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Countering superstitions in health care

by Dr. Derek Yach (WHO Director of Mental Health)

The World Health Organisation in a document on epilepsy sent to us recently speaking on the difficulties doctors encounter in countering deepseated age-old superstitious beliefs that people (specially in the developing world) have in relation to some of the diseases, in their case Epilepsy says "Epilepsy is a neurological disorder that affects at least 50 million people world-wide, with around 85% of them living in the developing countries, with nearly 2 million new cases getting added up to the total every year.

Even though 80% of these cases could lead normal lives with proper treatment yet an overwhelming majority of them does not get any treatment at all, due among other matters to age old beliefs that people have that the disease is caused by some supernatural powers.

A recent survey of 30 Latin American countries revealed that non of them had any national policy for epilepsy. In sub-Saharan Africa there is only one neurologist for four million people.

"Our biggest challenge is to de-mystify epilepsy, and to make people understand that there is nothing supernatural about it. Age old superstitions die hard, be it in Cairo, Calcutta, Caracas or Sri Lanka. Indeed in UK a law forbidding persons with epilepsy to marry was repealed only in 1970.

Physical, psychological and social impact of epilepsy is profound. It is not unusual for children with epilepsy to receive inadequate schooling.

The rate of unemployment is two to three times higher for persons with epilepsy. Many would hide their condition.

It contributes to social isolation, low self-esteem and can lead to depression and suicide.

Causes

This medical condition can be triggered off, especially in predisposed individuals, by any brain disease or injury, infections such as meningitis, or encephalitis vascular disease, tumour or alcohol abuse.

Preventable parasitic diseases, malnutrition and inadequate care in childbirth are common causes of this disease in the developing world.

Sub-standard drugs

In developing countries the situation is much more complicated than in the developed world, with social stigma and discrimination, lack of trained personnel and shortages of anti-epileptic drugs. Even where drugs are available they can be of sub-standard quality or too expensive for the people to buy.

Superstitious lurking

In the developed countries our (WHO) main goal is to improve quality of life for persons with epilepsy.

But even there, centuries old superstitions are lurking in the shadows.

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Living with artificial joints

by Dr. Mandeep S. Dhillon

With the life expectancy rising dramatically, and a large geriatric population expecting a better quality of life, aging problems related to joints are rapidly coming to the fore. Modern technology has allowed many worn out organs to be replaced; most body systems like the heart or kidneys need human or at best closely related (eg. pigs! ha, ha) organs, which are implanted so that the metabolic function of that organ is carried out.

This may prolong life, but the quality of life is significantly altered due to the drugs that must be taken to avoid organ rejection. Artificial kidneys or hearts are thus taken from matching donors, implanted with caution, and there is the ever present fear of transmittable disease and rejection problems.

The skeleton on the other hand has a mechanical function only and hence artificial joints need only to perform a weight bearing function while allowing movement, and all the principles of low friction, strength, durability etc, which have been developed by the automotive and rocket industry can easily be applied here.

The only essential pre-requisite is that the constituents of the artificial joints should be inert so that the body does not reject them and this has been very well achieved by the use of different types of alloys ranging from steel to titanium, along with a bearing surface of specialised plastic. Joints can thus be manufactured in factories, different sizes can be made, and specialised types for various ages, problems etc. can be mass produced.

With modern manufacturing technology, a combination of titanium and high density plastic gives the longest lasting joints. Fixation to bone is done by one of two methods; by the use of bone cement, which is not a glue, but works like ordinary cement by interlocking in the spaces inside bone and by the use of no cement wherein special treatment of the artificial joint implant encourages bone to actually grow inwards and hold it firmly.

Perhaps the most successful operation of the last century (according to TIME magazine) is the replacement of a painful or deformed hip joint. A crippled patient with unremitting pain becomes independently mobile and becomes a contributor to society rather than a drain on it.

It was the pioneering work of Sir John Charnley in England (in the 1960s) that has made all this possible, and now the technology has so advanced that replacement of knees, ankles, shoulders and elbows is a routine operation at specialised centers. So much so the small joints of the hands and feet are also being frequently replaced, giving better function and deformity correction.

Nevertheless the most successfully replaced joints are still the hips, followed closely by the knees; other joints do fairly well after replacement but the biomechanics involved are complex and I would say that the development of a perfect ankle or a perfect shoulder is still some way off.

So what should you expect from a replaced joint? Please remember that joint replacement is a quality of life issue and not a matter of life and death. Patients present primarily with pain which hinders day-to-day life and motion restriction and deformity are secondary issues.

