Online edition of Daily News

In a recent appeal made to all working in the state healthcare system, calling for the adoption of positive attitudes and qualities towards the patientcare services they are involved in, the Health Department has posed the question - Are the people losing confidence in our healthcare system?

Health Watch yesterday received a copy of the appeal made by the Deputy Director General (Medical Service I) Dr. Terrence de Silva, who formerly held the post of Director, National Hospital, Colombo. In the appeal printed in a booklet form running into 16 pages. Dr. de Silva says - "The health service in this country is almost on par with those in the developed world. Nevertheless, in recent times, the attitudes of those in the sphere of health towards their patients have left much to be desired.

"This is also perhaps reflected in the increasing number of cases of litigation against healthcare personnel. "This also may be a sign of gradual loss of trust and confidence of the people in our system. Perhaps this is part and parcel of the situation in the society at large.

'Strengthening the positive attitudes and qualities among the health care staff could help to reverse this trend. The aim of this appeal is to promote such positive attitudes and qualities in those who are working in the health sector."

For whatever reason you may have entered this service, whether it was fulfilling an ambition you had, or just a chance that came your way when you were looking out for a job. The fact remains that you are now a member of a team caring for the sick. It's a service sector with responsibility for human life.

Naturally the variety of positions in the healthcare service provides a livelihood to the personnel involved. Yet in this noble service, you have to accept your position as more of a calling than a job, giving you an opportunity for a meritorious service in this life.

The Health Care Service has its own specific public liaison activities. The hospital is a busier place than an office serving a limited clientele. Work at a hospital is of a more arduous nature, giving rise to many diverse problems. It is often difficult to provide a service to meet the needs of people from all walks of life and holding varied opinions. It is more so, since the people who come to a hospital for treatment are patients ailing from various causes.

The personal attached to hospitals have problems specific to the service. These include the difficulties in obtaining leave even for an urgent personal matter, obligation to report for work even on Sundays and public holidays enjoyed by other state employees and to work on night shifts; the need to report for work during such eventualities as disrupted transport services and being called upon to work on unexpected work shifts is emergencies.The health personnel too have to face personal or family problems. Despite all these, you are expected to work in a spirit of real dedication. Whatever your personal constraints are, when you are on duty at the hospital, your heart should go out to the patients.

The VIP at the hospital is the patient and no one else. A hospital is a sacred place. In the days gone past, patient care and cure were associated with temples and churches.

A patient enters the hospital in a physically weak and mentally depressed state. Your patient expects from you the same affection kindness, attachment and love that a child expects from his mother.

If you can assure that this expectation is fulfilled, the patient will think of you as a person with divine qualities. This feeling will give you a satisfaction of being "special" among others.

The patient will be pleased with your care only if it is tempered with a feeling pouring out from the bottom of your heart.

If a patient leaves the hospital after treatment thinking about the hospital in following terms what fruit would your service have yielded?

"They order us around and put us through all sorts of procedures without even telling us what they are doing or why"

"They don't care if we are upset, or scared, or in pain: they just do what they like and pass us on to somebody else".

These are the thoughts of some who leave our hospitals. It is your duty to do everything possible to rid this unsavoury impression and help sustain the trust and confidence placed by the people in the health care system.

The words of Mother Theresa, whose untiring efforts to relieve the suffering of the sick are legendary, spell out how a patient should becared for:

If you too can direct your efforts towards serving the patients with a personal touch and with special interest in each individual, you can rest assured that the patient gets immense relief. The blessing the patients invoke will surely fall on you and your loved ones.

A patient enters a hospital unwillingly away from his usual home environment. As such he is often uneasy to begin with. It is your duty to treat him with an understanding of his predicament. It is likely that the patient or his loved ones may blame you for no fault of yours.

Do not get disheartened by the words of those who are going through some disturbance of mind. Bestow mercy and compassion on patients

Your smile costs you nothing, but it brings pleasure and comfort to the patient. Go about your work with a smile on your face. What good does it do to blame the patient or to use harsh words? In patient care, flexibility is of vital importance. Always try to accommodate the requests of patients as far as possible. When you talk about such matters as cleanliness of the hospital, or in instances of giving medical advice, do so with a kind and pleasant frame of mind.

When you explain the matters related to an illness to the patient or to his relations, use the simplest language possible, the common, conversational language of the laymen. Not only is the medical terminology beyond their grasp but they may be further confused by such words.

It is necessary to address the patients with respect and it is better to address the patient by name, and ensure that his dignity and self-respect remains unsullied. The words that make the patient pleased can be used.

To cite examples, addressing a patient as "Mr." or "Madam" may go a long way to win the confidence of patients their relations and public.

In the sphere of health it is important to arrive at decisions for the common good of the country overriding personal interests.

One day when you finally leave the health service, if you have acted in a way to make your content that you have done a fruitful service in life, you are a person who has done your best for the country. It is certain that one day you'll really enjoy that spiritual solace arising from a clear mind and a clean conscience that you have helped in sustaining the trust and confidence, the people have placed on the health care service of this country.

