Health Watch

Healthy justice!

Nadira GUNATILLEKE

If you are a regular newspaper reader, you must remember some of the tragic incidents reported in the Daily News and all the other newspapers some time back. In one instance a doctor pushed an innocent young female patient from the fifth floor of a state hospital and killed her.

Few months ago there was another news item where a doctor raped a pregnant mother, warded at Sri Jayawardenepura Hospital for childbirth. Do you still remember them? I do remember them because I reported them for the Daily News! Maybe there are many people who remember those incidents and wonder what happened to those culprits.

Verdict

The MBBS doctor who pushed one of his female patients from the fifth floor of a state hospital is now in remand prison. The case is still going on. The verdict to be given. The doctor who raped a pregnant mother warded at a state hospital for childbirth is now interdicted, not dismissed! But these are not the only cases reported from our health sector in the past and definitely these are not going to be the last cases.

Therefore, something has to be done for the protection of patients because the so called watch dog (media) is being silenced by some type of force.

There are many cases of medical negligence that take place in almost all private hospitals in Sri Lanka often, but non of them come into the light or report it to the media. There are very important questions to ask in this regard. Are there incidents of medical negligence that happen in private hospitals in Sri Lanka?

No evidence

The answer is yes. If you ask this questions from yourself! Maybe you still remember how you suffered even after paying a large amount of money to obtain their service. Then why are such incidents not reported to the media?

This question has to be asked because whenever something goes wrong in a state hospital it is media which start a ‘crusade’ to tarnish the health service while earning good money by selling the story. But it is not so when it comes to private hospitals and to certain `holy doctors’ who appear in our society time to time and ‘cure’ people or send them directly to heaven !

As a health journalist, I can answer this to question myself. You may not believe, there is a private hospital mafia in Sri Lanka. It cannot be seen openly and no evidence at all. But it is there. I got my first experience of this mafia when I had to report something negative about the private hospitals.

I received the information from the Health Ministry. I reported it in my newspaper. After reading the news item, this private hospital `mafia’ contacted me and forced me to write the opposite of the same story which I did not do. Another incident took place when I reported about an `operation’ that was preventing poor people getting quality drugs at a low price. It seems some `elements’ are much more powerful than anybody else.

General knowledge

You have a big responsibility as a patient when it comes to ensuring that you get the best care. The first requirement is a good general knowledge.

You have to know simple things such as there are small and big cannulas available in all hospitals for the use of babies and adults.

If a nurse comes with a huge cannula to give an injection/saline to your baby, you should ask her to use a baby cannula. If she says no, you have to ask why she cannot follow the relevant procedure. You have to do this especially when you pay money and obtain services from the private sector.

Medical tests

It is same when it comes to medical tests. Some medical tests require certain preparations. For an example if you are warded at a hospital to obtain a abdominal ultra sound scan, you need to drink adequate water to fill your bladder and have to wait without passing urine.

But according to my own experiences, in certain private hospitals, this preparation part is completely ignored (especially when you are warded with no serious illness or symptoms), and the patients get wrong medical reports.

This can put their lives in danger. The patient pay thousands of rupees for a useless medical report which does not contain the actual information of his/her condition! Do not hesitate to ask questions when you do not know what is going on and when you suspect something.

Learn the names and appearance of simple drugs such as different types of antibiotics, pain killers and other medications. Once my father saved my life when I was given Inderal (a medication prescribed for heart aliments) tablets instead of Incidal tablets (a tablet prescribe for skin diseases).

I was just a 7 years old kid and my father compared the name of the tablet and the name in prescription and found out the fatal error made by the unqualified pharmacist. My father used Inderal.

Do not place your entire trust on the hospital staffs, medical equipment and even lab reports.

They can go wrong at any time. Take a part of the responsibility to your shoulders. After all it is your life. Memorize the history of your disease and describe it to the doctor in detail in advance.

What you feel is more important when it comes to your health. You cannot diagnose your own disease but doctors or nurses cannot ignore what you feel inside your body, especially when it is difficult to diagnose your disease.

Health promotion for a healthier tomorrow

The authorship of our own health and well-being is with us; Lord Buddha had taught. Transforming this authorship from our traditional health care provider to the individual has proved to be a promising mechanism in resisting the obstacles and achieving optimal well being.

This simple but important fact is the core theme in health promotion. In the past few decades, factors determining our well-being were notoriously inept and they continue to be so.

