Compiled and coordinated by Edward Arambawela

College of Surgeons SL on academic bridge building sessions in Jaffna

The College of Surgeons Sri Lanka last month (May 13-15) went to Jaffna and had its (College) Annual Academic Conference there, which the College President Dr. Indrani Amarasinghe described as an 'Academic bridge building session' between Jaffna and Colombo. She said a bridge of this kind had been non-existent for the past 25 years in Jaffna owing to the war situation that prevailed there, thus starving the peninsula of all such academic exposure from professional bodies in Colombo up to now.

Dr. Amarasinghe in an exclusive interview with the HealthWatch on this event said, "I feel proud that I got the wholehearted support and cooperation of all our members to do this important task, and that we became the first college to do so - 'A successful bridge building operation'. Other colleges can follow suit now and feel and experience for themselves the warmth, understanding and friendship of the Jaffna students and academic bodies.

Sinhalese Medical students in Jaffna Medical Faculty

Dr. Amarasinghe said, "Most people in Colombo do not know that there are 21 Sinhalese medical students in the Jaffna Medical Faculty. They are in their second year now, peacefully and happily mixing with the Tamil students and continuing their studies.

I met all of them and spoke to them, and I could see the inner glow of happiness they had as they were pioneering and laying a strong foundation stone themselves for a bright future in Sri Lanka in unity, harmony and togetherness. She did not fail to mention how grateful the college was to Mahanama Dodampegama of Baurs who under their Medical Education Assistance Programme, sponsored the event.

Here we quote a few lines from the speech she made in Jaffna at the inauguration of the annual sessions.

The college is committed

The College of Surgeons, is committed, as enshrined in its constitution, to the advancement of the science and art of surgery across our country and beyond. The college has 4 young surgeons who are members, working in the city of Jaffna. We understand and recognise the enormous challenge facing them, as the city of Jaffna awakens after 25 years of war, and like a phoenix rising from the ashes, begins to grapple with the problems of health and organisation. The college comes to lend its strength and to open its newest regional chapter.

Three generations of surgeons

We bring to your city, 3 generations of surgeons. The senior chapter of the college is represented in force and dignity with a total of 12 past presidents in this hall. These are surgeons who have dedicated their lives to uplift the science of surgery in this country and have achieved, by and large great fulfilment doing so.

We bring to you, our youth, the surgeons-in-training today and the future surgeons of this county. They have come to take away with them the memory of your warm hospitality, your vibrant culture and share with you your challenges of the future. There are many challenges in other parts of the country as well, so there is great understanding of the problems.

Foundation for an academic bridge

Every man and woman who got onto our charter flight from Colombo, consciously or unconsciously, has come to lay the foundation for an academic bridge, which we hope will stand the test of time.

We, the surgeons of this country, have walked across the bridge, which we have laid down, and we hope you will walk across it as well. So that one day, with the mixing of intellectual strength, giving to us a harmony of the mind, there will be understanding and prosperity in this wonderful land of ours.

Twenty one Sinhalese Medical Students in the Jaffna Medical Faculty

Dr. Amarasinghe said at the sessions she met the 21 medical students who are in the Jaffna Faculty now in their second year. They were all very happy and were mixing very well with the Tamil students. The Tamil students were helping them with translations when talking to Tamil patients.

Dr. M. Ganesharatnam chief guest at the occasion observed:

I wish to thank the Council of the College of Surgeons of Sri Lanka for giving me this previledge of being chief guest on this occation which is a great honour in my native place of birth. This is the first instance where any Sri Lanka College has come to Jaffna for their sessions. I am grateful to the president's untiring effort to make this happen.

I wish to speak of one of the difficulties surgeons have in the periphery. Although Jaffna Hospital is a teaching hospital, it is like a peripheral hospital in many ways. The difficulty surgeons here face is the insecurity and uncertainty. They feel insecure due to many reasons, mainly that they are isolated from the rest of the island due to poor communication and transport facilities. These get worse during periods of war.

The surgeon is unable to contact his teachers or colleagues to get advice and is also unable to transfer the ill patients. This gives them a feeling of insecurity as the surgeon is uncertain of what he is to do. Uncertainty is also caused by the lack of updated knowledge of recent progress and changes that are occurring rapidly in the medical profession.

