares - both stationary and mobile - no matter what time of day it is. The ill-effects of noise on the human body have been adequately described in Health Watch by eminent doctors. What is noise?

Very simply, noise is unwanted sound. Noise annoys, irritates, and disturbs people, and also causes stress and health damage in children and adults, both in the short - and long-terms. In the contributions that have appeared in Health Watch and in those on the same subject that have been published previously in other columns, it is quite clear that the public are very worried on this issue. However, they are compelled to be silent sufferers.

Why do people want to be noisy? May be they are ill-mannered. May be they want to show off their high powered music systems or their vehicles by blowing their horns. May be it is just a bad Sri Lankan habit. Or may be people believe a function will be a non-starter without a loudspeaker. Perhaps, it is a combination of all these.

Should not the concerned government authorities do something about this menace? They should but they don't Why?. Because a politician has not asked them to do so.

But are there such institutions? What about the Ministry of Health? What about the Central Environmental Authority? What about the Ministry of Transportation and the National Transport Commission? What about the local authorities? What about the Police? There may be others too, as there are now a multitude of ministers and ministries. Nobody really knows who's responsible for what or what's happening where. They are all sleeping! Do governments care for public opinion? Not in the least. Far reaching laws are enshrined in the statute books but nobody bothers to implement these.

To begin with, the constitution of the country declares in article 14 of chapter VI, that "The State shall protect, preserve and improve the environment for the benefit of the community." Does not the subject under discussion come under the purview of this article?

Section 23P of the National Environmental (Amendment) Act states "...with effect from the relevant date no person shall permit the emission of excessive noise, unless he complies with such standards or limitations as may be prescribed under this Act in regard to the volume, intensity or quality of such noise." The story goes beyond into sections Q and R as well.

Regulations have been gazetted in 1996 and whose responsibility is it to enforce these? Are these regulations valid to arrest the issues of the present time. For example, construction work has been permitted to extend up to 2100 hours; beyond the permissible daytime period of 0600 to 1800 hurs. Is this fair by children studying, the sick and the elderly? Today our bureaucracy has lost its ability to act independently for the greater good of the people.

Where are the private voluntary organisations such as the Automobile Association and the Ceylon Society for the Prevention of Accidents? May be they believe that noise pollution on our roads by all the loud-horning bus drivers is none of their business!

The most sad thing is that there has not been a single response to the article in Health Watch by any of the institutions who should have stated explicitly the action being taken presently or what is proposed to be done to curb this menace - very lucidly highlighted as a serious health and nuisance problem - by both laymen and professionals. It is this "couldn't care less attitude," so typical of government institutions that has been the bane of our country keeping pace with the developed world - even though Sri Lanka has the highest literacy rate in Asia - ever since the departure of the British Raj in the late 1940s.

Present day bureaucrats, most of them gloss over the real issues when a problem surfaces and numerous committees are formed so that nothing tangible results and the problem become cancerous, by which time it is too late to effect well-meaning solutions.

Hence, the actual causes of a problem are invariably not addressed most of the time.

In this note I propose very briefly to place before readers, a cross-section of the sources of noise pollution in a given community and the action needed to eradicate (not always minimise) the problem. The focus is primarily on what the community in general is compelled to put up with day in day out, and does not discuss such areas as the factory shop floor or other industrial activities outside residential areas. The sources of noise pollution cited are not in any order of severity but a random selection.

It is hoped that all aspects of noise management would enter the statute books and be enforced through relevant regulations and public awareness programmes by all those institutions having a stake. Let us travel through a typical suburban neighbourhood and experience the varied nature of the problem - (To be continued)

"Dev Siri Sevana" is a home where we admit person with no one to care for them and with no resources, which means we start caring for those with no place to call their own and with no one who should care for them. But many are those who come to us seeking refuge and having misunderstandings or enmity with their own children or vice versa.

I have on every occasion said no to them but if possible counsel them and bring them back together. The elder ones who live with us are free of any complain to make but they have to be helped to settle down showing them have a heart for them and are ready to give them an opportunity to spend the eventide of their lives well.

