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Strike free health service looks a reality soon

Edward Arambewala (Co-ordinator Health Page)

We are in a position, after speaking to several responsible officials in the Sri Lanka Medical Council, Sri Lanka Medical Association, Government Medical Officers Association and the Health Authorities, to inform our readers and the public that an Arbitration Board solution to strikes in the state health services, is being actively pursued by the country's medical profession, and the Health Authorities. All indications are that before the end of the year patients will be able to get strike free health care service from the state sector medical institutions.

Last week a major step in this exercise was taken, when the medical management committee of the - SLMA, headed by Dr. Maxi Fernandopulle, Dr, Ananda Samarasekera, and Dr. Lucian Jayasuriya, among others met both the health secretary Dr. Reggie Perera and Health Services Director General Dr. Athula Kahandaliyanage on this issue, and a decision was taken to request retired supreme court Judge Justice F. R. R. Sousa to head the Health Sector Arbitration Board to be set up to resolve the sector disputes amicably thus avoiding them leading to strike situations.

Dr. Reggie Perera has also informed the SLMA Committee, that the Labour Ministry had been written to by him to amend chapter XXXI of Establishment Code, and also incorporate the necessary amendments to the Trade Union Ordinance, enabling the setting up of Arbitration Board to resolve employer-employee dispute in the state sector institutions.

As you can see all these indicate that positive steps are being taken by all parties concerned to ensure a strike free health care service to the people.

We are reliably informed that this whole exercise of Arbitration Board dispute resolution without resorting to strike action had been initiated by Dr. Samarasekera three years ago when he was the president of the GMOA at a meeting of the joint council of health sector trade unions which had met to discuss the possibility of resolving union disputes without resorting to strike action.

Thereafter the GMOA, the SLMA and the SLMC had been working on it relentlessly and pushing the Health authorities to do their part without much delay.

We reproduce below the paper on Arbitration Board for the Health sector, submitted by Dr. Samarasekera to the Health Minister last year.

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The essence of arbitration is the settlement of differences by a panel chosen by the parties themselves. It is common for the parties concerned to choose by agreement, a panel that is intended to resolve the dispute between them. Such agreements have existed over centuries in the history of legal systems.

The popularity of arbitration as a mode of settling disputes is due to the fact that arbitration is considered to be speedier, more informal, and less costly than conventional judicial procedure, and provides a convenient forum to the parties, with choice of time, place and other procedural details. Further, where the dispute concerns a technical matter, the parties can select an arbitrator who possesses the appropriates skills, knowledge and qualifications.

The basic concept of arbitration lies in the "arbitration agreement".

The definition of an "arbitration agreement", (in India) means a "written agreement to submit, present or future differences to arbitration, whether and arbitrator is named therein or not".

In Sri Lanka arbitration is used in settling industrial disputes in the non-governmental sector. When a dispute arises between the employee's trade union and the employer, the Minister in Charge of the subject of Labour, has powers to refer the matter in terms of provisions of the Trade Union Ordinance for arbitration. Thereafter it will be binding on both parties to accept the settlement recommended. When the matter is referred for arbitration, trade union action is not permitted.

However there is no legal or administrative provision for arbitration of trade union disputes in the state sector, probably due to the fact that the employer is the state sector and the Minister of Labour as a part of the government cannot compulsorily refer the matter for arbitration, unlike in the private sector in which he has no stake.

The reality is that, there must also be a suitable and acceptable forum for state sector trade unions, particularly those of the health sector, to take up their problems and have them dealt with in a fair and just manner. If such an avenue is available, most of the trade union related problems could be resolved, thereby preventing unwarranted trade union action including strike.

Recommendations:- Therefore it is recommended that legal and administrative provisions pertaining to arbitration be included in the trade union ordinance and the Establishment code.

Dr. Ananda Samarasekera, Vice-President SLMC

Tea for teeth too

It's Tea again. Tea is good for your teeth. recent studies by dental Researchers in the University of Medical Sciences of Poland resulted in the presentation of a Research paper at a meeting of the International Association for dental research held in Cardiff, Wales, in September 2002, which reported that "green tea helps prevent the build-up of dental plaque, and not just because it contains fluoride".

The researchers provide evidence to indicate that polyphenols, long known to be to a constituent of tea may also have a definitive role in arresting tooth decay.

Scientists have been aware for many years that green tea is a source of polyphenolic compounds, which function as anti-oxidants which remove free radicals straying in the body, thereby protecting the body from a range of diseases including malignancies and hardening of arteries.

The recent studies under reference reveal that "drinking green tea and brushing your teeth with fluoride containing toothpaste could double your chances of preventing tooth decay".

While the precise mechanism of this effect is still not established with certainty, researchers confirmed the additive effect resulting from the combined use of green tea extract and fluoridated toothpaste by the fact that test feeding of rats revealed that the amount of plaque "dropped by a factor of four when both green tea extract and fluoride were consumed", as opposed to "a factor of two, when either one of them was consumed individually".

