Health Watch

Health promotion as a tool of improving mental health

Senali S.Perera

To kill a weed, you pluck it from its stem; it will keep growing strong and fast. But if you pull it by its roots, the weed will have no part of itself left that could bring it back to life. The roots. You should get it by the roots and destroy it.

The workshop “Health Promotion as a Tool of Improving Mental Health” was held at the Hector Kobbekaduwa Agrarian Research and Training Institute, Colombo 07 recently. A group of mental health physicians, getting together in an attempt to ‘pull the weed by its roots’. The event was organized by The Forum of Community Base Mental Health Physicians in collaboration with Rajarata University.

“Through this, we are mainly focusing on the community service,” says Dr. U. L. Sarafdeen, diploma psychiatrist of The Base Hospital, Sammanthurai, Kalmunai. “Rather than sitting in the hospital clerking your patient, we take a step forward and go directly to the community level and enhance the coping skill of the people.”

According to Dr. Sarafdeen, the target is mainly to enhance the mental health of the community. Prior to diagnosing illnesses, the doctors are determined to find the roots where these mental illnesses and disorders start and make a change because prevention is always better than cure.

Lack of physicians

In the aftermath of the tsunami, the World Health Organization (WHO) found there was severe scarcity of Psychiatrist in the island. This issue was brought to the concern of the then Health Minister Nimal Siripala De Silva who worked hard to implement the Diploma programme. Diploma psychiatrists undergo nearly one year and six months of special training. Apart from their independent work, diploma psychiatrists work at grass root community level in co-operation with other community staff.

The amount of work that they are doing –creating awareness about mental health, has been identified as best at present. They cover many areas by out reach clinics. In certain areas, diploma psychiatrists cover 3-4 out reach clinic in a month in addition to their working place duties.

“As we all know, in Northern East –and even Colombo, people have the impact of the many years long war,” says Dr. Sarafdeen further. “Especially in northern east, the war in addition to the tsunami caused damage to the people. It is important to improve these people’s mental health.”

Gender based violence

Gender based violence has also become a major issue nowadays. “In such incidences, we provide service to those who have been victimized to gender based violence,” mentions Dr. Sarafdeen. “Each and every mental health unit currently working under the Ministry of Health has a unit for gender based violence where the family issues are discussed and problems are sorted out. We provide counseling.” According to Dr. Sarafdeen, when the affected party comes in search of help, they are treated for any physical injury and then the root of the certain issue is found out by the unit. Counseling is provided to both parties and they are advised. And if there are necessary legal procedures, the unit guides them to solve the problem.

If there is a major issue like a divorce, the unit calls all the stake holders –the police, The

Child Protection Authority (if the child is being affected), and other non-government organizations and even the religious leaders from the certain area. The next step is to conduct a ‘case conference’ which is, according to Dr. Sarafdeen, “the milestone in the management of gender based issues.”

“This procedure has been incorporated into the mental health service and it is another development,” says Dr. Sarafdeen.

Empowerment

According to Dr. Sarafdeen, mental health units in areas like Eastern Province –Ampara provide service called “Empowerment” where mentally unstable patients, after receiving treatment in hospital, are provided guidance to have a quality life. “If you fall ill mentally, that does not mean you should be isolated in the society,” says Dr. Sarafdeen. You deserve to continue your life like a normal citizen.

“Empowerment” helps such persons to find jobs and move on with their lives. The doctors of the unit make sure they are employed, working and leading a happy life with their families. If a person who is facing the aftermath of a certain mental illness needs support to protect his or her family, the mental health units recommend them to the Ministry of Social Services where the supportive system would support them.

According to Dr. M. S. Farook, mental health coordinator –Mathale District, “substance abuse has become a major issue. People with mental health problems are more likely to be addictive or dependant.”

“According to a recent survey, we found that the prevalence of substance use among Ordinary Level and Advanced Level male students in Mathale District is around 28 per cent,” says Dr. Farook. To deal with this matter, the doctors take care to detoxify the addicts and provide them with counseling.

Sometimes even family counseling. “But it seems it’s not adequate,” says Dr. Farook.

“We encounter more and more adolescents with poor coping skills. They undergo a lot of stressful events,” states Dr. Farook. “Abuse is relatively common. These kids lack the necessary life skills. The school curriculum focuses only on the academic part of education. Social and emotional competence is not improved. So these children are not resilient.”

According to Dr. Farook, surveys have found that one in every four suffers from mental health issues.

So what steps have been taken in order to deal with these issues? What has to be done? “Mental health is everybody’s business,” says Dr. Farook further.

