HEALTH WATCH

Leprosy: Eliminated but not Eradicated

Keep your eye on early signs:

Dr. SHANTHA HETTIARACHCHI

When Mahatma Gandhi was invited to inaugurate a leprosy hospital called kasturba kushta nivaran nilayam building in Tamil Nadu, he replied the invitees as: “Get someone to open it. Opening a hospital is not a big matter, but I shall come to close it”.

He emphasized the need to eliminate leprosy from India. He represented, worked and spoke on behalf of innocent patients of leprosy. Mahatma Gandhi was trying hard to guide the minds of people towards peace.

“An eye for eye makes the whole world blind”. This was one of his greatest historical saying on non-violence. Therefore, this great spiritual leader in Asia is commemorated twice a year internationally.

His birthday, on October 2 is commemorated in India as Gandhi Jayanthi, a national holiday and in the world as the International day of non-violence. His date of death, January 30 is marked as Anti-leprosy Day throughout the world.

Leprosy was a disease that disturbed the mind of public while affecting the body of innocent patients. It was ubiquitous hundred years ago but now mostly confined to tropical and subtropical regions of Africa and Asia. It was considered as one of the most misunderstood diseases in the past.

There were some non-scientific belief on the causation of the disease such as divine curse, heredity and food habits. Some people have thought that it can be caused by undesirable mixture of foods.

One example for that was eating onion with milk or foul fish. Leprosy was accepted as a deforming, disfiguring, incurable, highly infectious and fatal disease.

The patients with leprosy, were in compulsory isolation and segregation due to the myths and misconception of the disease in the past. Some discriminative rules and regulations were imposed on these patients in many countries.

The patients who worked in the institutions may have to go on long leave of absence from work. Life insurance corporation of India, did not insure leprosy patients. They were not allowed to contest elections. The traveling was restricted for them.

The divorce was granted under various marriage acts on the ground of leprosy. The separation and later divorce was permitted through Christian Marriage Act 1872 and Muslim Marriage Act 1939. Acquiring driving license was not allowed according to motor vehicle Act 1939 in India.

Under the Hindu Succession Act 1956, patients could not have a share of the ancestral property and could not give any property to his heirs because he was considered to have undergone social death.

Segregation camps were built in many countries to keep away the leprosy patients from the society in the past.

The first leprosy asylum in South East Asia was established at Hendala, Sri Lanka in 1708. The second leprosy asylum in Sri Lanka was established at the island Manthiv, within the Batticaloa lagoon. The leprosy patients were admitted to these hospitals till 1960, compulsorily when identified.

Currently, there are about forty inmates in Hendala hospital though they have been cured with proper treatment. These elderly inmates have no relationships with their families as they were staying there for decades.

Leprosy was considered as a contagious disease until the discovery of treatment with dapsone in late 1930. Sometimes later resistance has been developed by leprosy bacilli to dapsone.

Then the leprosy has been changed into a completely and easily curable disease after the introduction of multidrug therapy with dapsone, rifampicin and clofazimine in early 1980s. Nowadays, patients are treated and managed at out patients clinics while they are engaging their routine work at home and work places.

Mycobacterium leprae, the causative organism of leprosy was the first pathogenic bacterium, discovered in the medical history. This bacteria can disseminate in air as a droplet infection through sneezing or coughing of a patient who are in the infective stage.

Mycobacterium leprae can enter to the human body through upper respiratory tract or abraded skin. It should be remembered that eight out of ten leprosy patients are not infectious.

Even this small proportion of infectious patients become non-infectious after commencing treatment. Other distinctive factor is the possessing of inherent immunity to this bacteria by 90 to 95 percent of normal population. Therefore, it is not a cause for fear psychosis among the people today.

Everyone should have basic knowledge on early signs or manifestations of this curable disease to allow the commencement of treatment at correct time to avoid any complications.

These signs are pale or reddish skin patches with loss of sensation, skin nodules and lumps, painless wounds in hands and feet, neurological deformities and ocular manifestations such as inability to close the eyes.

According to WHO reports, the global prevalence of leprosy at the beginning of 2009 was at 213,036 cases, while the number of new cases detected during 2008 was 249,007. The number of new cases detected globally has fallen by 4 percent during 2008 compared with 2007. Pockets of high endemicity still remain in some areas of India, Nepal, Tanzania, Congo, Brazil, Angola, Central Africa, Madagascar and Mozambique.

Sri Lanka has reached the target of elimination of leprosy as a public health problem with the prevalence of less than one patient for 10,000 population at national level in 1995.