It must also be stated for the sake of completeness that black tea which is more commonly used, both locally and in the West, also contains fluoride and polyphenols and appear to have a salutary effect on the prevention of dental caries by "killing or suppressing the growth and acid-production of cavity causing bacteria in dental plaque".

So, the well-known truism "any time is tea-time", is now known to have special health preserving overtones, be it green tea or black.

Living with artificial joints.....Part II : Joint Replacement and You

by Dr. Mandeep S. Dhillon

Although they are one of the most significant advances of the modern surgical era, artificial joints have their downside too. These are a boon for many thousands of people crippled by pain, deformity and restricted motion. When used in the right kind of patients, with good technique, and at a center where the operation is routinely performed, the outcome is usually excellent. However failures can occur and it is important to analyze the causes of these.

Perhaps the most frightening factor about joint replacement (or any medical treatment for that matter) is the cost, which can be prohibitive for the average Sri Lankan Costing tens of thousands for the implant alone (Hip is cheaper than the knee), the total cost of an operation escalates tremendously when hospital costs, medication and surgeons fees come into the equation.

This puts off many patients, and surgery is often deferred to a time when the problem becomes much bigger, leading to more complications with the operation. This could well be rectified in the future with the advent of medical insurance schemes that allow for joint replacement surgery.

Another downside is the longevity of the implant. Whatever the status of modern technology, the artificial joint is still an artificial joint and will wear away with time; this is unlike the human joint, which when it wears has the power of partial healing, that however decreases with age.

At best the average age of an implanted joint is 15-20 years; some last longer, and some fail earlier, but those are different issues. This means that the joints are best replaced in the elderly who are not expected to outlive their implants. This population group also has lesser activity levels, and the demands on the joint are thus less, leading to lesser wear and a longer joint life.

A unique population group is the young adult, who is crippled either by disease (arthritis that develops in adolescence or in the early 20s) or by trauma that has destroyed a joint. These are individuals who are expected to live much longer than 20 years, and if they become mobile, will wear out the joint earlier. In these cases joint replacement is purely a quality of life issue and I recommended that it be done to make the patient pain free and independently mobile.

An important rider that must be attached is the awareness that a second replacement (known as a revision operation once the first joint fails) will be required within 15-20 years. Revision surgery is always more difficult and the results of the operation are always less predictable; however a better life in their younger years is preferred by most. Multiple joint involvement is also a negative factor, though there is no contraindication. At the PGI there are many patients in whom 4 joints have been replaced, and worldwide there may be some in whom even more have been changed.

An important factor for a good outcome is the surgeon and the center where the procedure is performed. Sir John Charnley used to say that if a surgeon does not perform 6 joint replacements in a week he should not be doing the operation; this is because the success of the procedure is technique dependant, and very precise methodology and expensive, specialised instruments are essential to minimize complications.

The most feared early complication is infection and the precautions needed to reduce this incidence to acceptable standards are many and need specialised operation rooms. Thus the center you chose for the surgery should be thought about with care, as a complication after joint replacement may make you more disabled than before.

Nevertheless total joint replacement remains an excellent option for pain relief in a well selected group of patients.

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

SARS cannot spread through brief contact - American family Physician magazine

by Edward Arambewala

According to a report on the SARS vitus carried in the American Family Physician April 2003 issue, there is no evidence to suggest, that the SARS respiratory disease can be spread through brief contact or through assemblages of large numbers of people.

Several copies of the American Family Physician have been sent to the medical profession here where it is stated.

Meanwhile in Colombo Prof. Anton Jayasuriya head of the Open International University for Alternative Medicine, in a statement to the Daily News attributes the emergence of the SARS vitus to Man's inability to live in harmony with the natural environment and the continued destruction of it by man without proper understanding of its impact on human life.

He says the only preventive for SARS is to improve and strengthen body's immune system, through Homoeopathy and Acupuncture therapies, which he is doing at his clinic at the Kalubowila Hospital.

Prof. Jayasuriya said that at the forthcoming International congress of alternative medicine to be held at the BMICH, Colombo in October the conference will be adapting an integrated system of medicine for the whole world, which the participating countries will present to the WHO, for consideration and implementation.

"Unfashionable" diseases still cause deaths

I was very much impressed by the down-to-earth letter "Sandals that leak hookworms" by R. Perera, and published in HEALTH page dated 4th April 2003. There is a great deal of truth in what has been written - we are being pressed on all sides with a mass of information on so called fashionable diseases receiving hi-tech medicine, at great financial cost, whilst the preventive measures for the unfashionable diseases, that are still of public health importance, and costing less, have taken a back stage in health care. We seem to have forgotten the truism of the old adage that "an ounce of prevention is worth a pound of cure".

May I, also, comment on another unfashionable disease in our contemporary society namely, acute diarrhoea, which affects mainly children. In this regard, let me share some insights into this disease and its prevention, from the recent issue of "Insights" which is a research development publication of the Institute of Development Studies, University of Sussex, UK.

