HEALTH WATCH

Garbaging your health!

Nadira Gunatilleke

Health Minister Maithripala Sirisena revealed a very important piece of information during a recent ceremony and he repeatedly mentioned the same fact several times during various ceremonies held last week. But it seems the fact did not receive adequate publicity through the media.

Minister Sirisena said that during past three months no rabies deaths were reported from the country as a result of destroying garbage under the National Dengue Control Program implemented countrywide.

This should be a `breaking news’ for Sri Lankans. Rabies is not the only disease promoted through garbage. There are many other diseases. There is no need to say that it is garbage which cause the majority of health problems in Sri Lanka. But this bitter truth had been ignored by the relevant authorities and the public during the past until garbage mountains were removed under the National Dengue Control Program implemented by the Presidential Task Force with the assistance of armed forces.

Now Minister Sirisena is planning to have a sustainable national program covering the whole country to dispose garbage properly as one of the key steps to establish a healthy nation. It will be done in coordination with relevant ministries. But no program will bring successful results without the active participation of the public. Active participation of the public comes through having the right attitude.

What is the present attitude of the public on garbage and garbage disposal? It is clearly visible all over the country.

Here is the current attitude of the public on garbage and garbage disposal. It is the sole responsibility of the state to collect garbage and dispose properly. The public have nothing to do with it. The public can collect the garbage as they wish and dispose garbage as they wish no matter how where and when!

Garbage mountains can be ignored and there is no impact of them on human life. Sri Lanka has some of the highest health indicators and one of the highest literacy rates in the world. But this is the attitude of the Sri Lankan public on garbage disposal. Foreigners who visit Sri Lanka may be wondering whether Sri Lankan have healthy noses!

The Sri Lankan public is dangerously ignorant about the connection exist between garbage and health. For example they did not see the direct connection between the garbage and rabies until it was proved by the National Dengue Control Program. The garbage problem is something that can be ignored for the Sri Lankan public. The only people who fight against garbage are the ones who reside next to huge garbage mountains. The smell, flies, stray dogs are not `issues’ for the majority of the Sri Lankan public. That is how thousands of unhygienic food outlets operate countrywide without a good income.

If there is a huge garbage mountain next to your home, What would you do about that? Usually the residents of the area ignore garbage mountains or act against garbage dumping once or twice. That ends there. Most of the times garbage does not come to a place from far away. The residents of the same area dump garbage. Rarely you can see a Buddha statue standing tall at a place where a huge garbage mountain located earlier. This is the only practically successful step that can be taken by the resident to stop garbage dumping and they do this rarely.

No Sri Lankan is interested in collecting their garbage separately in order to dispose properly. The accepted method of garbage collecting is collecting the garbage in separate bags/bins as the stuff that decay and the stuff that can be recycled or not decaying. But no Sri Lankan home collect garbage according to this system. What they do is collecting everything into one sili sili bag and dispose the bag somewhere.

Nowadays some Sri Lankans have developed an extremely negative method of garbage collecting and disposing. They collect garbage into a bag no matter how large their home garden is.

Even when they live in a 25 perch land, they collect garbage into a bag.

They collect it as a mixture of everything including food waste, paper waste, glass waste, plastic waste and sometimes iron waste.

They keep their garbage for the maximum time possible.

After that they wait till midnight and throw the garbage bag by the roadside or anywhere else they can find! There are some people who burn their garbage including plastic and polythene polluting the air of the whole area!

This is not so when it comes to countries like Sweden where the public is very concerned about garbage and garbage disposal.

The public is well disciplined when it comes to disposing garbage. The country has tough rules and regulations on garbage disposal. No wonder walking on roads in Sweden make people healthy and selected the country as one of the best places in the world to live. But it is the opposite when it comes to Sri Lanka.

There is a very small connection between garbage disposal and the economic status of the country. What matters is attitude and the tough law. This is what lacking in Sri Lanka.

Saving lives through awareness

Lanka Hospitals partners Sri Lanka Heart Association :

For nearly four decades the Sri Lanka Heart Association (SLHA) has championed the cause of preventing heart related diseases through proper preventive steps. Each year, a deserving organization is chosen to partner the SLHA on its annual heart health walk, held on World Heart Day.