It is primitive to believe in health as a passive concept that is mainly dependent on the health care provider. Health should be viewed as a positive concept emphasizing social and personal resources, as well as physical capacities of an individual.

In the recent past, we have begun hearing about an increase in premature deaths due to non-communicable diseases, in addition to chronically escalating violence, accidents and suicide.

True, at present the life span of a Sri Lankan individual is considered relatively long. However, the added years are lived in poor health causing reduced quality of life to the victim, additional burden to the caregivers, and cost to the health system.

The threat to lives of the younger generation by the above mentioned health issues is an immediate matter of concern. Many of these health issues pose a significant bearing on the productivity of the nation through reducing quality of life on a long-term basis. The major non-communicable diseases are cardiovascular diseases, cancer and diabetes.

These diseases are attributable to the highest number of deaths in our South East Asian Region. The risk factors leading to these diseases are mainly a cluster of life style factors, for example, major ones being smoking, alcohol consumption, physical inactivity and unhealthy dietary patterns. These can be readily controlled. Projections have shown to be that these major diseases will continue to be the main health challenges in the years to come.

Although the technological revolution in the medical field is progressing, somewhere we are failing to control the epidemics of communicable as well as the above-mentioned non-communicable diseases, injury and suicide. Government efforts are massive in spending both manpower and money on ill health. So where is the slip-up?

We have failed to empower our communities in making them responsible for their own health. Traditional health systems continue to make decisions on behalf of the patients, oversee their needs and we still practice a conventional top down approach.

In this scenario, health promotion has appeared as a trustworthy reconsideration to our health systems. The Ottawa Charter (1986) defines health promotion as: “the process of enabling people to increase control over, and to improve, their health..”

The strategy of health promotion has several guiding principles, one of which is understanding that health is affected not only by genes, but also by the individual’s lifestyle, the community’s quality of health care, and social, environmental, economic as well as political factors.

Acting on a particular area or working on a sustainable change based on the best available data and evidence, and working to reduce social injustice against every individual, family and community so that they can fully benefit from a health promoting society, are another two general principles of this philosophy.

Furthermore, encouraging community participation to enable individuals to make individual decisions on their health, using information, skill development, support, advocacy and structural change strategies so that people are not wholly reliant on the health care providers is a main principal of health promotion.

In other words, health promotion articulates empowerment as a major health outcome or the final step of the behavior change. Additionally of course, it is necessary that health promotion is initiated in collaboration with a broad range of sectors; not simply the health sector and with those that do not have a distinct health focus.

This action will hopefully deliver quality health promotion programs and will reduce duplication or fragmentation of the effort. Through the above-mentioned frame or principles, it is hoped that health promotion flourishes as a quality and accepted resource in maintaining population wellbeing.

In this background a question arises as, what is the role of health care providers in health promotion? The answer is reflected in three bold words; enabling, mediating and advocating. That is, health care providers should enable the individuals and communities to have control over their own health through provision of information and skill development.

They should be capable of mediating between different sectors and then advocating on the importance of health promotion to decision makers and communities. However, the present health professionals are incompetent in those three roles. If we are anticipating success in the field of health promotion, the education curricula of health professionals must be appropriately reoriented.

Considering the promising ideologies of health promotion, all the same it is slow to progress. There are several reasons for this matter. Firstly, our traditional health systems still adhere to the more conventional health approaches whilst barring the communities from experiencing control over decisions that influence their own well-being.

Resultantly, communities themselves feel more comfortable having health care providers making decisions on their health. In short, our communities are not adequately empowered to independently control their own health.

Not understanding the importance of working together with other sectors, but working in isolation inevitably results in losing potential benefits for the communities. Mediating skills of health professionals decide on the successfulness of such collaborations.

Awareness of decision makers on health promotion is weak. So it is of utmost importance of advocating them on this matter on behalf of communities.

Advocacy is to gain political commitment, policy support and the desired social acceptance, with the aim to protect vulnerable people and empower whose requirements and views should be listened to.

Another issue is that although the concept of health promotion encourages the use of best available evidence based practices, in our setup the research practice gap is huge.

Usually evidence-based information from foreign cultures, some in which the socio-cultural adaptability of is questionable, are incorporated. It is mandatory to involve the policy makers at initial stages of research in order to facilitate the knowledge transfer smoothly and timely.

Moreover, the value of partnership building cannot be underestimated in health promotion. Here too, the health sector lags behind. Not to mention in the inter-sectoral partnership, within the health system private public partnership is also very weak.

