Prof. Herbert A. Aponso on:

Out Prescribing Expensive Drugs and Investigations

EMERITUS Professor Herbert A. Aponso of the Peradeniya Medical Faculty will speak at the OPA annual sessions opening this Sunday (September 16) at the BMICH in Colombo, on training doctors to keep out prescribing expensive drugs and investigations to their patients, thus helping to bring out a people friendly affordable healthcare service to the public in this country.

Prof. Aponso will outline this training scheme proposed in his new public & private sectors combined - ‘Family practitioner service’ which is now being worked out in detail by a special committee with representatives from the Ministry of Health.

Health watch last month carried two articles on this new health service proposals, for which there had been a good response from the public and professionals in this country.

Prof. Aponso in a letter to the HealthWatch while thanking us on the response he had to the two articles states.

Reference the two articles that you have kindly published:

‘Affordable Family Practitioner Service in the offing’

‘Leading Cardiologist (Dr. D. P. Atukorale) suggests inclusion of Ayurveda doctors into the FPS scheme’

I have already had several comments, commendations and constructive criticisms from the public and health professionals. To mention a few of them: Prof Amarasiri de Silva & Prof Tudor Silva (Sociology), Emeritus Prof George Dissanayake (Physics), Dr. Ranil Abayasekara (Economics), Dr. Heshan Wickramasuriya (Agriculture) - all of the U. of Peradeniya - Dr. Dennis J. Aloysius (past President, Sri Lanka Medical Association, Organisation of Professionals, College of General Practitioners), Mr. J. V. Thamber (retired Deputy Director of Social Services), Dr. Nimal Sanderatne (retired Deputy Governor, Central Bank and former Chairman, Bank of Ceylon), Prof. B. Hewavitharane (Emeritus Prof. of Economics and Chairman, Institute of Policy Studies, where this proposals was presented and discussed), Dr. Lucien Jayasuriya (former Director General of Health Services - Teaching Hospitals), Dr. W. P. Somasiri, Family Practitioner, Gampola.

Dr. Nanda Amarasekera (Consultant Physician and former President, Ceylon College of Physicians) and his wife, Dr. Esther Amarasekera (formerly Chief MOH, Kandy), have written that “it is a well thought out document dealing very comprehensively about the advantages of starting such a venture with state patronage - hope the Ministry will take up your proposal speedily - in the near future.”

Furthermore, it should be mentioned that all the members of the group that studied this proposals, very critically, have unanimously endorsed it in its final form, these include Dr. Palitha Abeykoon (WHO Advisor to the Ministry of Health), Prof. Lalith Mendis (President-elect, Sri Lanka Medical Association), Dr. Preethi Wijegunawardena (President, College of General Practitioners), Dr. W. A. Ferdinand (President, Independent Medical Practitioners Association) Dr. Leela Karunaratne (Founder Professor of Family Medicine), Dr. Sarath Paranavithana (Senior Family Practitioner, Nugegoda), Dr. Ruvaiz Haniffa (Senior Lecturer in Community Medicine, U. Kelaniya).

Including Ayurvedic Doctors

Regarding Dr. Atukorale’s suggestion to include Ayurvedic doctors, it should be mentioned that this was strongly advocated by Dr. Nimal Sanderatne, but, though accepting it in principle, it was felt that: a) the main concept should be accepted and implemented first before adding on more controversial suggestions, and b) the main proposals should be kept as short as possible Re other suggestions of Dr. A:

The scheme is for the whole country, with special emphasis on the rural areas The Family Practitioner (FP): Population ratio in SL is about 1:30,000; in contrast to 1: 2,000 in UK. Of these FPs, most are in urban areas, whereas the urban/rural ratio is about 25:75.

Due to the dearth of FPs, especially in the rural areas, there is an alarming number of unqualified practitioners (“quacks”) who dupe the public.

The FPs would be trained to provide an efficient and affordable service without resorting to unnecessary and expensive drugs or investigations, which practice is unfortunately happening to a large extent today.

Therefore it is stipulated that they should have served at least one year in the state health service - preferably 6 months in a hospital OPD practice and 6 months in the public health service (MOH, MO/MCH) - after completing the internship.

On selection, they would be given paid leave to obtain the Diploma in Family Medicine (DFM), if not already obtained (These stipulations may be waived for experienced doctors)

All medical colleges should provide a training in Family Medicine.

Drugs. The organisation should set up people friendly pharmacies, such as State Pharmaceutical (SPC) outlets, at every Group Practice, or support private pharmacies that give discounts on prescriptions of FPs.