“What we are trying to do in Mathale is to give the message that this is everybody’s business –Department of Health, Department of Education, Department of Social Services- all must come into close contacts to face these issues. We should work together and take up the responsibility equally.”

Teacher counselors are being trained, awareness programmes are carried out in schools, but this doesn’t seem to be satisfactory. “We need more doctors, more trained social workers, counselors to work with us. And The Department of Education must know that it’s a top priority to train teacher counselors.”

“We have to understand that these issues are everybody’s business. Mental health is everybody’s concern.

Unless we do that, we can’t form a resilient community to encounter these psychiatric problems,” concludes Dr. Farook.

Directly addressing the behavior is not adequate. Identifying underlying factors is crucial. Sometimes the important determinants are not visible.

This attempt is to pull the weed by its roots and clean the society for the betterment of everyone in it.

Face this issue as one resilient troop and we can defeat the mental health disabilities within ourselves –stand up strong, fight until you win.

Food sovereignty in Sri Lanka: challenges

W Annesley Sumith Fernando

Continued from November 26

At first genetic engineering was carried out within the same species and it was much less identified. Later totally unrelated, organisms were combined in genetic engineering. Soya Beans were genetically engineered to carry a gene of a bacteria which was used as a weed killer. All the plants except the soya plant was killed instantly with this weedicide and the soya which was once the miracle food on earth has lost its value. What was the result?

The flowers and pollen of the soya plants carried the gene and it was noticed that the monarch butterflies of the region were exterminated. Moreover, when the flowers were cross pollinated the bacteria was carried to the other traditional soya plants. This is the way that all the crops on the earth get affected. The facts emphasized by the environmentalists against genetically modified crops can be read as follows:-

* The modification of food by engineering genes of bacteria and virus causes the emergence of new diseases.

* The other organisms in the eco system are harmed. Butterflies and birds, and all friendly insects will be extinct.

* Unknown effects on bio-diversity (loss of flora and fauna)

* Unethical tampering with nature may cause severe disasters.

* Dependence on developing countries on industrial countries for fertilizers, pesticides and germinating seeds. The developed countries will dominate the farmers.

* Biopiracy - Exploitation of natural resources from under-developed countries for genetic engineering and obtaining patent certificates.

Many countries sued the company responsible on the grounds that the genetically modified crops can cross-pollinate with the organic plants and lose their distinctive appearance. Their crops will not be accepted by countries where such food are banned. Despite objections the companies were allowed to carry out with their genetic engineering processes after a full environmental study which was not carried out.

Lack of research

A prominent scientist was hired by Companies to make a safety procedure of genetically modified food crops into the market. In his research, he found that rats suffered various physical changes and pre-cancers after the continuous feeding of genetically modified potatoes.

The genetic engineering on food was first introduced to the world in the 1990s. It is said that the media did a great service to the companies by promoting and issuing many articles on the subject, helping the safe procedure of such food. No proper independent research has been carried out so far to confirm their safety. Almost all the research has been carried out by the productive companies themselves.

Though many promotional measures have been carried out, there is more and more controversy and arguments against genetic engineering of foods and more and more people rally round against them and turn towards organic food.

It is a known fact that when an insecticide is introduced and used longer, the insects develop immunity to the chemical in later stages. A stronger insecticide will have to be used to overcome that effect. The Companies will gather more profit by selling both genetically modified seeds and strong insecticides.

The farmers usually portion out the best lot of the harvest to produce germinating seeds. They would cease doing that any longer and look forward to genetically modified seeds expecting to derive a better harvest. Thus, few multi-national companies will deal with the entire agricultural procedure on earth.

The most serious effect that the environmentalists suspect is that the genetically engineered seeds may contain well planned genes that may cause infertility in the next generation. Eventually, the entire species of the original organic seeds will remain fertile. The farmer will again be exploited in the form of providing genetically modified germinating seeds. The companies known as Delft, Pineland and Monsento are merely overwhelmed that they would establish their economic security by selling their products to Asia, Africa and Latin America.

Vandana Shiva, an Indian environmentalist has described the two companies as an aggression of the northern pole over the southern pole. They will make under-developed countries their colonies. The medicinal plants which the farmers have been using for centuries have been plundered with the help of paid labour and now they try to export them to the same countries under patent license. The better known plants Saffron and Margosa (Kaha and Kohomba) were saved from the hands of such exploits, but we can never expect the under-developed countries to do the same continuously. This depends on the ability to change the regulations of the patient rights.