Health programs are rarely designed based on the needs of its communities. However, health promotion programs maintain sustainability through considering the specific needs of the local communities and making sure that the latter is involved in every stage of the program design, implementation and evaluation.

The above failures of the local health situation are not the only reasons to reconsidering a new strategy; that is, in the form of health promotion. It is a highly cost effective measure and is the ideal solution to our escalating health expenditure.

Our well-developed existing public health network will be a reliable channel through which this concept can be disseminated to health and non-health sectors and local communities.

Furthermore, strong sustainability of results is assured since the major activists in this approach are the empowered individuals. And it is reassuring that different approaches of health promotion are adaptable to our existing health systems without much of an infrastructure modification or expenditure, simply with the people’s dedication.

What’s more, settings approach can be incorporated to any community or institution while life course approach of health promotion can be practiced through mainstreaming the health promotion concept in to an existing health program, such as Maternal and Child Health program.

Placing the empowered communities as the main pillar of this process, building partnerships with a broad range of sectors, implementing a variety of interventions designed by and with people but not on people, health promotion will lead to the desired shift in population well being, a sustainable one.

Dr. Sujatha Liyanage, Health Education Bureau

Tummy Ache?

Blame it on Biodiversity Loss

Mallika Naguran

Thanks to a kind of frog that can no longer be found, millions of people suffering from stomach ulcers (peptic ulcers) have lost a chance to heal better.

The southern gastric brooding frog (Rheobatrachus) discovered in the Australian rainforests in the 1980s intrigued scientists with its ability to raise its young in the stomach where enzymes and acids could have digested them instead.

This amazing fact led to preliminary studies that the baby frogs produced substances that inhibited acid and enzyme secretions the gastric tract, or stomach.

As the frog has been extinct, the research stopped prematurely. “The valuable medical secrets they held are now gone forever,” key authors of the newly released book Sustaining Life: How Human Health Depends on Biodiversity Eric Chivian and Aaron Bernstein said. New treatments for thinning bone disease, kidney failure and cancer plus a new generation of antibiotics may all stand to be lost unless the world acts to reverse the alarming rate of biodiversity loss, the book argues.

It also comprehensively explores the medicinal relevance of diverse species such as bears, cone snails, sharks, horseshoe crabs and gymnosperms.

Since time immemorial, plants and animals have provided solutions to many of mankind’s quests for health by learning more about how they live and stay alive in spite of unusual factors.

It has now unfortunately become increasingly difficult for research in natural medicinal sources due to the critical reduction of biological diversity.

As animals become extinct due to climate change and the destruction of their natural habitats such as rainforests (both human influences) the chances to study evolution and biology to better understand our planet become difficult.

The head of United Nations Environment Program Achim Steiner describes the rate of biodiversity loss as reaching ‘dramatic proportions’.

“Human activity, environmental impacts, climate change and loss of biodiversity have led to the loss of important ecosystems. It’s a tragedy that the world does not understand the value of biodiversity,” Steinerhe told media.

Who should sit up and take notice of biodiversity loss?

“It is no longer the luxury of ecologists or naturalists to care about preserving biodiversity but society as well,” Achim Steiner said adding that pharmaceutical companies greatly depend on nature, not just chemicals, to treating society’s health and well-being.

World Hypertension Day

The International Society of Hypertension declared May 17, as the World Hypertension Day. This is now an annual event. In this institution we have been having a Public Awareness Program for the third year in succession.

Of the 6 billion people in the world nearly 1.2 billion people suffer from Hypertension. In the USA (JNC7) guidelines anyone with BP>120/80 to 139/89 would be in the ‘Pre-hypertension’ category and BP>140/90 mm would be declared Hypertensions. Nearly 20 percent of global population are Hypertensives and more with pre-hypertension.

High Blood Pressure is associated with obesity, hypercholesterolemia, diabetes, Metabolic Syndrome and family history of hypertension. Expected complications in the untreated include.

Heart failure, Kidney failure and Angina. The course is usually primarily undetectable (essential hypertension) and sometimes secondary to kidney disease, endocrines disease or renorascular disease or associated with drugs.

Prevention is better than cure Lifestyle modification is mandatory viz reduce weight, reduce salt, smoking and strees.

A new Centre viz Kidney, Diabetes Hypertension and Cardiovascular Centre (KDHC) is promoting prevention and health promotion and early detection of these connected illnesses with common overlapping factors. They advice avoiding “9S” factors.