Even though the prevalence as a country is low, nearly 2000 new patients are diagnosing in a year up to now. The very unfortunate incidence is that some of these new patients are with late complications of the disease at the time of diagnosis, due to delay in seeking treatment.

Advices from the dermatology and out patients clinics at the Government hospitals is essential in suspicion of an early sign of the disease. Leprosy can be completely cured with drugs that are widely available and free of charge.

It is a responsibility of everyone to have a basic knowledge on this curable disease to increase the rate of self referral and positive attitude of society towards persons with leprosy.

A beautiful mind

Ishara JAYAWARDANE

Journalists and leading media personnel were called to the Ramada hotel last Monday to take part in a press conference titled “Mental Health and Journalism”. However the unexpected happened when we were asked to take part in a open discussion/an open forum.

Journalists and media personnel were called together to the Ramada hotel last Monday to take part in a press conference on “Mental Health and Journalism”. However the unexpected happened when we were asked to take part in an open discussion/ an open forum.

The seminar was led by Consultant Psychiatric Dr. Neil Fernando who invited everyone to take part on a voluntary basis.

At the start of his speech Dr. Fernando posed a question through a hypothetical incident. He asked, if he, as a neighbour harassed his other neighbour then is he or is he not a mental patient? This little story provide the foundation for later discussion and set the stage for an interactive session. He put the question to the gathering and asked us what we felt about him.

“Am I a patient? Why am I doing something like that? Am I suffering from a mental disorder if I am doing something like that?” queried Fernando. “Not a patient, but someone whose mental health is not perfect,” answered a lady in the gathering.

“That is the answer I was looking for. I am not a mental patient but I do have a problem. My mental health is not completely right/good. Even without a disorder our mental health can be not quite right,” said the Doctor in answer to the lady’s response.

The next part of the session was even more interactive with the gathering asked (on a voluntary basis) to write down their own problems that they have had and submit it. There was a variety of responses with problems regarding employment/ bosses and deeply hurt feelings.

“Journalists have the responsibility to talk and tell. They must spread the word about mental health. They must be sensitive to this issue because many of them have had first hand experience. A Mental health problem is something that can happen to anyone and which many are experiencing. Even I as a psychiatrist can experience this. We are humans,” Dr. Fernando said.

Dr. Fernando also highlighted a few salient points in this discussion regarding mental health. They were:

1. There is no development without health care

2. There is no health without mental health.

3. Mental health is more than the absence of mental illness - there is no mental illness but health may have deteriorated. This may have affected family and society.

It has been proved that the education of children suffer because of family problems. Children who don’t do their homework have been directly linked to family problems. A study has proved this. There is a similar pattern to all of this”

1. The father is addicted to alcohol.

2. Parents are not concerned about their children.

3.There are constant arguments in the house.

These children tend to be the type of children who ruin their education. This affects families and communities and even the economy. Economists have proved that mental health problem cost the country billions of US$ dollars. Poverty and Mental health problems form a vicious circle as Poverty is linked to mental health problems.

“Poor Mental Health Literacy: that is where the media come in. they can improve this mental health literacy. Stigma and Discrimination is another problem that the media can help in. they can lessen the stigma by enlightening the public,” Dr. Fernando stated.

Mental health is a serious problem and until it affects us personally we don’t really understand. So we need to be more empathetic and sensitive. People with mental health problems are not mad. They just need treatment and medication to enable them to function fully in society.

It is just like a physical wound. Only it is with the mind.

Indigenous medicine should be promoted

Nadira GUNATILLEKE

Dr. Niriellage Rohana Jayasinghe is an Ayurvedic Physician who practices in Sri Lanka since 2000. He had received ancestral training in Ayurveda from 1984 to 1995 from his father, a famous Ayurveda physician.

After that he practiced as an apprentice under his father.

Dr. Jayasinghe now offers treatment at his own Ayurvedic Treatment and Training Centre. He had also taken part in research activities at Kalubowila Hospital (Colombo South Teaching Hospital) and at Nawinna Ayurveda Research Centre. He acted as a mentor physician at State and private medical colleges in Sri Lanka. Here are some of his views on kidney diseases in Sri Lanka.

Q: What are the main reasons that stand behind kidney diseases in Sri Lanka?

A: It is because of the high intake of food containing more acid, alkaline and bile. Intake of excessive artificial drinks, drinking less water, drinking water associated with limestones and salt are some of the reasons.

Q: Is there any specific reason for the rapid increase of this problem in Wayamba and NCP?

