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Do medical professionals do little for nutrition?

I write to answer the question published on P18 of March 26, 2009.

Paediatricians following their gurus in Nutrition like Dr. C. Gopalan of India and the late Prof. C. C. de Silva have definitely done much for nutrition as they have saved more lives than publicly and politically acknowledged.

Firstly, Kwashiorkor has disappeared; so have Keratomalacia and Bitot's spots (due to longstanding dietetic habits - unlike in India and with UN sponsored Vitamin A promoting policies and programs implemented in the last three decades or more in Sri Lanka). Yes, child mortality has come down from seventy in the fifties and fifty in the seventies.

Secondly, successful immunization programs have reduced mortality and erased Kwashiorkor which followed Tuberculosis, whooping cough and measles. Yet malnutrition cannot be erased with a magic wand or jabs like in an immunization program.

Next, exclusive breast feeding has improved vastly from 25 percent in a study in the seventies to around 75 percent in recent times, recorded by Sri Lanka's Demographic and census studies.

Infant feeding practices have slowly improved and politically supported maternity leave extension to four months have vastly contributed to exclusive breast feeding for around six months. Bilinduposha was widely promoted by all paediatricians for easy nutritious complementary feeding. Who removed it? Then low birth weight has improved from studies in the seventies (21 percent) to around 15 percent.

This is mainly (80 percent) due to Intrauterine growth retardation which continues as an intergenerational factor of poor maternal nutrition. Have the obstetricians en masse supported Paediatricians in promoting breast feeding? Has the baby friendly hospital idea succeeded? No.

So medical and nursing professionals have not supported breast feeding sincerely and adequately. In the private sector maternity ward nurses promote bottle feeding unmindful of gentle persuasion to await gradual milk secretion (which is promoted by two physiological reflexes of sucking and 'let-down'). Further, baby is put to the breast as early as within two hours of delivery.

Some medical professionals succumbed to the industry support for more than social activities. But that is not to deny the principles of many who have been advisers to the UN's highest committees in Nutrition.

Perhaps it is true that the elders in Nutrition have bred the first generation of professionals in Nutrition. But the same momentum has failed in the very young generations that have followed.

One cannot forget the Research done by many medical professionals. The Growth Monitoring card which was on request issued to very new born citizen of Sri Lanka, has been found to be poorly utilised in action. More so, is the maternal weight gain chart, which could have promoted better maternal nutrition and weight gain in pregnancy in the country. True enough, the Medical Research Institute (MRI) has shown that anaemia in pregnancy has improved. But more could be done if mothers, too cooperate in the public health interventions more diligently.

A recent IBFAN study of South Asia has shown that Sri Lanka ranks first in infant feeding practices. So, Paediatricians have done relatively good work. But they alone cannot fight industry. One glance at the electronic and print media shows the unethical type of advertisements that sways young children and errant mothers to promote sausage rolls for tiffin at school and meat balls for lunch or dinner.

Hence, obesity is raising its ugly head at the other end of the spectrum of malnutrition. Medical professionals are fighting against changing lifestyles. Yes, the fight is in every home, the rich and the poor, who are aping the rich erroneous lifestyles 'to keep up with the Joneses.' They also say nobody knows you have no food to eat if we dress up adequately and ebulliently. Since the 1976 fuel and food crisis, it is better known that malnutrition is a malfactorial problem encompassing several disciplines like education, agriculture, poverty alleviation, economics etc.

A former Minister of Health and later of Agriculture did much for nutrition. He promoted school and home gardens. He participated in the National Coordinating Committee for Nutrition. This committee steered by a non-medical academic, skillfully co-opted secretaries of Ministries, one of whom is a Cabinet Minister in the present Government. Recently, he upheld the role of medical professionals in improving Nutrition, as the guest of honour at the nutrition society proceedings.

It is tragedy that no program is sustained successfully through changes in Government policy. Many students of mine, now professionals in their own right, join me in weeping for maternal and child nutrition, not only in focus this month, but always.

Readers, remember Adult Malnutrition viz. obesity causes Diabetes, Hypertension and Cardiac disease.

Panadura Railway Station Parcel and Booking Office

I recently had the occasion to telephone Panadura railway station late in the evening to enquire whether a parcel of coconuts which I had despatched to my son-in-law's address from Hikkaduwa railway station in the morning had arrived at Panadura Station. The Assistant Station Master who was on duty at that time answered my call and informed me that the 'Parcel Office' was located on the adjoining platform which was not provided with a telephone. He said that he would have to walk over to the other platform to verify whether this particular parcel had arrived at the station. This platform accommodates both the Parcel Office and the Ticket Booking Office of this important Grade One station.

It is strange why the department has so far not taken steps to instal a telephone in this building all these years. If a member of the public wants to find out whether a parcel address to him from an outstation has arrived or not, or if an intending commuter wants to find out the train fare to a distant station from the A.S.M. (Booking) on the telephone, he will not be able to get this information as there is no telephone available at the Parcel cum Booking Office at Panadura station.



Gamin Gamata - Presidential Community & Welfare Service
Ceylinco Banyan Villas
Donate Now | defence.lk
LANKAPUVATH - National News Agency of Sri Lanka

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