HEALTH WATCH

Sri Lanka Patients’ formulary

Book Review

The first ever Sri Lanka Patients’ Formulary has been published and launched

Any Formulary is a list of medicines and contains information regarding generic drugs, prescription drugs and over-the -counter drugs. Formularies have existed for decades and are usually used by hospitals, doctors, pharmacists and authors of patient management protocols. The Sri Lanka Patients’ Formulary has been designed for use by all these categories as well as members of the public who will at one time or the other be ‘patients’ on various medications.

Over the last few decades, the doctor-patient relationship has changed. No longer do patients accept ‘doctors orders’ unquestioningly. Patients are now viewed as consumers with options and rights, just as much as the purchasers of any other service or product.

They have a right to know, and they wish to know, the whys and where fores of medicines prescribed for them.

It may not be possible during the limited time available during a consultation for the doctor to communicate all the possible actions, undesirable effects and contraindications for taking a drug.

The Sri Lanka Patients’ Formulary explains such essential information in reader-friendly terms, with the objective of providing an opportunity for the general public to understand the nature of the drug prescribed to them. Its objective is not to encourage self medication, but to make laypersons informed consumers of common western medicines.

The nature of its content may be illustrated with a few examples.

e.g. 1 Amoxicillin and co-amoxiclav - among other information, the effects of co-amoxiclav on the liver and the possibility that it may negate the effects of some oral contraceptives is explained.

e.g. 2 Aspirin - among other facts it is explained that aspirin may be harmful to children below 16 years, in pregnancy and during breast feeding, should be discontinued before surgery and that alcohol should be avoided while on aspirin.

e.g. 3 Sildenafil (used to treat erectile dysfunction) - it is explained that, among other things, it is contraindicated if the patient is taking any nitrates such as glyceryl trinitrate, and that it should not be taken without a physician’s advice if the patient has heart disease, hypertension or a history of stroke.

These examples illustrate how useful the book is to layment as well as doctors, medical students and pharmacists etc. I would venture to say, it is a ‘must buy’, a ‘home doctor’ of sorts for families and others. By a systematic examination of this book’s General Index, and the Appendix 2 and gives a list of Generic versus Brand Names, readers can access useful information on over 400 generic formulations and over 500 branded formulations. There is valuable information on vaccines and vitamins as well. The book has a very useful Appendix 3 that gives the “normal values” for common laboratory tests.

One concern that patients have, is about cost. I hope that in a future edition, the authors could indicate whether the drug is available in the generic form, approximately how many brand preparations there are in the market and the price range between the cheapest and most expensive. Of course given that prices keep changing it will be a rough estimate but nevertheless a useful guide.

May I also suggest (the authors may already have plans) that this book be translated into Sinhala and Tamil. Sir William Osler is quoted by the authors - “The desire to take medicines is perhaps the greatest feature that distinguishes humans from animals”.

Perhaps this desire should be fulfilled in an informed manner. People who wish to be so informed may purchase copies from Rajya Osu Sala, Colombo 7 or from the Sri Lanka Medical Association at No 6, Wijerama Mawatha, Colombo 7.

Professor Lalitha Mendis

President,

Sri Lanka Medical Council

Editors: Professor Colvin Goonaratna,

Dr Chamari Weeraratne, Dr Manju C Weerasinghe, Dr Thiwanka Wijeratne

‘All Island Mobile Blood Donation Campaign November 2010’:

Support Blood Bank to sustain public health

National Blood Bank has organized the annual Blood Donation Campaign islandwide to sustain the needs of patients countrywide.

Although the National Blood Bank did a silent yeoman service during the internal war and health crisis the need for blood is rising due to the DHF, heart surgery, cancer operations and blood transfusions prevalent today. It is necessary to maintain and sustain blood supply to the blood bank on a regular scale. The importance of mobile blood donation camps are immeasurable. Everyday over 5 to 20 blood donation camps are being held nationwide to siphon regular blood supplies for the nation.

The general public in good health are hereby informed of the dates and places where the blood donation camps will be held, for their kind response to a nations needs.

‘All Island Mobile Blood Donation Campaign November 2010’:

Support Blood Bank to sustain public health

All Island Mobile Blood Donation Campaign :