Most candidates of joint replacement are elderly people where secondary considerations like uncontrolled blood pressure, long-term diabetes or even kidney problems make them high risk candidates for anaesthesia and increase the complication rates. However modern surgical methods have easily circumvented these problems and now joint replacement surgery is done under regional anaesthesia with the patient awake during surgery.

It is now also possible to replace two joints in the same patient (after special selection) with minimal added risk. This is best done in the knees, and fortunately diseases of the knee are the most frequent problem needing joint replacement in India.

After painting a rosy picture, a word of caution; there are downsides to this also but more of this in our next page.

(The writer is Senior Orthopaedic Consultant at Apollo Hospital, Colombo).

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Health Letter Box

On plastic surgery - Answered by Dr. Mrs. Poornima Aiyar Plastic Surgeon

Nithya at eureka.lk.writes

I would like to know whether there are any laser treatment for excess fat, loose skin and marks

Reply

Yes, Nithya, laser has a role to play for the loose skin in certain parts of the face like around the eye and around the mouth. Skin becomes wrinkled and looses elasticity with age. The Erbium YAG and Carbon dioxide lasers are useful in these areas. As far as excess fat is concerned, laser blepharoplasty is a tool for removing fat bags in the eyelids.

As far as fat in other parts of the body is concerned such as abdomen hips and thighs, laser has no role to play there. Laser is effective for removing 'marks' on facial skin such as lentigines or sun induced pigmentary changes. It is not useful for removing stretch marks which occur from excessive weight loss or the stretch marks in the abdominal skin after pregnancy.

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Ms. Nishalie in Pothupitiya wants to know the remedy for ugly fat folds in armpits. Cannot wear sleeveless or swimsuit. Had it even as a small child. Diet and exercises in vain even though some decrease occurs with weight loss.

Reply

The patients usually present with concerns about contour deformities of the abdomen, hips, thighs, buttocks, and lumbar regions. The factors contributing to soft tissue relaxation are, pregnancy, familial skin weakness, significant weight fluctuations and normal aging,

Treatment involves two basic methods

1. Liposuction. This deals with localized fat deposits and thick subcutaneous body layers.

2. Excisional body lifts are used to treat excess fat deposits and skin laxity.

3. A combination of the above may be needed in a given case.

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Health Question Box

On wheatgrass

Following a letter we carried in this page on March 21st 2003, by Dr Rosario George Christian on cancer where he mentioned "wheatgrass juice" as one of the cancer preventive food items, we had a number of letters from our readers, as to what wheatgrass was.

While we are awaiting a letter with more details on it from Dr. Christian a Sri Lankan from Canada Mr. L.M.G. George who is on a visit to Sri Lanka to see his relations has provided us with the following details taken from a web site which we think to some extent will meet with the information sought by our readers.

Wheatgrass is living food, full of vitamins and enzymes, the freshest food you will have all day, especially in the winter.

* Wheatgrass juice cleanses and builds your blood,
* Improves skin and hair,
* Builds muscle and endurance,
* Fights infections,
* Lowers blood pressure,
* Dissolves tumors,
* Acts as an appetite suppressant.

Wheat grass spronters were created

* For sick people to have at home so they can heal.
* For fitness buffs, athletes and weight trainers to improve performance
* For anyone who wants to feel energetic, vibrant and alive
* For anyone like me, who hates vegetables.
* For anyone who wants to grow stronger instead of older.
* For people on live, raw food diets
* For pregnant women so their babies are born healthy, strong and smart.
* For children to grow healthy and strong, smart and peaceful.
* For old people to help with their aches and pains and their digestive problems.
* For your pet birds and animals.

You can get more details from this web site http://www.growwheatgrass.com/ 
Compiler Health Page

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Does oestrogen therapy prevent heart attacks?

by Dr. D. P. Atukorale

There are several studies which suggest that hormone (oestrogen + progestogen) replacement therapy (HRT) could prevent coronary heart disease (C.H.D.) in post-menopausal women. But according to randomised trials (HERS study and WHI study) H. R. T. does not lower the risk of C.H.D. (Heart attacks) in women who used HRT (i.e. oestrogen and progestogen).

HERS (Heart and Oestrogen, Progestogen Replacement Study) study investigated the risk of cardiac events (eg cardiac death and new heart attacks) among 2763 post-menopausal women with documented coronary heart disease (C.H.D.) and showed that the risk of heart attacks (C.H.D.) increased by 29 per cent after administration of HRT. (JAMA, 1998, 28, 605 - 13) When H R T (combination of oestrogen and progestogen) was given it had been shown that progestogen has been shown to adversely affect serum lipid profile (i.e. caused elevation of bad cholesterol)

In W. M. I Study (Women's Health Initiation Study) H R T was used in 16608 healthy post menopausal women who were taking HRT.

