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| Saturday, 30 August 2003 |
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Daily News collaborated Centenarian Study interests Oxford University by Edward Arambewala
An Oxford University Team from UK has expressed interest to look into certain medical aspects of Sri Lankan Centenarians identified by Prof. Colvin Goonaratna Centenarian Study Team, done in collaboration with Daily News weekly medical page Health (earlier Health Watch). Revealing this to us yesterday Prof. Goonaratna said the Oxford University proposal which had been made through a lecturer in the Kelaniya Medical Faculty is now before the Sri Lanka Medical Council (SLMA) for ethical clearance. Centenarian Study Prof. Goonaratna said that the Oxford Team is seeking the possibility of a collaborative Study in detail in respect of some specific health aspects of the Sri Lankan Centenarians that already been identified in the studied subjects, by the Prof. Goonaratna - led study team, and also look into some areas not covered by the study. Prof. Goonaratna said that this is the first time in the world that a study of this nature ever in a small scale has been launched by any country, and the idea of the study came from a journalist in this country in the ANCL group. He said that 27 centenarians in the country of a total of 57 so far registered with the study group had been visited by the medical study panel and studied. Some of the findings of general interest to the pubic, and ethically permissable for publicity had already been carried in the Daily News Health Page - Health Watch. These reports which had also been carried in the internet, and made known to the world. Probably the Oxford teams interest in the Sri Lankan Centenarians is a result of these published study reports. The study team said that among the findings are some unique features of the Sri Lankan Centenarians who are mostly from the rural areas which could be attributed to the rural lifestyle they led; deeply religious, stress free, no high expectations. In the case of Engonona from Mihiripenna Galle who is 116 years now; Sri Lanka's No. 1 citizen in age, and believed to be the 2nd oldest in the world is still mentally alert, able to walk with help, attending to her personel needs on her own past memory perfect, recent memory also not so bad, Dementia not affecting her much. *********************** Doctor operates on himself by Dr. Viraj Peramuna An American doctor in New York had operated on himself to prove a point that even major surgery could be done under local anaesthesia, provided the patient has courage to go through it. This doctor, Dr. Evan O'Neill Kane in his 37 year surgical career done over 4000 appendectomies, had been so convinced that it could be done even under local anaesthesia without any mishaps. Since he had not been able to find a patient courageous enough to face it, he had done it on himself. The case has been reported in a US medical publication - In The Eye of The Storm. Max Lucado in his story writes Dr. Kane a crusader Dr. Kane is a crusader against the hazards of general anaesthesia. He contends that a local application is far safer. Many of his colleagues agree with him in principle, but in order for them to agree in practice, they will have to see the theory applied. Dr. Kane searches for a volunteer, a patient who is willing to undergo surgery while under local anaesthesia. A volunteer is not easily found. Many are squeamish at the thought of being awake during their own surgery. Others are fearful that the anaesthesia might wear off too soon. Eventually, however, Dr. Kane finds a candidate. On Tuesday morning, February 15, the historic operation occurs. The patient is prepped and wheeled into the operating room. A local anaesthetic is applied. As he has done thousands of times, Dr. Kane dissects the superficial tissues and locates the appendix. He skilfully excises it and concludes the surgery. During the procedure, the patient complains of only minor discomfort. The volunteer is taken into post-op, then placed in a hospital ward. He recovers quickly and is dismissed two days later. Dr. Kane had proven his theory. Thanks to the willingness of a brave volunteer, Kane demonstrated that local anaesthesia was a viable, and even preferable, alternative. But I said there were two-facts that made the surgery unique. I've told you that first: the use of local anaesthesia. The second is the patient. The courageous candidate for surgery ... was Dr. Kane. "To prove his point, Dr. Kane operated on himself!" *********************** e-Health - An Introduction In addition to what is mentioned above then there are also paramedics like nurses, nurse practitioners (in the west), medical laboratory workers, pharmacists, health care workers, midwives, native physicians, self-declared physicians and alternative medicine practitioners, priests, clergy and counsellors. In fact understanding the health care in this sense is the most basic requirement to understand the feasibility or otherwise of e-Health. Now having a correct understanding on health care and ICT in a minimal way one may be ready to assess the feasibility of the application of ICT in the delivery of health care - in short e-Health the subject of this paper. Probably the best way to get an understanding is to see what has been done using ICT currently. Among many other types of applications the following are some of the common health care applications seen in the Internet - web pages, chat groups, news groups, patient discussion groups, patient support groups, aids to medical diagnosis, decision support systems in medicine, medical calculators, online medical diagnosis, e-mail consultations and communications with medical doctors, medical education, patient health education, provision of second opinion on medical diagnosis, nutrition advice, writing meal planners, counselling, advice on drug treatment, online drug purchase, online counselling, online access to most up to date medical information and drug trial data even for laypersons. While this list is not meant to be exhaustive it should convey the idea that a lot of e-Health activity is already taking place. But the degree of feasibility alone is no justification to adopt new technology. Cost efficiency, cost benefit, optimal outcome, acceptability for the end-user, legal and ethical matters, social repercussions of adopting new technology like augmenting the social and class differences or digital divide too however matter. While it is not proposed to review these matters in detail here this subject is again broached when it is argued whether e-Health is a utility or luxury later in the next section. Is e-Health a utility or a luxury unaffordable for those of us in developing or underdeveloped countries? It is the considered opinion now that e-Health is a utility. This means e-Health should be made available at an affordable price for each member of the society. The social and telecommunication infrastructure