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Health is wealth

by Aryadasa Ratnasinghe

"No one is healthy as long as some of us are sick, suffering and dying from causes that could have been prevented. This has been one of the central forces that have prompted the evolution from disease curability to health promotion". (Hakan Hellberg - WHO).

Patient positioned on trolley for post-therapeutical handling

Throughout the world, April 7, each year, is celebrated as World Health Day, because it was in 1948, that many countries have ratified their signatures to bring the Constitution of the World Health Organisation (WHO) into force.

After World War II (1939-1945), the dominating aspect of many human endeavours was the feeling to live long, without being subject to ill-health, decay and disease. This led to the research and development of medicine and community health programmes. The hospitals, clinics and medical centres equipped with doctors and medical staff were able to put down the mortality rate.

Advanced techniques in diagnosis, such as X'ray, scanning, electrocardiograph (ECG), electroencephalography (EEG) etc., have made a great leap forward to cure patients suffering from various ailments. Innoculation, vaccination, by-pass surgery etc. have contributed much to save the life of the diseased from untimely death.

Due to ill-health, millions of people worldwide are trapped in the vicious cycle of poverty, malnutrition, disease and despair, sapping their vitality and reducing their work capacity.

A person, who had attended the funeral of one of his friends, whom he had not seen for a long time, seeing the dead body lying in the bier, remarked: "What a strong and healthy man he was when I met him last.

This middle-aged man, ruddy in countenance, muscular, of large bone and deep chest, of irrepressible activity, knew no fatigue." This man had suddenly fallen sick with pneumonia and died. It means health has no guarantee because sickness is part and parcel of life, whether it is physical or mental.

The Greek philosopher and physician, Hippocrates (460-377 BC), once said: "Let it be said that, in the absolute sense, there is no health. What we so name is entirely relative to the conditions of life. If a person were to remain perfectly healthy, he would live forever. It follows that no man lives a complete life of perfect health. The idea of absolute health, therefore, may be cast aside as an illusion."

One of the oldest diseases known to mankind is trachoma, i.e., infection with a Chlamydia bacterium that affects the eyes, leading to conjunctivitis and blindness. Chlamydia is a genus of spherical, non-motile bacteria that multiply only within the cytoplasm of true nucleated (eukaryotic) cells.

The microbe Chlamydia trachomatis, spreads from eye to eye through contact with fingers, flies or the use of shared towels or handkerchiefs. The disease leads to the formation of scarring on the inside of the eyelids, which after many years of repeated infections, gives rise to inverted eyelids (trichiasis).

New scientific discoveries in medicine and health care, maternity and child health rapidly developed to bring the mortality rate down, because most people died of diseases for which there was no positive cure.

Awareness of the nutritional requirements of pregnant mothers, children and infants, developments in immunology, prophylactic treatment, vaccines, control of infectious diseases, paediatrics etc., have made a rapid stride in medical research. So far, there is no treatment for viral infections, after the onset of the diseases, e.g., rabies (hydrophobia), tetanus, measles, chicken-pox, mumps, pertussis (whooping cough) etc.

In 1950, maternity and child health care began to develop rapidly, and well defined packages of treatment were able to put down the mortality rate.

Antenatal care included the detection or pre-eclampsia, anaemia, screening and the Rhesus Factor, a series of closely related but distinct antigens (agglutinogens) usually present in the plasma membranes of human red blood cells. Individuals with the factors are Rh+ and those without are Rh-. A Rh woman carrying her first Rh+ child may produce anti-Rh antibodies after birth. During the next pregnancy, these antibodies may cross the placenta, and if the foetus is Rh+ they may cause haemolytic disease of the newborn.

The two common but major health hazards are smoking and drinking. Throughout the world, millions of people die each year having become excessively addicted to the vices.

In most countries, smoking (specially cigarettes) is linked to at least 80% of all deaths, as a result of lung cancer or chronic bronchitis, or 75% from heart disease. According to WHO "Tobacco is a known or probable cause of death of about 25 diseases. It is the most important cause of lung cancer. Smoking tobacco is one of the greatest public health hazards facing the world today.

Alcohol affects almost all organs of the human system, specially the liver and is almost lethal. Alcohol's toxicity and the byproducts, after metabolism, damage the liver. Injury depends upon the volume and the duration over which it is consumed. Most alcoholics eat very little because the damage to the liver gets compounded with loss of appetite.

Alcohol cannot be stored in the body, and it has to be oxidised and the liver plays a major role in this process. The liver is a gland with digestive functions. It secretes bile, facilitates the digestion and absorption of fats. It also manufactures the anticoagulant heparin and other plasma proteins, stores glycogen, fat, iron, copper and vitamins and detoxifies harmful substances.

Fatty liver is the earliest sign of alcohol abuse.