This year’s partner, Lanka Hospitals has been a driving force behind the development of health care standards and practices in many medical spheres.

The theme for this year’s walk was “Work place wellness – take responsibility for your own heart”- focusing on easy and effective preventive steps that, in the long term, will help patients reduce the risk of heart diseases and ailments to a staggering degree.

The walk was held on September 26 starting at 6.30am at the D.S. Senanayake College junction at Borella and ended at Lanka Hospitals where an event was organized to educate the public about heart health. The event also featured free cardiac checkups and consultations with some of Sri Lanka’s leading cardiologists.

Speaking on the event Lanka Hospitals CEO Lakith Pieris emphasized the need for enhancing the awareness of the walk. “Each year an estimated 33,000 people suffer from heart related ailments that can be prevented by educating the public on the simplicity of preventive methods. With the ever increasing pace of life, people often let their health take second place to work commitments, while simple and easy to do preventive methods could save lives.

“Through our partnership with the Sri Lanka Heart Association we hoped to enhance the general public’s awareness on heart diseases and help to prevent the development of heart diseases and ailments. We are very thankful to the SLHA for choosing to partner with us this year and making the event successful with over a 1000 participants”. Having consistently maintained that the key to good heart health is through preventive methods and awareness, the SLHA has always been at the forefront in enhancing the standards of heart health across the island.

“The mortality rate of heart ailments is one of the highest in Sri Lanka and around the world. The fact remains that once you are diagnosed with a heart ailment, taking measures to prevent the condition deteriorating becomes a lifelong challenge. This is why it is so important to educate the public on the steps that can be taken to prevent heart ailments from occurring. Through participation at the walk, we pledge our commitment to reducing the number of deaths related to heart ailments and pledge our commitment to continuing our campaign to enhance the standards of heart health in Sri Lanka,” President of SLHA President Dr. W. S. Shanthiraj said speaking on the importance of the event.

Diabetes Mellitus:

Complications avoided in early identification

Dr. SHANTHA HETTIARACHCHI

He had been admitted to the accident service of a leading hospital with multiple injuries. This unexpected journey was due to a road traffic accident, that he met, while travelling in a motorcycle to his workplace as a routine in the morning. While receiving proper care at this moment, he found that he has lived with a very high level of blood glucose without any clue.

This middle aged public servant was tested for blood glucose at this time as he has a family history of diabetes. Then more attention had to be given for newly found diabetic status than his immediate problem, resulting from the accident. The gravity of the issue was so high as his blood glucose level was nearly 400 mg per deciliter, more than tripled the normal value.

This incident is a good example in highlighting the issue of hidden diseases in anyone’s life. It is a common finding that the clinical manifestations of chronic non communicable diseases, such as diabetes, hypertension, cancers may express in years after the initiation of the illness. There may be some adaptation of the body even to the high level of blood glucose to hinder the clinical expression of the disease for longer period but the risk for every systems, organs and tissues of the body is continuing from the starting point.

Therefore, screening for these diseases are utmost important in avoiding many preventable complications, especially if there is a family history of the relevant disease or an identifiable risk factor, such as obesity, physical inactivity or psychological stress.

Diabetes mellitus is characterized by high blood glucose level or hyperglycemia due to a deficiency of a hormone, called insulin or inability or resistance of the cells to make proper response to this hormone.

According to statistics from the World Health Organization (WHO), more than 220 million people are currently living with this disease, worldwide. Nearly 1.1 million people have died of this chronic ailment in the year of 2005. It has been revealed that the death toll of the diabetes may double between the period of 2005 and 2030.

The disease burden is more in our region, as 80 percent of diabetic deaths are reporting in low and middle income countries. It has been estimated that 1.5 million people in Sri Lanka are suffering from Type 2 diabetes. The disease prevalence has been marked as 10.3 percent in the country.