Keeping abreast is not possible for a busy surgeon in the periphery. This applies to both in the diagnosis and the management of patients.

The periphery hospital lacks equipment and some of what is already there is non functional most of the time. This makes the surgeon wonder if he is doing the best for his patient with inadequate facilities.

The surgeon feels insecure as he fears that he may be found guilty of wrong or improper and inadequate treatment. The retaliation may be legal or illegal means, as he lives in an isolated community. He also fears for his professional standing in the society and among his colleagues.

I wish to request the President of the College of Surgeons to remedy part of this problem by establishing a link to the College where peripheral surgeons could seek advice from experts in various fields of surgery whenever necessary. This can be established by a satellite link or a telephone link to an established unit which will direct the calls.

Dr. S. Raviraj President to the Jaffna Chapter of the College of Surgeons had this to say:

I am very happy to say that we have successfully completed this regional sessions of college of surgeons. This is the very first occasion in the history, a college have joined with Jaffna Medical Association and having this grand regional session in the Northern region.

This credibility belongs to our college of surgeons Sri Lanka. Our special thanks to our medical students to add more colour and grace for this occasion by their cultural programme and helped in various other ways to honour this sessions. - E. A.

Sahanaya on the need for Psycho - Social Resource Centre

The Tsunami that hit three quarters of the coastline of Sri Lanka on December 26, 2004 left behind a trial of destruction to both human lives and property. Around 40,000 people were killed, and about a million people or 5% of the country's population were left homeless.

Even though many of these people have now left the camps to reside with family or friends, the country is now left with the enormous tasks of rebuilding - of both lives and property. Towards this end, aid is being received from friendly countries, international agencies and other private individuals to supplement the assistance being provided by the local civil and corporate communities and the Government. This would address the tasks of rebuilding the infrastructure, providing temporary shelter and then permanent homes to the homeless and restoring livelihoods.

There is however, a further task that has to be undertaken without any delay. Immediate steps must be taken to address the psycho-social impact of this tragedy on the men, women and children who were affected, in order to ensure that they could, in time, build for themselves a new life. A tragedy of this nature could impact different people in different ways and it is important that this process be handled with an awareness of the problem in hand and the knowledge to treat each person recognising the culture and mindset of the respective communities and the individual needs of each person.

Sri Lanka has already had to face the consequences of 20 years of civil strife, which killed more than 60,000 people and has left both physical and mental scars on thousands of its people, particularly its women and children. There are generations of people who have not known a life devoid of violence, destruction and death. With the Tsunami, the county experienced a new disaster, which in a matter of minutes created a new and large category of affected persons.

It is in this context, that it is noted that there are only about 30 qualified psychiatrists in this country, and only a handful of health workers who have been trained in providing psycho-social care. This number is grossly insufficient to meet the demands of the country in normal times, it is even more so following this recent tragedy.

It is therefore imperative that steps be taken to develop new strategies and approaches to address this shortfall and build capacity that would allow for the handling of the psycho-social needs of our people.

Vitamin needs for the aged
 

by Dr. D. P. Atukorale

In 1989, Recommended Dietary Allowance (RDA) for adults for Vitamin A was 1,000 mg for males and 800 mg for females. There is an age related delay in the clearance of vitamin A absorbed by the liver and other tissues, and Vitamin A absorption increases with age. Carotinoids, due to their anti-oxidant properties, may reduce the risk of cardiovascular disease, cataract and cancer. Therefore reduction in the RDA for vitamin A for older adults may be unwise.

Vitamin D

In contrast to Vitamin A there is growing support for increase in the requirement of Vitamin D with age. Vitamin D is obtained from diet as well as from skin synthesis upon exposure to sunlight. the Vitamin D3 thus formed is the metabolically active from of Vitamin D, which stimulates intestinal absorption of calcium. Important food sources of Vitamin D include Vitamin D enriched milk, fish oil and liver. Currently the RDA for Vitamin D for older adults is 5 mg (200 1 U) for both men and women. Older people are at risk of Vitamin D deficiency because of inadequate dietary intake and limited exposure to sunlight. Adequate intake of Vitamin D reduces osteoporosis, a disease characterized by reduced bone mass, and osteoporosis, related bone fractures.

