In the horizon rising...

A second youth for the aged

Dr. Upul Banagala at his introduction recently as President of the College of Surgeons, Sri Lanka, in his presidential address on 'looking beyond the horizon for the rising ageing population' had this to say 'A second youth for the aged is on the cards'.

A grand new era

"A grand new era of medicine has dawned. We now hope to live longer and also to stay young, healthy and happy. Recent strides in medical science has taken towards meeting these expectations, are truly amazing."

"Surgery has of late undergone remarkable refinement, with the result that the seriously ill or injured people can be successfully treated."

Young looking aged

"Now there are various modes of treatment to repair or replace tissues and organs. There are devices that stand in for failing body parts and treatment to keep us slim and wrinkle free. New drug therapy, gene therapy, gene manipulation, local application of cells, biologically active molecules etc, are now available to keep the aged looking and feeling young."

Further he observed: With the general aging of the population the overall prevalence of visual loss as a result of lens opacities increases each year. All these patients will need surgery.

Good health is a vital individual asset as well as a blessing. Irrespective of whether we are young or old, all of us hope to live long, and be vital, healthy and happy.

The World Health Organisation defines health as a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity. To reach old age in good health and well-being requires individual efforts throughout life and an environment within which such efforts can bear fruit.

In the past, elders were not considered as a specifically vulnerable group in Sri Lanka. Their numbers were not large enough to warrant the adaptation of special measures for providing medical care for the aging. On the other hand caring for the elderly has been a part and parcel of our rich culture.

However, the society that we live in now is completely different. While representing a big segment in the population barrel, elderly people today are more educated than in the past. They demand high quality medical care.

Government's responsibilities

It is primarily the responsibility of the Government in a country to create a supportive environment that enables the advancement of health and well-being into old age. The Sri Lankan Government has already started planning for the anticipated demographic change. The Ministry of Health is drawing up plans as well to face this change.

I strongly believe that our College as a professional organisation also has an important advisory role to play by assisting the Government to create the required environment. We need to advise the Government on the surgical problems the health sector will have to face in the future due to changes in the demographic pattern.

Some suggestions

Health education is needed to assist patients in areas of risk reduction and prevention of injuries, minimizing repeated injuries and reducing workplace injuries. In this regard, our college has an important role to play. I am confident the media will help the college to achieve its noble objectives.

People should be educated about Osteoporosis, prevention and early diagnosis of this condition. This will prevent long-term disability. We should provide facilities to measure Bone Mineral Density in major hospitals. These facilities should be easily available and accessible to the elderly.

When fractures do occur they need surgical treatment. For this centres of excellence need to be established in each district.

Screening programmes for early detection of cancer such as breast cancer, cervical cancer, rectal cancer should be organised islandwide and be easily accessible to the elderly.

More urological facilities should be established throughout the country with facilities for endoscopic prosthetic resection.

Humanitarian and economic reasons

For both humanitarian and economic reasons, it is necessary to provide older persons with the same access to preventive and curative care and rehabilitation as other groups. Patients need to be educated to access, monitor and to know when they need to seek... appropriate care.

The algorithms of the future will start with an educated patient entering the system. This is an area where there is real potential for other health providers to address and take the lead.

Consider the new members present today, as well as those of you who will be attending our Annual Scientific Sessions in 20 yrs and after. Problems they will face may be entirely different from what we are facing now.

I feel it is the duty of the present membership to anticipate these problems and draw up necessary plans. Our profession will continue to be influenced by changes that the college may not be able to withstand alone. It has to be a collective joint effort of other Colleges, The Post Graduate Institute of Medicine, and the Ministry of Health.

We may need to re-evaluate, re-assess and possibly restructure the education and training process of the Surgeon of the 21st Century. Further, Faculties of Medicine in our Universities should seriously think of introducing Geriatric Medicine in our medical curricula.

We have an obligation to our future members. We have the opportunity as well as the obligation to those that follow us in surgery, to see that they will feel just as privileged as we are. We have a responsibility to see that they receive the type of training that is appropriate for the surgical needs of the thousands of patients they will be serving.

After years of hard work and sacrifice, we need to be certain they have professional opportunities commensurate with their training. Once we have the necessary manpower every effort should be made to retain them within our own country by providing necessary facilities and incentives.

However, the future plans of the Ministry of Health do not reflect that this problem has been adequately addressed. In my opinion, cadre projections that have been drawn up to year 2013 are totally inadequate.

As members of the college we should try our best to convince the authorities of the necessity of investing for the future development of the healthcare system of the country.

As the College of Surgeons, it is our duty to advise the Government on Surgical Health Problems the health sector will face in the years to come due to changes in the demographic pattern.

Heart valve diseases and health care after valve surgery

HEART VALVE DISEASES: Dr. Nimal Rajapaksa (FRCS) Cardio Thoracic surgeon of the Colombo National Hospital stresses the importance of ensuring proper medication after heart valve replacement operations are done in the human body.

Speaking to the HealthWatch on heart valve diseases in human body, where diseased valves are replaced with artificial metal valves in human body, he said it was essential for the patients concerned to strictly ensure that they take on the prescribed drugs without a break if they are to get the best out of the replaced valves and maintain good health.

He said this applies mostly to replaced metal valves, which has generally a life time of 20 to 30 years if medications are properly taken.

What has to be understood by the patients here is that if the opening and closing the heart valves which are 4 in number do not happen properly, it impedes the circulation of the blood.

In the case of the metal valves if this function is to happen properly the normal blood has to be thinned to some degree otherwise the artificial metal valves tend to get clogged.

For this purpose the patients have to keep taking a drug called 'warferin' daily. They also have to take a blood test (INR) regularly at intervals to check that the blood is maintained of a certain level of thinness.

In the case of tissue valves, that is replacing deceased valves with valves taken from pigs the 'warferin' problem does not arise, because it functions as a normal human valve, but its durability is limited to 4 to 5 years.

On account of this, we generally don't advise young patients with valve defects to go in for tissue valves, because this being a major operation taking 1-2 hours, it is not possible for a person to undergo 4-5 operations in his life time.

Causes for valve defects

There are several causes which result in a person getting valve defects. Among them are,

(1) The congenital factor. That is from birth.

(2) Rhumatic Fever can affect the heart valves and the effects surface 20 to 30 years later in life.

About 60 to 70 per cent of the people affected with valve problems are from the lower strata in society because poor social conditions and under-nutrition contribute to this problem immensely.

Poverty alleviation the best preventive

A metalic heart valve costs about Rs. 50,000, so the State sector has to bear a heavy cost of treating these patients annually. That's why we always advise the policy makers, that the best preventive for sicknesses is to adopt measures to improve the social conditions of the people, and strike at poverty.

Dr. Rajapaksa said that approximately five heart valve operations are done monthly in his unit in ward 36.

Common symptoms

The common symptoms of anyone having a valve disease are getting fatigue very often and shortness of breathe.

At the first sign of those symptoms, one should consult a doctor without delay, and get the appropriate treatment recommended.