To make them feel that even our medical bills are very low and our home doctor is always happy to see them in good health and high spirits. I will not fail to tell our present generation to always keep their parents happy and healthy.

They have to treat them thus knowing that they themselves will go into old age. Happiness is living with love and sharing that love with one another. Good health is an outcome of it. More and more counselling centres are needed in Sri Lanka for the young, middle aged, and the elders. These have to be supported by all religions and aid agencies.

All questions in this column are being answered by Dr. D.P. Atukorale ,Consultant Cardiologist and a Member of the Health Watch Medical Advisory Panel. :

May I have your confirmation on the following since a large number of our people have a number of misconceptions:

(a) From the cradle to the grave can a person be a vegetarian? Does a person at any age need to consume any kind of meat, fish or eggs to be in good health?

(b) If a person does not consume meat, fish or eggs, will such a person be subject to any kind of vitamin deficiency in his system such as poor eye sight ? I would kindly appreciate a lucid reply from you through the esteemed page of "Health Watch," Daily News.

Reply: A person can be a vegetarian from the cradle to the grave and such a diet is very much superior to a non-vegetarian diet in so many respects. Vegetarian diet which is composed of fruits, vegetables, cereals, nuts and fats contains (i) all the carbohydrates, (ii) good quality proteins (containing all the essential amino-acids), (iii) fats containing all the essential fatty acids, (iv) all the vitamins (v) minerals and (vi) fibre which is not present in meat, fish and eggs. In fact, vitamin C and fibre are present only in vegetables and fruits.

Magnesium which is essential for our health is almost always present in vegetarian diet. For a meat eater who does not consume vegetables and fruits, only way to get his/her magnesium is by eating bones.

There are millions of vegetarians who never consume meat, fish and eggs in India, USA, Europe and other more developed countries. Vegetarians are healthier and live longer lives free of chronic diseases such as cancer, ischaemic heart disease and other degenerative diseases. Vegetarians are subject to less heart diseases, less hypertension, less cancer, less kidney diseases, less food poisoning, less osteoporosis, less fractures, less obesity, less gastro-intestinal diseases, less alcoholism, less stress and less psychoneurotic illness when compared to non-vegetarians.

(b) If a person does not consume meat, fish or eggs such a person is not subject to any vitamin deficiency as majority of vegetarians in the world are lacto-vegetarians (i.e) they consume milk and milk products). Vegans (Vegetarians who don't consume milk and honey and who don't use anything made out of animal leather) theoretically can get vitamin B 12 deficiency. There are thousands of vegans in Sri Lanka, but todate B12 deficiency has not been reported in our country.

There are millions of vegans in India but vitamin B12 deficiency is not a problem among vegans in India.

Your advice on health matters in the Health Watch page has been an immence value for thousands of readers of this page. Many a time we have been spared of going to specialist. And also there by saving a few hundreds of rupees.

I am 86 years. I am in fairly good health except for light defects in my eye sight and hearing. I can read and write fairly well. I eat anything that comes on my way, limiting sugar made products. I have no high or low blood pressure or blood sugar, not a diabetic. I have had regular checks on these matters but my present problem is sleep.

I do not have a comfortable sleep in the night. I am awake most of the night rolling from one side to the other on the bed. I feel that sometimes I do not sleep for more than 4 hours. Even during day time I do not sleep except for about half and hour after lunch. That is also not always the case but my main health problem is sleep - "That balm of peace and that indifference between the high and low".

I will appreciate your experience and learned views on this health problems. I think there are thousands of others who are victims of the same problem of sleep.

Reply: Insomnia has many causes and an accurate differential diagnosis is required before treatment. Prescription of hypnotics without regard to underlying disturbance, subjects the person to the risk of abuse, may mask the symptoms and signs of a pernicious disease and may dangerously exacerbate an unrecognised sleep apnoea. Furthermore behaviourial therapy, psychotherapy or a non-hypnotic drug when the insomnia has a specific cause may be indicated.

