Healthwatch

Prof. Rezvi Sheriff on Sri Lanka’s double burden of diseases

In countries like Sri Lanka we have a double burden of diseases as we still have a diminishing but sizeable communicable disease burden in addition to the increasing epidemic of chronic disease burden.

So said Vidyajothi Prof. Rezvi Sheriff the newly elected President of the Sri Lanka Medical Association (SLMA) in his inaugural presidential address to members of the SLMA in Colombo last week.

He was commenting on the WHO document on diseases, where it was stated that in the world communicable diseases are diminishing while chronic non-infection NCD diseases are rising up in almost all the countries.

Non communicable disease

Non Communicable Diseases accounts for 77 per cent of the global mortality and 85 per cent of the global burden of disease from low and middle income countries. The importance of this is further highlighted again in this WHO document.

The infectious diseases are diminishing and chronic non infectious or NCD is increasing in almost all countries.

In countries like Sri Lanka we have a double burden of disease as we still have a diminishing but sizeable communicable disease burden in addition to the increasing epidemic of chronic disease burden.

In numbers we can report that in 2005, of the projected 58 million deaths amongst 6 billion people chronic disease accounts for 35 million.

Chronic disease thus accounts for double the number of deaths from HIV, TB, Malaria, Maternal and Perinatal causes nutritional deficiencies combined.

Many factors are responsible for this shift of focus.

I have gently introduced the concepts of epidemiological transitions but there are other factors responsible for this change as listed in this slide.

Changes in the last 50 years

The changes in the last 50 yrs on societal health is attributable to many factors inclusive of the well-recognised Demographic and Epidemiologic Transitions.

Factors such as industrialisation, urbanisation, westernisation, changes in dietary styles, sedentary life styles, stress, improving infant and child survival, life expectancy, technological advances in diagnosis and treatment, health seeking behaviour, cost of health care, expectations of outcome, access to health information, easy communication, litigation have all contributed in some measure to this change.

The iceberg phenomenon

Chronic illhealth in society which presents to the doctor is smaller in number than the larger numbers undiagnosed.

This iceberg phenomenon puts health screening packages a useful tool in tackling this epidemic.

We may need to mobilise the patient and family who present with symptomatic illness to volunteer to screen those around them to help the cause as health workers alone may be insufficient to identify all at risk.

Diabetic scenario in Sri Lanka

Many doctors have studied the diabetic scenario in Sri Lanka from the 1990s. These studies although small shall have been showing a increasing trend with time and we now have a prevalence rate of 10% in 2008.

In Sri Lanka too we find the prevalence as the rise and earlier onset of diabetes in 20s & 30s. Prasad Katulanda’s studies in my department at Faculty of Medicine Colombo linked with Oxdem - The Oxford Dept of Diabetics & Endocrine Medicine showed a diabetes prevalence of 10.3 % and 36% of them did not know they had diabetes when diagnosed.

This shows the value of screening programmes to detect diabetes in the community.

Alarming Feature

The alarming feature is the increasing tendency for diabetes to be detected earlier in young adults.

If we detect early, and the patients comply they can minimise the onset and progress of the dreadful complications of diabetes.

Diabetic nephropathy/ retinopathy is serious as Sri Lanka is woefully short of Retinal surgeons and Nephrologists. Many suffer in silence with sexual dysfunction.

Treating patients at these late stages is very expensive and will account for need for large funding allocations.

In these difficult times many patients suffer or die disappointed due to shortage of facilities.

Thus Diabetes is undoubtedly a serious malady accounting for a big portion of epidemic chronic disease burden in society.

It is a major risk factor in Hypertension and Cardio vascular diseases and contributes to mortality.

It is controllable, complications preventable and we can reduce the misery if planned effective and timely preventive measures are put in place.

SLMA’s Major effort

A major effort by the SLMA in the form of the Diabetes Prevention Task Force headed by Prof. Chandrika Wijeratne & Prof. Ravindra Fernando Chairman Non communicable disease Committee have been very active in 2008 to increase awareness in society, amongst doctors, patients, school teachers, schoolchildren etc.