Fifty years late compared to the subcontinent Sri Lanka has finally established a degree programme in pharmacy at the University of Colombo.

The multidisciplinary nature of the pharmacy curriculum has made in a integrated study course conducted jointly by the Science and Medical Faculties including the Pharmacy Department of the Ministry of Health. Given the constrains of the present day university education system it is to the credit of the staff of the two faculties that has made this course possible. One must also appreciate the services of the visiting staff who contribute teaching in not less than five subject areas.

First Batch out in September with the passing out of the batch of ten pharmacy graduates during September this year an immediate cost free administrative benefit is that Sri Lanka qualifies to be documented in all relevant health indicators as a pharmacy degree awarding country.

Sri Lanka conducts two certificate courses in pharmacy. They are of two years duration and are under the responsibility of the Ceylon Medical College Council. There is a diploma in pharmacy which is two years duration with an additional one years internship. It is conducted by The Faculty of Medicine, University of Colombo.

B.Sc. Pharmacy degree course of the University of Colombo is a four year programme followed by a six months internship. At the end of the second year competitive examination students belonging to the Science Faculty from the Biological Sciences stream are selected on merit to follow the B.Sc. Pharmacy special course. The students spend the third and fourth years learning pharmacy subjects. Only ten seats are available per batch.

In the third year they undergo training in several subject areas. They include anatomy, physiology, biochemistry, pharmaceutical chemistry, pharmaceutical analysis, nuclear pharmacy, pharmaceutical microbiology, pharmacology including practical lessons in most of these subjects.

Fourth year subjects include pharmaceutics, pharmacology, pharmacognosy, quality control, statistics, computer, forensic pharmacy, ethnics, pharmaceutical management and administration and pharmaceutical practice which consists mainly of field work in hospital ward setting and practical work.

On a selected pharmacy related topic each student has to prepare a report and conduct a seminar to an audience comprising undergraduates and academic staff. Each candidate also has to undertake an elaborate research project for which the students are released for two days of the week during the entire final year.

To maintain internationally acceptable standards of the pharmacy degree programme both the question papers and answer scripts are assessed by pharmacy academics from the United Kingdom.

The six months internship falling in the fifth year covers industrial pharmacy, community pharmacy, hospital pharmacy and quality assurance including regulatory affairs concluding the four and a half years of rigorous training.

The pharmacy degree programme at the University of Colombo carries the blessings of The World Health Organisation recommendation and approval by the University Grants Commission. This university is the right place since it has the wherewithal in it's forty years experience in this area having conducted certificate and diploma courses in pharmacy. It is also the first interfaculty degree course in Sri Lanka which is an arrangement having it's own charm.

For an undergraduate to be under the shadow of academics of two faculties is a rewarding experience in itself. We are however aware of the fact that in most foreign universities there are fully equipped independent pharmacy departments. Majority of the famous universities in the world have faculties of pharmacy. There are also three exclusive pharmacy universities in the world.

The world has realised that a medical error costs one life at a time where as a pharmaceutical error can cost many lives. The errors incidental to pharmaceuticals are usually realised too late and more often passes undetected.

Sri Lanka hopes that the new pharmacy graduates shall live up to the expectations of all. The entrepreneurs and investors may count on them in the new endeavours.

Drug companies are sponsoring creation of a new medical disorder known as female sexual dysfunction in order to build markets for drugs among women, despite controversy surrounding the medicalisation of sexual problems, finds an article in this week's BMJ.

Over the past six years, researchers with close ties to the pharmaceutical industry have been developing and defining the new disorder at company sponsored meetings, writes journalist Ray Moynihan.

One of the milestones in the making of the new disorder was a JAMA article in February 1999, which suggested that 43 per cent of women aged 18-59 have female sexual dysfunction. However, leading researchers have raised serious concerns about this figure, describing it as misleading and potentially dangerous. Many researchers believe that portraying sexual difficulties as a dysfunction will encourage doctors to prescribe drugs that change sexual function, when attention should be paid to other aspects of the woman's life. It's also likely to make women think they have a malfunction when they do not. But perhaps the greatest concern is the ever-narrowing definitions of 'normal' which help turn the complaints of the healthy into the conditions of the sick, says the author.

Although the corporate sponsored creation of a disease is not a new phenomenon, the role of drug companies in the construction and promotion of new conditions needs more public scrutiny, he concludes.

Researchers in this study were: Dr. Irwin Goldstein, Professor of Urology and Gynaecology Boston University School of Medicine; Ed Laumann, Professor of Sociology, University of Chicago Dr. Sandra Leiblum, Professor of Psychiatry, Robert Wood Johnson Medical School and Dr. John Bancroft, Director, Kinsey Institute, Indiana.