Next stage is alcoholic hepatitis (inflammation of the liver) and the final stage is cirrhosis (death of liver tissue, scarring and fibrosis). A pint of beer, a schooner of sherry to two glasses of wine, a double gin or a double whisky or two drams of arrack means all the same to the liver.

Dispelling myths about heart diseases, Dr. Ingrid Martin, specialist for Cardiovascular Diseases, WHO, says "the prevention of heart diseases in individuals calls for the active promotion of health among the people.

Misconceptions about cardiovascular diseases (heart attacks, strokes and hypertension) have existed for many years and have, in effect, become myths". The misconceptions are that (i) heart disease is a problem in developed countries, (ii) it is a problem of the rich, (iii) it is mostly a male disease, (iv) it is a problem in old age, (v) it is not susceptible to community action, and (vi) it is no longer public health issue."

As men live longer, they are liable to develop prostate cancer, specially among those who are beyond 70 years of age. Blood test can detect the disease but there are doubts whether mass screening of elderly men would pay dividends.

The prostrate gland surrounds the urethra (the tube connecting the bladder through the penis in the male). Any enlargement of the prostrate will reduce the flow of urine by constricting the urethra. Cancer usually first causes symptoms by simply reducing the flow of urine, which leads to poor stream size, dribbling and the need to pass urine several times during the night. There may also be blood in the urine.

A sensitive blood test (the prostate-specific antigen - PSA) measures the protein secreted by prostate cancer cells and accurately reflects the amount of cancer present.

Prostate cancer cells can spread through the bloodstream and tend to form deposits in bone, specially in the spine, a process called metastasis (the change of place). According to Dr. Karol Sikora, Chief of the WHO programme on Cancer Control, "Cancer can also spread to the pelvic lymph nodes, inducing renal failure by blocking the ureters, as they descend from the kidneys. The disease can also metastasize further afield to affect the liver, lung and brain."

Some of the diseases that affect the health of the community are Malaria, dengue, filariasis, tuberculosis, leprosy, poliomyelitis, plague, rabies, rubella, typhoid fever, cholera, dysentery, diphtheria, ascariasis, chickenpox, yellow fever etc., and from a health point of view, these can now be treated with advanced medicine.

Smallpox was a highly infectious viral disease which has now disappeared from the globe since 1979. The WHO has given the guarantee that this disease has been completely eradicated.

The first recorded quarantine regulation was written in Venice in 1377, to protect the city state from diseases carried by shipborne rats, specially plague (the most notorious epidemic disease of all time) caused by infection with Yersinia (or earlier known as Pesteurella) pestis, carried by fleas that infest rodents and squirrels, which then bite humans.

The features of severe infection is seen with the development of 'buboes' (inflammatory swelling of the glands, especially, in the groin or armpit). Hence the name bubonic plague. Earlier it was known as the 'black death'. Following a World Health Assembly resolution in 1995, the WHO is now revising and updating the International Sanitary Regulations to make them more applicable to infection control in the present century.

The WHO estimates the annual number of human deaths from rabies at over 50,000, but the figure could be much higher because of the many deaths that go unreported. However, newer, effective, safe and less expensive second-generation tissue or avian culture rabies vaccines are now available in most parts of the world.

The French scientist Louis Pasteur (1822-1895), developed the first vaccine against rabies, to save many victims bitten by mad dogs on the prowl.

The use of nerve-tissue-derived vaccine began in 1986. The old method of administering 17 or 21 painful injections around the navel has now been abolished in giving way to modern vaccines.

Scratches by cats are also a source of human infection, specially in children exposed to young kittens. 'Cat-scratch-disease' caused by a recently identified bacterium Bartonells henselae, is typically a benign, subacute, regional lymphadenitis (inflammation of the lymph nodes), in which the agent responsible is introduced through the skin.

Usually, parents do not consider a cat bite as so serious as a dog bite. In children or even in grown-ups, whose immune system has been weakened, it causes bacillary angiomatotis (a life threatening vascular disease in which tumours are formed from blood cells.

The red blood cells were first seen by the gifted but eccentric Jan Swammerdam in 1658. In 1665, M. Malpighi saw them but did not realise their importance. He described them as "fat globules looking like a rosary of red coral in the sanguineous fluid." It was Antonie van Leeuwenhoek who gave a correct description of the red cells and its importance in the circulatory system. In man a 20th part of the body weight consists of blood.

The temperature of blood in health is 37 deg. (Centigrade) or 98.4 deg. (Fahrenheit). A cubic millimetre of blood contains 5,000,000 red cells and 7,500 white cells. Malnutrition leads to ill health and even diseases associated with it.

To maintain good health, we must eat nutritious food, drink pure water, engage in sports activities or exercises, shun liquor and tobacco which are injurious to our health.

Ageing is the surest demographic reality of the present century. Improvements in living conditions, sanitation, control of environmental hazards, better nutrition, public health facilities, medicine and antibiotics play a major role in Sri Lanka to keep the people healthy and those who are concerned with their health in the sunset of life.

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