This study showed a significant higher incidence of heart attacks but this study had to be abandoned because of a high incidence of invasive breast cancer.

So in both above studies the cardiac events (heart attacks and cardiac death) increased when a combination of oestrogen and progestogen (H R T) was used.

Dr. Nicole Cherry of University of Alberta, Edmonton, Canada carried out a study using only oestrogen to find out whether oestrogen alone is helpful in the prevention of heart attacks in case of post-menopausal women.

The above trial was carried blinded, placebo controlled and randomised using only oestrogen (without progestogen) and 1017 post - menopausal women aged 50-69 years who have survived a first myocardial infarction (heart attack) were used. Patients were recruited from 35 Hospitals in England and Wales.

As mentioned earlier the purpose of the trial was to find whether oestrogen therapy helps these females to prevent (a) a second heart attack (b) cardiac deaths and (c) all - cause mortality.

It was found that oestrodiol valerate does not reduce the overall risk of further cardiac events such as re-infarction and cardiac deaths (secondary prevention) in post-menopausal women who have just survived a heart attack (Lancet 360, December 21/28.2000).

Your questions on Heart Disease

Dr. D. P. Atukorale will respond to your questions on heart disease and related issues through this page. Please write to him direct - No.14 Rajapakse Mawatha, Horton Place, 
Colombo 7.

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Computer applications in delivery of health care stressed

Health Informatics Society Sri lanka (HISSL) informs us that it conducted its Second Academic sessions on 30th (Sunday) March, 2003 at the Lionel Memorial Auditorium Colombo. The Chief Guest for the occasion was Minister of Science and Technology Keheliya Rambukwella. The other distinguished guests were President, Sri lanka Medical Association Dr. Seneviratne Epa and President of the Computer Society of Sri Lanka Chandana Weerasinghe.

Professor M. T. M. Jiffry, the society's president in his address outlining the work already carried out by the society identified in particular the representations made to the Y2K task force appointed to look into the issues related to the millennium change and also registering of the society under the companies act, as significant contributions during the tenure of the founder President of HISSL Dr. Shyam Fernando. Prof. Jiffry, said future plans included encouraging the use of computer applications in the efficient and cost effective delivery of health care by all health professionals.

'Computer use should be utilized to make a visible effect to improve the standards of health of the poor people in the remote villages'.

Minister Rambukwella encouraged the members to further enhance the use of computers and promised his fullest support to achieve its objectives.

He also commended the society for having set up a body like this to meet the challenges of the rapidly advancing technology, especially in IT, amongst the health care profes sionals. The academic sessions consisted of guest lectures, delivered by three specialists from overseas, namely Prof. Ian Purves and Dr. Sharon Smart from UK and Dr. Peter Moorman from the Netherlands. There were also fifteen free papers presented by the local doctors. The session was well attended and fully sponsored by the Texcentric technologies Pvt Ltd., the premier e-learning institution in Sri Lanka.

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Therese Motha from Colombo writes : The power of prayer

The following information is taken from "Direction" magazine. The headline reads "A remarkable experiment shows the power of prayer".

An eminent cardiologist attached to the San Francisco General Hospital randomly divided 400 patients into two groups.

One group were prayed for regularly by home prayer groups and the others were not. In every other way, they were treated normally by the hospital staff. It was an experiment in which neither the patients, nurses, nor doctors knew which group the patients were in. The doctor recruited Protestants and Catholics across the U.S.A. to pray for the first group.

They were given the names with a little information about their condition, and were asked to pray daily. Each patient in the prayed for group was on the list from five to seven of the volunteers.

The results of the ten month study were remarkable.

Those prayed for differed from the others in several striking ways e.g. they were five times less likely to need antibiotics; they were three times less likely to develop fluid on the lungs from heart failure; fewer of them died during the study. Our otherwise sceptical doctors should be writing on our order sheets "Pray three times a day; if it works, it works". Most important, there are no side effects, and the cost is nil.

Music therapy

A study published in the journal of the American Medical Accociation found that listening to music in the operation room probably lowers the blood pressure and pulse rate of many surgeons.

But the calming effect is most pronounced when the doctor gets to choose the play list, it added.

In the study, fifty surgeons were given stressful maths tests, accompanied by music they chose, or those chosen for them, or no music at all.

The study found the best blood pressure and pulse rates prevailed when the doctors chose the music themselves.

So if your surgeon prefers Beethoven, keep hard rock music out please.

Health page co-ordinator - Thank you for writing

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