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
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
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?
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,
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.
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
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.