The National Diabetic Centre is a model for the country but we need more Diabetic Centres in Provinces, Hospitals and the Private Sector too should be encouraged and helped to set up organised specialist led teams of doctors, nurses, dieticians, eye care, foot care personnel linked to such centres to serve the public.

This is the way forward in giving quality clinical care. Case detection/ screening; clinical care teams and other population based strategies especially to reduce risk factors contributing to morbidity can be tackled at multiple levels led by Government using all help available...NGOs International Agencies, Private Sector and Voluntary Patient Groups.

Five year health vision for Sri Lanka from SLMA

Sri Lanka Medical Association (SLMA) as an advisor body on health policy to the government has outlined a five year policy on health from 2009-2012. The document was released to the medical profession last week by the SLMA.

Among the General objectives and strategies outlined for SLMA in the document are -

General Objectives

1. Enhance the capacity as the apex professional and scientific organization of all categories of medical doctors as defined in the constitution of the SLMA.

2. Play an advocacy role towards comprehensive curative and preventive health services for the people of Sri Lanka.

3. Promote professionalism, good medical practice and ethical conduct among doctors.

4. Disseminate state-of-the art knowledge, clinical practice, technology and emerging concepts in medical sciences among medical professionals.

5. Provide opportunities for continuous professional development with particular emphasis on the National CPD programme.

6. Encourage ethical medical research.

7. Educate the public on health-related issues.

8. Enhance closer professional and scientific links between medical doctors and professionals allied to healthcare.

Strategies to achieve

general objectives

General Objective I

Enhance the capacity as the apex professional and scientific organisation of all categories of medical doctors as defined in the constitution of the SLMA.

Specific objective 1.1:

Redefine our role among colleges and form a consensus group with Colleges and other healthcare related associations and societies.

Strategy 1.1.1:-

Appointing a SLMA committee to plan and implement the setting up of a consensus group, comprising one member from each College/Society and chaired by the SLMA

Specific Objective 1.2

Take appropriate measures to enhance the corporate image of the SLMA

Strategy 1.2.1:-

Assign the Public Relation Officer and the Media Committee of the SLMA to plan and implement the corporate image enhancing campaign with the assistance of selected experts in this field.

Specific Objective 1.3

Develop strategies to attract more doctors to join the SLMA

Strategy 1.3.1:-

Assign the SLMA Membership Committee to formulate the proposals

Specific Objective 1.4

Develop a mechanism to respond rapidly to important current issues

Strategy 1.4.1:-

Empower the President, Secretary and Media Committee to respond quickly with the advice of appropriate experts to health issues that emerge, pending covering approval of the Council

Specific objective 1.5

Network with outstation clinical societies and association to strengthen academic and professional links

Strategy 1.5.1:-

Assigned to the SLMA Assistant Secretary dedicated to outstation activities, and the Website Committee

Sri Lanka achieves milestone in medical examinations

Sri Lanka’s postgraduate Medical examinations conducted by the Board of Study in Family Medicine and General Practice of the PGIM has a milestone in conducting these examinations in India for Indian doctors.

Vidyajothi Prof. Rezvi Sheriff President SLMA and Director PGIM in a statement to the Healthwatch in conducting this examination in December last year for the 9th time in India states.

A milestone of PGIM holding its DFM examination in India for the 9th occasion

The Board of Study in Family Medicine and General Practice was able to hold its Postgraduate Diploma in Family Medicine examination for the 9th occasion in Chennai, India. The examination was held in collaboration with the Indian Medical Association and the IMA College of General Practitioners of India. 33 candidates registered but only 28 sat the examination and all of them passed the Diploma.