Antidepressants improve sleep in people with endogenous depression and phenothiazines or haloperidol improve sleep in psychotics, phenytoin when there are paroxysmal nightmares and analgesics when sleep is impaired by pain.

Some people who take heavy fatty meals for dinner have insomnia. Others who consume coffee at bedtime get insomnia.

At your age of 86 years you don't need 8 hours of sleep. Perhaps 5-6 hours of good sleep is sufficient for you. Since you are a case of long-term insomnia use of sedative hypnotic drugs is controversial.

Your insomnia is ideally managed by psychiatrists who are experts in the field of insomnia. My advice for you is to see a psychiatrist with a referral letter from your family physician.

I am a 75-year retired government servant. I have undergone heart surgery recently and now I have come back to normal and now I am following the same dietary habits as you have mentioned in your letter to 'Health Watch' column.

Some are of the opinion that all the nuts are conducive to health except cashew nuts (which I like most) and avocado which are not good for health as both above items contain cholesterol. Please enlighten me on this subject and please let me know whether any recent research has been done to this effect."

reply: All nuts including cashew nuts are good for health. Avocado is the most nutritious fruit found in this world. All nuts including cashew nuts and avocado do not contain cholesterol. One ounce of dry roasted cashew nuts contain 7.76 gm of monounsaturated fat, 2.23 gm of polyunsaturated fat and 2.60 gm of saturated fat.

Cashew nuts also contain significant amounts of protein, fibre, thiamine (vitamin B1), riboflavin, biotin, pantothenic acid, vitamin B6, folic acid, calcium, iron, zinc and trace mineral selenium (known to be essential for prevention of cancer).

On the other hand 200 gm of avocado contains 19.31 gm of monounsaturated fat, 2.93 gm of polyunsaturated fat and 4.90 gm of saturated fat, 2.98 gm of protein, 4.24 gm of fibre, 122.61 mg of vitamin A, 15.88 mg of Vitamin C, 0.22 mg of thiamine, 0.25 mg of riboflavin, 3.86 mg of nicotinic acid, 1.95 mg of pantothenic acid, 0.56 mg of vitamin B6, 126.40 mg of folic acid, 22 mg of calcium, 0.34 mg of iron, and 0.14 mg of zinc.

Cholesterol is found only in animal fats and all plant products do not contain cholesterol. As you are a heart patient, it is advisable for you to consume cashew nuts and/or avocado daily as both these are very rich in heart healthy mono-unsaturated fat which increases your HDL (good cholesterol) and decreases your LDL (bad cholesterol).

Plenty of research has been done in most of the developed countries especially in Australia and USA after 1980 and the researchers have come to the conclusion that consumption of both cashew nuts and avocado is beneficial to patients with coronary artery disease especially those who have low HDL cholesterol. Low HDL is a well-known risk factor for heart attacks.

Mrs. Lucille Peiris of 104/1, Galle Road, Dehiwela (North) in a letter to the Health Watch states: "I have read with much interest the article on cost effective option for by-pass surgery in the Daily News Health Watch on August 16th.

"This is just to inform you and the readers that this therapy has been carried out in a private hospital in Colombo for the last 4-5 years.

The treatment has become a boon to the poor heart patients who cannot afford the high cost by-pass surgery.

With regard to the letter sent by E. Abeysinghe of Hantane, Kandy on tightness below the chest after by-pass I think your questions were asked by Dr. Dalpadadu at the Suwasevana patient-doctor discussion held on Sunday August 25. meet him personally for advice.

cardiac surgeon Dr. L. Dalpadadu (extreme right) discussing a point with Prof. Herbert Aponso when answering a question from a by-pass operated patient (2nd from left) Dr. Dennis J. Aloysius (Health Watch medical advisory panel) and Dr. Mrs. S. Jayawardena (Cardiologist Kandy Teaching Hospital).