A human is made up of shoddy material. There are millions of them. Every doctor's office has them. They don't show any definite ailment. They wonder in and complain, listlessly or accusingly that they are always weak and tired, always get pains, somedays here - somedays there never well - never happy - always ailing.

It is not their minds. It is their bodies. They are biologically inferior. And no surgery - no treatment of any kind can do much for them. They can't stand up any stress and strain of normal life. They are inadequate. And the only thing you can prescribe is rebirth or a better set of forebears.

Deputy General Manager of the State Pharmaceuticals Corporation (SPC) E. M. F. Samuel who is responsible for distribution of SPC - imported drugs to the SPC islandwide Agents told me that he was aware that drugs importers had obtained approval/registration for the same SPC imported drug/drugs, but under a different brand name.

Our "Osusala" outlets everywhere abide by our marked prices because of the wholesale discount we give them. But many in the islandwide chain of pharmacies, except for the reputed, long-standing Colombo metropolitan pharmacies are reported to be charging exorbitant rates above and beyond the marked price-an unscrupulous act on which the SPC has no control. He added that once the Consumer Protection Act becomes a reality, this negative attitude could be remedied through state-fixed price controls.

It had to take the courage of their conscience for two key officials of the Ministry of Trade and Consumer Affairs to reveal that at present there are absolutely no price controls in force.

This applies not only for essential consumer items, but more importantly for imported essential drugs that decides the destiny of seriously-ill patients, who are warded, at state and private medical institutions or are outdoor patients.

Diabetes is spreading from rich countries like the United States and turning into a worldwide epidemic as much of the developing world turns to more sedentary lifestyles say the Scientists. Diabetes cases are expected to climb 170 percent in developing nations over the next three decades,compared to a rise of 42 percent in the developed countries, said scientists from the U.S. Centre for Control and Prevention. They expect 22 million Americans will have diabetes by 2025 up from 16 million today.

Diabetes is an increasing problem in the United Kingdom and yet a huge number of people don't even know they have it. In Britain today there are 1.4 million sufferers and another 1 million who remain undiagnosed.

Yet the longer the disease goes untreated, the greater the risk to long term health. The hallmark of diabetes is an excess of glucose,sugar in the blood. This is caused by a shortage of of the hormone insulin , which moves glucose from the blood into the cells from where it is converted to energy.

There are two main types of diabetes. Type I is caused by a sudden and almost complete inability of the body to produce insulin. It can occur at any age but often appears in in children under 15. Symptoms such as thirst,weight loss and tiredness are usually severe and the diagnosis is fairly fast.

This type is treated with insulin injections. Type 2 is more common and accounts for 80 percent of diabetics in the UK. It is found mainly in people over 40, but is now occuring in younger people including teenagers. It can happen when the body is unable to make enough insulin but with most Type 2 sufferers there is a fault in the body's response to insulin.

This is known as insulin resistence, because although the hormone is produced, it is unable to move the glucose into the cells. The main reason for developing this type is being over weight. People who carry excess weight round their middles are particularly at risk. Unlike type I diabetes, the symptoms of type 2 diabetes are often mild and start gradually.

They can include tiredness, thrist and the need to pass urine more often. Some find their vision slightly blurred or they lose weight for no given reason. Far too often diabetes is picked up by a routine urine test or by a blood test carried out for other reasons. Many people carry the disease for years before it is detected. Though Type 2 diabetes is thought of as a "mild" condition, it is not and can be as deadly as Type I diabetes. Diabetes affect every part of the body - particularly the heart , bllod vessels, kidneys, nerves and eyes.

The Sri Lanka Medical Association (SLMA) will induct Dr. Sunil Seneviratne Epa (MBBS, MD, MRCP, FRCP (Lond) FCCP) as its 102nd President, for the current year in office today. The ceremony will take place at the SLFI, in Colombo at 6.30 p.m.

Dr. Seneviratne a consultant pysican practising in Matara is presently the Chairman of the SLMA Committee on non-communicable diseases and he has been a member of the association for 16 years. Dr. Seneviratne who is an old boy of Thurstan College, Colombo has graduated from the Colombo Medical Faculty. He will be the Associations first president to hold office, while professionally practising in Matara furthest away from the Associations head office in Colombo. Upto now two other presidents practising in Galle and Kandy had held office.

Next issues of Health Watch will be devoted to the following health issues:

Next Friday Health Watch will carry an article on - "Stenting the heart blocks", the latest in clearing heart blocks, without opening up the heart as in the case of Angioplasty. The difference being the insertion of a "stent" or a spring like device where the block is and leaving it in place so that there won't be any re-stenosis, or recurrence of the block, thus making it a life long clearance for the patient.

The article will be based on interview Dr. Mohan Rajakaruna (M.D., F.A.C.C.; F.C.C.P. (USA) the Health Watch Consultant Cardiologist gave last week in response for information on this procedure made by some of our readers.

Dr. Rajakaruna will answer readers' queries on this subject based on the article after it is published.