Studies of the health impact of water, hygiene and sanitation have shown that sanitation and hygiene promotion, were twice as effective, than improving the quality of water, to reduce risk of diarrhoea. Hygiene promotion, therefore, can have a big impact in the reduction of diarrhoea. It is through unclean hands that faecal matter containing harmful germs is carried to household utensils, food and water and lead to diarrhoea.

What is meant by hygiene promotion in this context, is hand washing with soap. The researchers say that although the message "wash hands with soap to save lives" sounds simple, the task to effectively carry across the message is huge.

The message to wash hands with soap has been one of the basic guidelines of cleanliness, and included in the health education programmes, for many years in developing countries, including our own. However, a recent study involving seven countries of Asia, Africa, and South America, has shown that the use of soap by the mother after toilet use and after cleaning up a child is very low, the median rates being about 16 per cent - perhaps, in our country also, it remains low.

Adequate education of women is specially vital because of their important role as mothers. Unfortunately, it is likely that much of the health education, thus far, has not being sufficiently focused to bring about major changes in hygiene practices in the community.

The researchers point out, that soap marketers have managed to get soap into almost every household in developing countries, if only for washing of clothes, and for bathing. Even in our country, the electronic media are full of commercials advertising various brands of soap for the above mentioned purposes. It is therefore, felt that soap companies will make ideal partners in this new promising approach in hand washing promotion.

Therefore, it is reported that WHO, Unicef, and the World Bank, have initiated work with Governments and soap companies to design a full scale hand washing programme to cover a number of countries. The London School of Hygiene and Tropical Medicine, and the Academy of Education Development, UK, are assisting in this endeavour.

Dr. Terence Perera, Former WHO Senior Advisor, Family Health.

Herbal Medical Treatment of a University Don : increasingly popular with foreigners to colombo

Herbal Medicinal programme based on the traditional ayurvedha system of medicine prevalent in Sri Lanka, prepared by Dr. L.P.A. Karunatilleke Senior Lecturer, Institute of Indigenous Medicine, Colombo University has become increasingly popular with German and French Nationals.

Dr. Karunatilleke, who has been to develop the traditional system of herbal and ayurvedha system of medicine upto international standards and thus make Sri Lanka an International centre for herbal medicinal treatment has offered his services free to the Ayurvedha Pavilion in Negombo. in a five acre set up of 15 residential villas , in the Pavilion, his herbal medical treatment is provided mainly for foreigners.

Dr. Karunatilleke told the Daily News Health Page that among diseases herbally treated at this villa centre include Diabetes, Hypertension, stress conditions and fistula. Patients who come here for treatment stay in the villas for periods of 3 to 5 weeks, and take treatment as prescribed by him and his associate medical team.

Values in family practice

The College of General Practitioners Sri Lanka has recently published a book on values in family practice for the profession entitling - advising ourselves about values in family practice.

The college committee on, values in family practice, which has compiled the book in its introduction has this to say.

* Family Practice is the medical specialty that provides continuing and comprehensive health care for the individual and family. In Sri Lanka this type of care is available only in the private sector.

There is a professional component as well as a business (service) component to the care that is provided by most practitioners. The majority of practitioners reside in the localities where they work.

In most instances these family physicians are in solo practice and opportunities for peer review are few. Professional relationships are complex with many families in the same area and many members in the same family unit being clients of the same general practitioner. Hence it would not be difficult to appreciate the need for good family practice and ethical behaviour.

This book is an attempt to facilitate such behaviour. However, it does not contain an exhaustive list of directions from the College to its associates and members.

Conceptually, it is hoped that the "professional conscience" of practitioners would receive a boost from this book.

For in the Market-place,
one Dusk of Day,
I watch'd the Potter
thumping his wet clay:
And with its all obliterated tongue
It murmur'd -
"Gently, brother, gently, pray!"
- Rubaiyat - Omar Khayyam.

In preparing this booklet the fundamental principle of adult education namely that it is a two-way process with the learner and the teacher swapping roles often, has been kept in mind ("Advising ourselves").

The impact of eastern values may also be noticed here. "Gratitude" as a good attribute of family doctors would be a case in point.

Another would be the recognition of the environment as a benevolent force. The worth of our Sri Lankan heritage has also been appreciated.

Personalized care and long-standing professional relationships are cornerstones of the speciality. This made it logical for us to focus on personal attributes that clients would value in their family doctors.

Would they like their doctors to be decent, compassionate. empathetic, trustworthy, loyal, competent and grateful? Would they also appreciate doctors who are independent and willing to take up the cause of the community and the environment? Wouldn't we?

3.8 billion condoms on sex outside marriage - APHA report

The American Public Health Association in a condom need study has estimated 3.8 billion condoms for married-men for use in extra-marital sex.

According to this study report published in volume 28 of the UNFPA magazine the total annual estimated need of condoms in the world is 24 billion.

The researchers say "worldwide efforts to promote condom use as a weapon against AIDS are falling flatly short, by about 15 billion". That number would fill the lethal gap between six to nine billion condoms now being used annually by men when the estimated need is about 15 billion. To arrive at this figure the researchers had analysed population censuses, surveys and study data on annual condom use in 227 countries.

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