The examiners from the PGIM were Dr. Leela de A. Karunaratne, Chairperson of Board of Study, Dr. Dennis J. Aloysius, Dr. A. D. P. A. Wijegonawardena (Co-ordinator) Prof. Nandani de Silva, Prof. M. S. A. Perera, Dr. A. L. P. de A. Seneviratne, Dr. Sanath Hettige and Dr. Janaka Ramanayake. The Indian counterpart Examiners were Dr. S. Arulrhaj, Dr. V. N. Rajasekaran, Dr. K. Vijekumari, Dr. Preetham Arthur, Dr. J. A. Jayalal, Dr. G. Mathiyaprakasam, Dr. M. K. Sudhakar and Dr. K. Vijeyakumar. The examination was held at the Sri Ramachandra Medical College and Research Institute in Chennai.

The examination commenced on Monday 1st December and concluded on Wednesday 3rd December with the Results Board being concluded at 8.30 in the evening.

An orientation programme for candidates was held on Sunday 30th November and the examiners and the candidates were briefed of the programme of the examination.

The candidates were from areas all over India, such as, Trichy District, Tuticorin, Madurai, Tamil Nadu, Coinbatore, Kerala etc. and they had a course organised by the local colleges.

The staff of the PGIM including the Director, Prof. Rezvi Sheriff, the Acting Senior Asst. Registrar/Examinations, Mr. N. M. Boteju, the Programmer/System Analyst, K. G. K. Palitha and Staff Assistant (Clerical) Mrs. M. A. L. Daluwatte also took part at this examination.

The local examiners who undertook this challenge of organising the examination and the Indian examiners who did their best to conduct the examination with fairness and keeping to PGIM standard are to be congratulated. The PGIM which is an Institute of the University of Colombo has exported this examination to India regularly and is held in high esteem by the candidates.

A few DFM candidates have now registered for the MD in Family Medicine.

An analysis of the vegetarian way of life

Please try to grow your own organic food even in pots or polysack bags .

Try to find literature and seeds to do so successfully. When you are associated with plants you become sensititive to nature and beings.

Combine meditation as the mental exercise to keep you maintain peace and calm in your mind by focussing on the in breadth and out breadth for at least 3-5 minutes per day. Your mind so overwhelmed with the negative forces around you has to be cleansed with this exercise.

Extend unlimited loving kindness to all beings and nature starting from your own family. This exercise would teach you to be aware of what comes to your mind to see as they are to react in the right way of talking and reacting.

Analyse quickly your thoughts to check whether they arise in greed ,hatred , or illusion and not be victim to any neagtive thoughts .

The natural calamities happening frequently are the result of man misusing nature. There are so many predictions that is currently happening as natural calamities and by 2012 some changes could happen to eleminate the bad according to them. Even now we are not late .

If we determine to reform and treat nature and its beings with due respect and love understanding them as divine gifts, Nature would unravel her true treasures to man to survive.

These facts are mentioned in the book written in sinhalese - Balangoda Maha Nahimi Sabadi Katha

- Mahind Wijethilaka

Elderly food pyramid:

The guide to appropriate eating, which divides food into six key groups of varying sizes.

Even as appetite may decrease in elderly, the need doesn’t. Drinking plenty of water, almost 8 glasses each day. Lack of water or fluids can cause constipation and dehydration.

Research recommends six or more servings of bread, cereals, rice, whole grains.

Choose vegetables, 3 or more for vitamins and fibre.

Choose fruits 2 or more servings for proper fibre intake. Whole fruits better than juice. Consider dairy group like milk, curds etc. which are low in fat.

Choose lean meat and white meat like fish, chicken, eggs etc.

Use fats, oils and sweets sparingly (as shown in the narrow portion of pyramid).

SLMA’s Medical view in HealthWatch

Beginning from next week, Sri Lanka Medical Association will be writing its opinion on current health topics relating to the country, in the Healthwatch.

Readers who are interested in getting the Medical Association’s opinion on any of the health and health related issues are welcome to write to the Healthwatch, C/o Features Editor Daily News Associated Newspapers Ltd.

No. 35 D.R. Wijewardena Mawatha Colombo 10.