Water soluble vitamins

Old people need more Vitamin B6 and B12 than the young. Old adults who limit intake of milk and dairy products, which are the best dietary sources of riboflavin, may be at risk of riboflavin deficiency. The elderly may show changes in the mouth, lips due deficiency of B vitamins such as, riboflavin, macra and pyridoxine.

Minerals

Scientific evidence shows that the RDA of calcium of 800 mg per day is not adequate to meet the needs of ageing people. Increased calcium intake reduces the risk of osteoporosis. There is evidence to show that increasing calcium intake with vitamin D reduces age related bone loss and risk of osteoporotic fractures. Elderly persons are advised to take 1,500 mg of calcium per day. Milk and other dairy products are a good source of potassium, which may be deficient for ageing people.

Other consideration

Constipation is common in the elderly due to reduced intake of fibre such as red rice, pulses, green leaves and fruits.

Many older people do not drink sufficient fluids. They should drink 6 large glasses of fluid per day. Summary

To meet the nutritional needs healthy ageing people are encouraged to consume nutritionally balanced, nutritionally dense diet containing a variety of food in moderation. Adequate intake of fluids, and regular moderate physical activity e.g. aerobic exercise will maintain healthy active life for several more years. Anaemia is common among the elderly due to deficiency of folic acid and Vitamin B12 and iron.

It is advisable to give supplements of thiamine, niacin, riboflavin, pyridoxine, folate and vitamin B12 to the elderly to counteract the effects of malabsorption and Vitamin C to aid absorption of dietary and medicinal iron.

Osteoporosis is preventable. How?
 

by Dr. Chandrani Piyasena, Member of the Food Advisory Committee of the MRI

(Continued from last week)

Nutrition intervention guidelines for Osteoporosis

The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in a balanced proportion. In particular, calcium and vitamin D are needed for strong bones as well as for your heart, muscles, and nerves to function properly.

Nutrition intervention in people who are already at risk:

* Optimize nutritional status. Attain or maintain a body mass index (BMI) of 22 to 27. Consider high calorie, calcium and nutrient-rich foods or liquid supplements if weight loss is a problem.

* Adequate calcium and vitamin D intake are crucial for developing optimal peak bone mass and preserving bone mass throughout life. For those who do not achieve recommended intakes from dietary sources, bioavailable supplements should be considered.

* Calcium intake: A range of 1,000 to 1,200 mg/Day (1,300 mg for teenagers 9 to 18 yr) is the current recommendation for calcium.

* Vitamin D intake: The currently recommended intake for adults is 5 to 10 micrograms, or 200 to 400 IU daily. Sunlight exposure of 10 to 30 minutes daily can also increase serum vitamin D levels.

* Alcohol intake: Excess alcohol intake is deleterious to bone.

* Sodium Intake: Low sodium intake is desirable.

* Caffeine intake: Those who consume very large amounts of caffeine should be encouraged to drink milk and/or obtain calcium from other sources.

* Vitamin A: Megadoses should be avoided.

* Promote regular physical activity, especially regular weight-bearing exercise or high-impact, high-intensity strength and resistance training exercises. These activities should be consistent with the individual's ability and physical status.

* Achieve or maintain peak bone mass. The best defense against later osteoporosis is strong bones prior to age. Maximizing calcium intake during peak periods of bone mineralization in childhood, adolescence and pregnancy is critical to maintenance of optimal bone health later in life.

Provide education to help reduce the likelihood of falls. Understand and seek to limit factors that contribute to increased risk of falling. These include gait and balance disorders, weakness, dizziness, environmental hazards in the house, confusion, visual impairment, postural hypotension, and being alone more than 10 hours per day.

* Smoking cessation. Cigarette smoking reduces bone mineral density by an average of 5 to 8% in both men and women.

* Medication use (i.e., corticosteroids, anticonvulsants, anticoagulants, heparin, thyroid hormone, vitamin A in large doses). Consider limited use or use of alternatives in people at high risk for osteoporosis/fracture.

* Replacement hormones. Assess the appropriateness of hormone replacement therapy (HRT) in post-menopausal women.

Treatment

A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. Most drug therapies work by decreasing bone resorption. With a wise selection of food you can stay bone healthy.

(Concluded)