A: It is mainly due to the drinking water. Insecticides get into drinking water and wrong food habits also contribute to increase the seriousness of the situation. These are the main reasons for the rapid increase of kidney diseases in those specific areas.

Q: What are the main symptoms?

A: The main symptoms are increasing or decreasing of urination, swollen legs (lower parts) and swollen face, especially under eyes. When the sickness increases, the patient gets fever. Treatment should be started without any delay as soon as these symptoms appear.

Q: What are treatment available?

A: There are many ayurvedic treatment available for kidney diseases and urine troubles. Kidney diseases can be cured completely if diagnosed and treated properly. It can be halted before reaching to the last stage where dialysis is required. Ayurvedic medicines are capable of doing this.

Q: How can healthy people take care of their kidneys ?

A: It is good to drink more clean water, may be about three litres per day. Taking less acid, and containing artificial food and drinks, avoiding intake of alcohol are some of the good food habits that will help healthy people to maintain their good health.

Actually people have faith in indigenous medicine and they come for treatment in large numbers. What is lacking is state sponsorship. Indigenous medicine should be promoted through state sponsorship. This valuable treatment system is still alive because of traditional Wedamahaththayas who dedicate their lives to ayurvedic treatment system and to treat helpless patients.

A huge service can be done through the Indigenous Medicine Ministry towards this.

Antidepressant use rises among Americans

Susan BRADY

Antidepressants have risen to the top spot as the most commonly prescribed class of medications in the US and, according to a new survey by Consumer Reports, it is a preferred method of treatment for people battling depression. After all, it is much easier to take a pill than sit in a therapist’s office and talk for an hour.

Consumer Reports polled its subscribers on the use of antidepressants, and which ones worked best and had the least side effects. Much of the data collected from the 1500 respondents reinforced conclusions from prior research.

According to Columbia University researchers, there were around 27 million Americans, the age of six and older by 2005 taking antidepressant medications. “Several factors may have contributed to this trend, including a broadening in concepts of need for mental health treatment, campaigns to promote mental health care and growing public acceptance of mental health treatments.

In parallel with growth in mental health service usage, psychotropic medications have become increasingly prominent in treatment,” according to the study authors. The report highlighted the fact that while antidepressant drug usage increased, the use of psychotherapy decreased from 32 percent to 19 percent for those evaluated.

Researchers found that only one in five Americans that suffer from clinical depression receives treatment that is consistent with the recommended guidelines. Researcher Hector M. Gonzalez, PhD, from the Wayne State University in Detroit, and his colleagues wrote in the Archives of General Psychiatry, “Although depression is a leading cause of disability in the United States, few Americans with recent major depression receive. any form of standard care and even fewer receive care that is concordant with the American Psychiatric Association guideline.

Consumer Reports stated that their “survey shows that a combination of therapy and medication works best,” however the marketing push by pharmaceutical companies has won over customers. That marketing push cost $300 million in 2009 for just Cymbalta and Pristiq alone.

Television ads, print ads, discount coupons, free samples for doctors to dispense—these two drugs are known in most households in America whether they use them or not.

However, these two new drugs called SNRIs, aren’t necessarily the best course of pharmaceutical action. The Consumer Reports survey found that there is “no evidence that newer drugs like Pristiq and Cymbalta work any better than older medications in their class,” meaning that the older medications, SSRIs like Prozac and Zoloft, are just as effective and probably easier on the wallet, too.

Depression is a serious illness that needs to be treated. If left untreated, it can lead to other health issues. There are a variety of options today to help treat depression, so if you suffer from depression, talk with your doctor to see what you can do to get back on track to a happy, healthier you.

-Healthnews.com

Auslmat’s 19th visit to SL

The Australia Sri Lanka Medical Aid team will make its 19th post-tsunami visit to Sri Lanka from June 12.

Dr. Jennifer Johns-cardiologist at the Austin hospital in Melbourne, will lead the team which will include Dr. Quintus de Zylva, Dr. G.U. de Silva, Dr. Kamala de Silva, Dr. Jerome Ephraums, Malithi de Silva, Una Jones, Ranjini Dassenaike, Professor Sam Menahem (Professor of Paediatric Cardiology), James Coburn, Nalini Joseph and nursing staff Geraldine and Nalene.

The Australia Sri Lanka Medical Aid Team (Auslmat) was formed in the aftermath of the Indian Ocean Tsunami when like minded GPs, medical specialists and their supporters came together to assist Sri Lankans affected by the disaster.