A large gathering of people numbering over 200 participated at the Suwa Sevana hospital auditorium in Peradeniya Kandy, on Sunday August 25, when Health Watch in association with Suwa Sevana hospital held its August patient-doctor discussion on by-pass heart surgery and heart disease.

The medical panel at the discussion comprised Prof. Herbert A. Aponso (Consultant Paediatrician and Director Suwa Sevana Cardio Hospital, Dr. L. Dalpadadu (chief cardiac surgeon) Suwa Sevana, Dr. Dennis J. Aloysius (family physician and member Health Watch medical advisory panel), Ms. Subashini Jayawickrema (Consultant Cardiologist) and Dr. Gamini Weerakoon (Consultant Cardiologist).

Prof. Aponso opening the discussion commended the Daily News and its medical page Health Watch for the outstanding role it plays in presenting useful and important medical issues to the public in a very readable and an interesting way thus helping to buildup health education of the people, which is vital in preventive health, and thus building a healthy nation.

large audience at the event, with one participant in dialogue with the medical panel relating to heart surgery.

He said the packed auditorium on a Sunday evening was enough evidence to show how the gaining popularity of this series of patient-doctor discussions being organised by the Health Watch medical panel. He said another reason behind the packed attendance was the popularity in Kandy of the cardiac team who was in the panel, specially the resident cardiac surgeon Dr. Dalpadadu who has performed over 400 heart operations in Suwa Sevana Kandy up to now, with practically no casualties.

Dr. Aloysius on behalf of the Health Watch medical panel thanked Prof. Aponso and the Suwa Sevana management, for providing all the facilities to hold the discussion in Kandy.

Dr. Mrs. Jayawardena in a brief speech explained to the audience the vital role blood played in human life from birth to death, and the role heart played in circulating the blood thus feeding the cells in the body and keeping them alive. She also explained how heart blocks occurred giving rise to angina and strokes.

When Dr. Jayawardena concluded her talk Dr. Dennis Aloysius threw open the session to the audience for their questions and thus the patient-doctor dialogue commenced which lasted for more than two hours. Cardiac surgeon Dr. Dalpadadu had to be on his feet for the greater part of the time as questions which were mostly on heart surgery and related matters were directed at him.

Dr. Dalpadadu who had done over 120 heart operations in Kandy in the last two years had to draw from his extensive experience when explaining certain matters connected with heart surgery.

In reply to a question on chillation therapy for blocked arteries, in place of surgery, Dr. Dalpadadu said: All types of alternative therapies for heart conditions and other diseases which have not been scientifically proved yet are being talked about, and also written in the press. As such, as a responsible medical man, he felt it is not ethical to comment on them.

Doctors said Wednesday they have documented a case of "superinfection" with the AIDS virus, in which the person became infected with a second strain of the virus while still fighting an initial infection.

The discovery, described in Thursday's New England Journal of Medicine, suggested that finding a vaccine against the deadly immunity disease may be more difficult than some have thought.

It also means that people with HIV, the AIDS virus, should avoid getting reinfected, otherwise they risk being exposed to a second strain that will make the disease even harder to treat, doctors said.

"Superinfection may precipitate more rapid progression of the disease," said Drs. Philip Goulder and Bruce Walker of Massachusetts General Hospital, in an editorial in the Journal.

"Infected and noninfected persons should therefore exercise the same degree of vigilance to prevent HIV-1 exposure," they said. Because sexual activity seems to be increasing among people infected with HIV, they added, "this is a public health message that needs to be broadcast loud and clear." Until now doctors had hoped that infection with one strain of HIV would protect the body from other strains, which would make it easier to develop a vaccine. More than a dozen strains of the virus have been detected around the world.

But a team led by Stephanie Jost of the University of Geneva uncovered the case of a 38-year-old man who developed a second HIV infection on top of the first. That discovery, said Goulder and Walker, provided "convincing evidence that HIV-1 superinfection can occur long after an initial infection is established." Because strains of HIV can vary significantly, they said, finding a vaccine against the various forms of the virus "is likely to be a formidable task." (Reuters)