DATE    PLACE
8 Cadet Team - Thangalla
9 SL Air Force - Trincomalee
9 Galadari Hotel - Colombo -01
9 Ceylinco Life - Meerigama
9 Hiyare M.V, Hiyare- Galle
10 Welpalla M.V - Welpalla
10 St Marys Church - Matara
10 Taj Samudra Hotel Col -03
10 Keerthirathnaramaya - Rambukkana
10 Brandix - Pinnawala
10 Ibbagamuwa Central College - Ibbagamuwa
11 Brandix - Katunayake
11 AEGIS Company - Wattala
11 Taj Samudra Hotel Col -03
11 Sri Rathnodaya M.V - Hangamuwa
11 Aluthwala M.V, Aluthwala
12 Manin Town - Col -01
12 Meerigama
12 Western Imfermary- Colombo -08
12 HNB- Head Office – Col-10
12 Southern Hemas (PVT) Hospital, Galle
12 Sudharmarama Viharaya - Kapugama
12 Hospital Minneriya
12 Brandix - Nivithigala
12 DS/OFFICE - Rideemaliyadda
12 Mallagolla Viharaya - Indulgoda
13 Brandix - Meerigama
13 Sri Bodirukkaramaya - Kumbukgahamulla
13 Mawathgama Vidyalaya - Homagama
13 Pubudhu Sports Club - Kiribathkumbura
13 Abinawaramaya - Ginigathhena
13 Irrigation Hall - Nattaranpotha
13 Mandawala Mahinda Vidyalaya - Weliweriya
13 Bopitiya Muthuraja Library Hall - Pamunugama
13 Export Garment, Pitigala
13 No-105/1,Nampamunuwa, Piliyandala
13 HNB - Embilipitiya
13 Jayasumanaramaya - Warara, Kurunegala
14 Bollagala M.V Ganewatta
14 Lumbini Viharaya - Dalugama Kelaniya
14 Mattumagala
14 SANASA Insurance - Matara
14 Gunasekararamaya - Ihala Biyanwila
14 SANASA Insurance - Colombo -03
14 Ambuldeniya Junction
14 Ulpatha Elagama Temple - Hingurakgoda
14 Wisdom School - Gampala
14 SANASA BANK - Kandy
14 SANASA Hall - Dalugama
14 Town Hall - Kegalle
14 Uswa Society - Hemmathagama
14 Lankarama Viharasthanaya - Hiloogama
14 Ramboda Temple - Ramboda
14 SANASA Bank - Chilaw
14 Thalagala - Sri Dharmendraramaya
14 SANASA Insurance, Ratnapura
14 SANASA Insurance, Karapitiya - Galle
14 Sanasa Developing Bank - Kurunegala
15 Brandix - Ekala
15 Brandix - Minuwangoda

Preventing HIV in Women part 3 - Continuation

Presidential Address 2010 – College of Venereologists

Dr CHANDRIKA WICKRAMASOORIYA

Consultant Venereologist

We are twenty-five years into the global AIDS epidemic and there is still no widely available technology that women can both initiate and control to protect themselves from HIV.

Male domination

To enable women to protect themselves, there are three issues to be considered:

i. Improving the social and economic status of women: women must be empowered to make informed choices and enabled to improve the quality of their lives.

ii. Top-level political commitment is needed to reduce the social vulnerability of women to HIV infection by improving their health, education, legal and economic prospects.

iii. Implementation of sustainable HIV/AIDS prevention interventions that provide the necessary knowledge, develop skills and support safer practices among both men and women, particularly in the most vulnerable sectors

2. Providing a practical method over which women have sufficient control independent of male participation is considered desirable in the context of male domination in decision making. Some of the possible solutions would be the use of the female condom and the use of microbicides:

Female condoms

This did not become popular in Sri Lanka as did the male condom because it is more expensive than the male condom. It is poorly marketed, it is bulkier and it still requires some degree of male cooperation.

Although the female condom is more expensive than the male condom, female condoms could be a cost-effective prevention method to be used to prevent HIV infections in situations where the male condom cannot or would not be used.

Vaginal microbicides

Vaginal microbicide - a gel or cream that could be applied to the vagina without a partner knowing and which would prevent HIV infection.

The last AIDS Conference in August 2010 Vienna presented the promising finding of the research on vaginal microbiocides.

Microbiocides are expected to prevent millions of HIV infections in women, men and children. Research has shown that even a microbicide that is only 60 per cent effective would prevent at least 2.5 million infections over the course of three years.

The CAPRISA 004 trial assessed the safety and effectiveness of Tenofovir vaginal gel, a microbicide in 889 South African women participants, with a retention rate of 94.8-percent at 30 months.

It comprises the insertion of the gel up to 12 hours before sex, a second application of gel as soon as possible but within 12 hours after sex. In women with high adherence, a 54-percent effectiveness was seen. Additional studies are urgently needed to confirm the findings of this trial both for safety and effectiveness.

Microbicides are intended as part of a broader package of prevention options. They would complement – not replace – options such as abstinence, faithfulness, and condom use, and yet would address a glaring gap in current prevention packages. Female condoms are not widely used. Microbicides are not yet available for us.

What do we have to rely on in protecting women and children?

Getting more men to adopt safer sex - protecting women from HIV is not solely the responsibility of women. Most women with HIV were infected by unprotected sex with an infected man. Preventing transmission is the responsibility of both partners, and men must play an equal role in this effort.

Finally till the days female condoms are freely available, acceptable and widely used vaginal microbicides are in the market for an affordable price it is men who have to play the vital role in protecting women and children.

Preventing the birth of HIV affected children

In my short address I made an earnest attempt to highlight the need for protecting women from HIV infection and thereby preventing the birth of HIV affected children. I have drawn attention to the subservient role of women in our society and the passive acceptance of male dominance. Women in our society need to be equipped with the necessary skills to overcome this attitude. Planning and implementing HIV prevention interventions that provide the necessary knowledge, develop skills, and support safer practices among both men and women is a daunting task. Nevertheless this challenge has to be met.

Although venereologists have an important role in the prevention of HIV, there is a need for commitment from all stakeholders, government organizations, NGOs and the community.

It is important that we recognize the most vulnerable sectors in the populations and focus our attention on them. The National STD/AIDS Control Program which plays the lead role in this activity may benefit from establishing closer links with the primary health care system in the country which would provide opportunities to educate women through the existing well-organized maternal and child health program, through its network of public health midwives and nurses.

Involvement of public health inspectors in educational programs for men will complement such a program. Similar linkages with NGOs and private sector organizations will strengthen our preventive actions.