Insulin, secreted from the gland of pancreas, is the key hormone responsible for the storage and controlled release of the glucose, absorbed through the gastrointestinal tract. Blood glucose levels are well maintained and regulated in a person while living with daily changing of the requirements mainly nutrition and physical activities, through the actions of this hormone. The liver absorbs glucose and stores it as glycogen to supply the need of the body tissues in utilization of glucose whenever necessary.

There are two types of diabetes, called Type 1 or Insulin Dependent Diabetes Mellitus (IDDM) and Type 2 or Non-Insulin Dependent Diabetes Mellitus (NIDDM). In Type 1, the body does not produce enough insulin while in the Type 2 diabetes the body cells do not respond to produced insulin.

In Type 1, the disease may be inherited and developed at younger age. The child of IDDM patient has an increased susceptibility to the disease. There is evidence that autoimmune diseases are also linked with the causation of Type 1 diabetes in some instances. Autoimmune diseases may develop when there is a failure to recognize the body’s own tissues as self, by the immune system and attack on them.

In Type 2, the patients are usually older and often overweight. There is no evidence of immune involvement in the causation but someone may have easy access to the disease when there is a family history of Type 2 diabetes. Physical inactivity, unhealthy diet and mental stress are the major risk factors for the disease similar with other non communicable diseases.

The clinical manifestations will develop rapidly in Type 1, but slowly in Type 2 diabetes. Polyuria or frequent urination, nocturia or necessity to urinate in the night, thirst and weight loss are among the main complaints of the patients. Sometimes , especially in the Type 2 disease, lack of energy or tiredness, blurred vision or itching in the genital region due to frequent fungal infection may be the first clue to the fairly old unknown ownership for this gift.

There is an advantage in detecting normal or diabetic status early, through the testing of blood glucose. There are two basic tests, namely, Fasting glucose and Two hour glucose testing in reaching the diagnosis.

Fasting glucose test to be done after 8 hours of fasting. It takes as normal, if the value is less than 110 miligram per deciliter or 6.1 milimole per liter. If it is more than 126 miligram per deciliter or 7.0 milimole per liter, diagnosis of diabetes is confirmed.

A Two hour glucose test is to be done after two hours of giving 75mg of glucose orally. It takes as normal, if the value is less than 140 miligram per deciliter or 7.8 milimole per liter. If it is more than 200 miligram per deciliter or 11.1 milimole per liter, status of diabetes will be revealed.

Another additional test in diagnosing and monitoring the control of diabetes is , Glycated haemoglobin test. The value of this test is more than 6.5 percent in diabetes. This test is important in reviewing the control of the disease while adhering to drug therapy and lifestyle changes. Testing must be beneficial at age of 45 years in any adult and adults who are overweight (Body Mass Index is more than 25 kilograms per square meter) or having one or more risk factors such as family history of diabetes, physical inactivity or mental stress at any age. If the tests are normal, repeat testing should be carried out at three year intervals.

There is a term, called pre-diabetes, in which the blood glucose levels are higher than normal but not high enough to diagnose as diabetes. The 100 to 125 mg per dl or 5.6 to 6.9 mmol per liter fasting blood glucose level (impaired fasting glucose) or 140 to 200 mg per dl or 7.8 to 11.1 mmol per liter blood glucose level, two hours after taking 75mg glucose (impaired glucose tolerance test) is included in this pre diabetic stage.

As they may end with Type 2 diabetes later, it is suggested to repeat the testing once a year in these instances instead of once in three years in a normal person.

A person may end up with complications, when the disease state is not revealed for a longer period or if it was not controlled properly after knowing the diagnosis. Skin infections, retinopathy with visual impairment, polyneuropathy with numbness and tingling sensation, diseases of the blood vessels and impotence could be considered as the main complications of the undiagnosed or uncontrolled diabetes.

Therefore, prevention as well as the control of the diabetes are equally important in ensuring the qualitative life.

Everyone should think about regular exercises or physical activities, maintenance of healthy body weight, healthy diet, mental relaxation and proper control and follow up with medication when it is diagnosed in this context. It should not be forgotten that the basic knowledge and healthy attitudes will protect the life from many risks.