necessary for such an endeavour are already being laid out in Sri Lanka. While it is not argued that all necessary components are in place nor fully optimized much of what is necessary for cost effective delivery of e-Health in Sri Lanka is currently available. The rest of the medical arguments for this assertion are as follows. First, major determinants of premature morbidity and mortality in many societies are smoking, obesity, alcohol, lack of exercises, exposure to occupational and environmental health hazards and lack of access to preventive and appropriate curative medical care. A government committed to develop an entire IT infrastructure to social development needs no extra resources to tackle these external forces of morbidity in large scale - for instance advice on nutrition and dieting, losing weight, improving vaccination coverage, provision of health education on occupational and environmental health hazards, methods of management of early hazardous substance exposure, health behaviour changing programs and advice on changing health behaviours, personal and psychological support necessary for health risk behaviour changes etc all can be carried out at very large scale with equal access to all those who need such services in a most affordable manner using the current ICT. Therefore to reduce preventable and premature morbidity and mortality if ICT is to be used it must be a utility not a luxury. A second reason why e-Health should be a utility is that probably the most cost effective way to deliver what is called Primary Health Care is use of ICT as in e-Health. Way back in 1977-1979 WHO made what is called a "Alma Ata Declaration" which planned to achieve "Health for All by the Year 2000". WHO being a premiere medical institute with best of international scholarly input it spelt in very clear terms what is necessary to achieve the ideal of "Health for All by the Year 2000" which was Primary Health Care. WHO defines Primary Health Care as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community by means acceptable to them and at a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self-reliance and self-determination". It forms an integral part of both the country's health system of which it is the central function and the main focus of the overall social and economic development of the community." Thus PHC is not an add-on but an essential component which health education, environmental sanitation, maternal and child health, prevention of locally endemic diseases, appropriate treatment of common diseases and injuries in the community, provision of essential drugs, promotion of sound nutrition and traditional medicine. The delivery of key components PHC based on the principles declared above needs a data transmission infrastructure which permeates the grassroots level of the community with connectivity to a centralized knowledge base for it to be scientifically sound. While there is always a need for human component, much can be investigated, planned, organized and effectively rehearsed using e-Health long before the stage or proper implementation which ought to be the final step in a long drawn out process. This essentially again proposes that e-Health should be a basic utility rather than a luxury for a developing nation like Sri Lanka. Third web is already an acceptable information repository. Google now searches nearly 4 billion pages per search. A recent search using Google produced 5,720,000 hits for depression. There were 3,490,000 hits for anxiety, 34,000 for acute appendicitis, 730,000 for migraine, 152,000 hits for tension headache, 176,000 hits for online medical consultations, 6,920,000 hits for pharmacy, 5,920,000 hits for counselling, 267,000 hits for cognitive behaviour therapy and 1,360,000 hits for medical decision support systems. Most of the net users in the west use Internet for searching information and out of this nearly 30% exclusively for health. As the numbers getting connected are exponentially increasing the Internet as a information repository will grow more and more in future. Therefore if the net is already catering to medical information needs of masses its adoption to local needs may not be a difficult task indeed. On the other hand net has some intrinsic features like, availability, accessibility, affordability (if not at least the potential to be made affordable) and acceptability (if not now at least in near future), which are also the essential ingredients in the definition of PHC quoted above, which makes it still more reasonable to consider e-Health as a utility. Fourth the concept of e-Health as a utility is in harmony with other sectoral developments which are being planned and implemented in Sri Lanka. These include ICT Road Map proposed by the Government for an e-Nation. Opening of ICT centers in schools, and inclusion of IT and computer education in school curricula are already taking place in the education sector. Current telecommunication infrastructure developments too are certainly very conducive to an e-Health implementation strategy. Further, interest and enthusiasm of the private sector of Sri Lanka in ICT, heavy capital investments by private sector in computer education and computer skills development, heavy capital investment by private sector in popularizing the computer and the internet use among Sri Lankans too argue for a sensible approach to e-Health. Thus making e-Health a utility will only enhance the total commitment by the government in IT. Fifth there is a miscellany of reasons for considering e-Health as a utility. These are patient empowerment, triage of perceived health care needs, cost effective navigation of maze of health care, power balancing of the patient-physician relationship, the potential to ameliorate the health outcome disparities and finally what is called "Information Deficiency Syndromes" in primary care. One of the basic outcomes of an effective e-Health program is an equal access to medical knowledge. Of course this assumes an implementation strategy backed by governments (like how already happening in Sri Lanka and India) which will create a networked environment with a minimum of digital divide. This access to medical knowledge is the source of empowerment. This knowledge can then be utilized in triage of perceived health care needs. This means prioritizing the significance of a problem accurately so that the correct amount of expertise is utilized in managing the problem most cost-effectively. For instance to rule out a heart attack in a person with chest pain the best expert may be a cardiologist. But if a more common cause for it can be identified and treated by primary care physician then this may be more cost-effective as the cost of a primary care consultation is lower than that of a consultation with a cardiologist. E-health can also contribute to easy navigation of health care maze. Health care systems usually are complex structures with many nested structures within. |
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