To state it very briefly, just consider one drug (space does not permit the many, many others): Diclofenac, a quick reliever for pain and fever; a 50mg tab (SPC brand name Divon) costs only about 60 cents, whereas other brands cost 6 to 7 times more.

At a later time, all common drugs should be manufactured locally

Investigations

Patients shall be referred, without payment, to state institutes for the common investigations — FBC, Urine FR, ESR, Blood sugar, Lipid Profile, X’rays, ECG, etc. Later, laboratories should be established for the group practices.

Special investigations such as EEG, Ultrasound Scan, Echocardiography, CT scan, etc. shall be available free only if recommended by the relevant hospital specialist.

Criticism

Another criticism is that there seems to be little need for these proposals, as there are enough general practitioners from the state sector, who treat patients during the hours when they are allowed to engage in private practice.

The answer to that criticism is that, due to the restriction of their availability at all times and the fact that they are transferable, the service that they are able to offer is mostly limited to a primary curative service, which is distinctively different from the concept of the service expected from full-time Family Practitioners; namely, a comprehensive primary health care, which includes the prevention of disease and the promotion of good health, The FPs in this scheme, would, in addition to treating the sick, conduct Family Clinics which would include Antenatal & Postnatal care, Family Planning services, Child Welfare (including Immunisations) services, Health and Nutrition Education, etc.

Another query is; “what would be the role of the present private part-time general practitioners (from the state sector), and what are their future prospects”? These doctors would be allowed to do locums at Group Practices.

They could opt to join the proposed scheme on a secondment basis As govt OPDs tend to get less congested, it is suggested that state MOs could be employed by the FP organisation, offering them half the govt salary, in addition to some of the proposed incentives, and their earnings as full-time FPs. It is not being suggested that these doctors should be deprived of their present practice.

Considering all these suggestions in their favour, this Proposal should, in the long-term, be of advantage to them.

Sri Lanka to achieve WHO 20/20 preventive blindness eradication goal

Dr. Amal Harsha de Silva Director Private Healthcare sector Ministry of Health of Nutrition last week said. Sri Lanka is determined to achieve - WHO’s 20/20 preventive blindness eradication goal by the year 2020, with the cooperation of the private healthcare sector in this country.

He was speaking at the first scientific sessions of the optometric Association of Sri Lanka, held at the Finger town and country club, Borelesgamuwa where he was the guest of honour.

He commended the Optometric Association for pledging to play leading part in this preventive blindness eradication programme to achieve the WHO goal.

He said the scientific annual sessions to upgrade the knowledge in latest techniques in optometry was in itself a good beginning for this programme.

The association’s President Sandaka Lenagala (Dip opto/MSLOA) while thanking Dr. de Silva, and Prof. Benita Stephen the chief guest for accepting the invitations to be the chief guest and guest of honour at this sessions said improvement in the optometric services in the country.

Optometric association President Sandaka Lenagala speaking at the event said while helping the country to achieve the WHO goal on preventable blindness eradication, the association would also would set up a University affiliated school for training in optometry, and introduced a code of ethics for opticians aimed at bringing harmony and stopping under cutting among them, in the course of this year.

Referring to the history of optometry in this country,he said:

Optometry began in 1344 AD

Optometry has been practised in the Island as early as 1344 AD. Earliest system of optometry that was practised in Sri Lanka was handed down from generation to generation within the opticians’ family.

Master craftsman by the name of Ms. Devanarayana who was commissioned to build the Gadaladeniya temple was requested to make a pair of spectacles for the then king Buwanekabahu the IVth. Now this is placed at the national museum.

In ancient times the spectacle frames were made out of materials such as tortoise shells, Ivory and Buffalo horns while the lenses were made from different types of quartz available in the Island. Descendants of this master craftsman are still living in Kiriwaula near Kadugannawa.

Primitive methods of cutting, grinding and polishing have evolved through generations to the much sophisticated optometry industry today.

Optometry today is a major discipline in Ophthalmology. I am proud to say that the present day standards of ours are on par with other developed countries. Since its inception it has evolved to present standards.

Today there are about 107 full members and 187 Associate members in our association. Contributions from our pioneering members are remembered here with the great respect. I am sure my colleagues in the profession would agree that the standard of our Sri Lanka Optometric Association need to be upgraded as frequent as possible.

This is why the annual Scientific Secessions born in addition to Study circles. This would definitely expand the horizons of our professional knowledge.

We have come a long way. But we also have a long journey ahead if we are to provide gift of sight to the people. It’s a great privilege and honour for me to address this historic event as the chairman of SLOA.

New hope for cancer patients

Ruwini JAYAWARDANA

Good health is the greatest gift that life can bestow upon you. Unfortunately there are many who lack this gift. Even those of us who seem healthy fear future aliments. None are free from risk.

Cancer is one of the leading killers in the contemporary society. It is estimated to afflict more than 10 million people annually the world over. In Sri Lanka there has been a steady rise of the disease throughout the years. The number of newly diagnosed cases of cancer reached 10,925 in 2000 and are fast growing.

Ceylinco Healthcare Services Ltd., (CHSL) recently established Sri Lanka’s first private Radiation Treatment Unit to offer its customers a quantum change in technology and techniques for the treatment of cancer.

In a six-storey, 19,000 square foot Radiation Treatment Unit of the Ceylinco Healthcare Centre lies Sri Lanka’s first Linear Accelerator, the international Gold Standard in the delivery of accurate, intensity modulated radiation therapy (IMRT) for the treatment of cancer. The unit also offers many other forms of treatment using state-of-the-art equipment.

FACILITIES: CHSL offers non-hospital environment Chairman of Ceylinco, Deshmanya Dr. Lalith Kotelawala with the representatives from the Washington Hospital Centre. Picture by Palitha Gunasena

Described as a “beacon of hope” for cancer patients, this programme enables the patients having to travel overseas for treatment plus it also gives the opportunity of the local doctors to gain knowledge on the latest treating methods related to the subject.

The speciality of the equipment lies in its ability to focus on only the cancer bearing regions of the patient thereby varying the intensity of radiation dose within the tumour bearing region.

The Ceylinco Healthcare Centre is affiliated to the Washington Hospital Centre and senior representatives from the institute visited Colombo to take part in the opening, which was a historic event.

Dr. Lawrence S. Lessin, Associate Medical Director of the Washington Hospital Centre stated that the he and his colleagues were impressed with the vision, determination and commitment of the Ceylinco Group in bringing new methods of technology and techniques to the island.

He added that the Washington Hospital Centre is committed to provide full benefits of its vast knowledge and experience in the treatment of cancer to the Ceylinco Healthcare Centre.

According to Dr. Sarath Abeyakoon, Medical Director and senior Oncologist of the Ceylinco Healthcare Centre, the unit also offers Brachytherapy or short distance radiation treatment with the most advanced equipment available and Radioactive Iodine Treatment.

“This modern linear accelerator is designed to deliver accurate radiation beams to highly focused cancer bearing regions of the patient,” he explained.

“Thus not only would it increase the chances of tumour control and cure but it would also prevent the irradiation of normal tissues.”

Radioactive Iodine is used to treat selected patients with cancer of the thyroid following a total removal of the thyroid gland. It can also be used to treat patients who have an increase activity of the thyroid gland or Thyrotoxicosis.

A CT Simulator and computerised Treatment Planning and verification system too enables a high degree of precision in treatment.

Luxury rooms and semi-luxury rooms, wards, reception areas, doctors’ rooms, visitors’ rooms and other ancillary requirements are met at the centre with a non-hospital atmosphere.

Deshamanya Dr. Lalith Kotelawala, the chairman of Ceylinco said that the facilities will be affordable for all. The CHSL formally commenced operations last week.

Mothers to be- don’t eat meat if you want to have fertile sons

Dr. D.P. ATUKORALE writes:

It is common knowledge among medical personnel that low sperm count is one of the causes of subfertily (sterility).

A new study in Human Reproduction finds that a pregnant woman’s meat consumption can reduce her future son’s sperm count. Researchers at the University of Rochester in New York analyzed the relationship between various sperm parameters and the eating habits of their mothers from the study for future families.

The more beef a mother consumed, the lower her son’s sperm count concentration. The sperm count was 24 percent higher in men whose mothers consumed less beef. The difference may be due to steroid hormones found in animal products.

Six hormones are commonly used in the United States to induce increased growth and development in cows and measurable levels are routinely present in animals muscle, fat, liver kidneys and other organs.

Cattle raised without extra - hormones still have significant hormone levels in their tissues because of endogenous hormone production and the nutrient profile of animal products tend to elevate hormone levels in the human body.

Reference: Swan SH, Liu F etal, Hum Reprod advance access published in March, 2007.