The World Trade Organization (WTO) has laid the foundation for the exploitation of biodiversity. The multi-national companies, specially Americans have gained power to carry on such activities. Eventually, they are permitted to destroy and exploit the environment and force their unwanted items on the people of the developing countries.

WHO has pointed out that every minute pesticide poisons a man of the developing world and every 45 minutes a death occurs as a result of poisoning. The suicide rate has increased and they are mostly caused by pesticides. It is reported that about one million four hundred people of the developing countries die owing to pesticides. The number may be more as some of the deaths are not identified properly.

Another method to escape regulations of their own countries is that they dispatch the chemicals separately and combine them with an unassuming developing country.

Parathion is a chemical weapon used during the 2nd world war. If affects vision and mobility of the arms and causes gradual death. A research conducted in Guatamala has shown that even breast milk and cow's milk are contaminated with chemicals.

A weedicide known as Tryclore panoxy Acytic acid was used against the Vietnamese in their war. Two other weedicide Agent Orange and Paraquat which were used in the war are known to cause mental disability, muscular pain, diaphone and kidney failure. Many pesticides are harmful to humans and animals. They cause plasma and destroy the red cells.

A research conducted by the “National Organization to search alternatives for Pesticides” has found out that the chemical known as Glyfesate remains in the soil as long as one year and the crops such as carrots and barley grown on it.

Ill effects

By using insecticides and pesticides, do we only kill unwanted elements? The growth chain wall all be broken. The insects which die are eaten by birds and cows taken the plants as food. We derive meat and milk from cows and insects in turn get absorbed into our body. We should not forget that the ancestral farmers used alternative methods such as the juice of medicinal plants to drive away insects.

Pesticides destroy bio-diversity altogether. They harm all insects, birds who feed on insects and seeds. The land tends to be barren and cause soil erosion, climatic changes and unknown diseases. Following are the benefits of organic agriculture carried out by our forefathers.

It helps not only individual growth, but helps community growth. It does not crush the weak, but helps to settle them on their feet.

The society will develop an awareness of other's rights.

There will be less conflicts and help the participation of the women. Develops personality and appreciation of our cultural values. The basis of organic agriculture is based on the co-operation of the members in the society. To help each other in need, to respect each other's rights, develop cultural values, treat the whole community as one family are basic features of organic agriculture.

In view of discouraging the use of chemical fertilizers, pesticides and genetically modified food, we should discuss how we could overcome these problems ensuring better living conditions with adequate nutrient food supplies. We should establish awareness and be informed to recognize our activities without which no results can be obtained, how much strength and wealth is used on this matter.

If the so called nutrient foods cause unidentified diseases, if the developed countries create an artificial food scarcity by discarding excess amount of food supplies into the waters, if our ancestral organic farming methods are destroyed with the motive of dominating agriculture what mercy can the people of the under-developed countries expect from the developed world.

Let us turn back, turn back to our ancestral organic agriculture, turn back to our co-operative culture, turn back to our agriculture linked with animal husbandry. Cowdung, rotten plants, hay will make fine manure along with our ancestral methods of pest control. Do away with the chemicals. Save the lives of the next generation.

As little children, we were taught that Sri Lanka earned its income mainly from tea, rubber and coconut. No more rubber, no more coconuts now. The plantations were partitioned and sold as small plots by real estate dealers. Thanks to the upcountry Tamil community, the low country farmer community, some of the tea ad paddy lands still remain.

It is quite necessary to take the following steps in order to safeguard organic agriculture methods. Make organic agriculture the government policy

Labelling all genetically modified food for public awareness Ban the import of genetically modified food in mass scale. Control the import of chemicals for agriculture purposes.

Lastly, as a mark of respect to Seattle, the Red Indian Chieftain, the great environmentalist, I like to quote some parts of his speech.

“Our dead never forget this beautiful land that gave them being. They still love their verdant valleys, the murmuring rivers, it magnificient mountains. Verdant lined takes and bays....”

“We are part of the earth and it is part of us. The perfumed flowers are our sisters, the deer, the horse, the great eagle they are our brothers. The rivers are our brothers. They quench our thirst. Every shinning fine needle, every sandy shore, every mist in the dark woods, every clearing and humming insect is holy in the memory.” Finally he says “Man did not weave the web of life. He is merely a strand in it. Whatever he does to the web, he does to himself”. May I humbly add “Every little flower that opens, every little creature that moves, every little cloud that floats, every little drop of water that falls are linked together like strands of a web. You plunder one strand and the whole nature's set up will collapse like a broken web”. This article is based on an interview Annesley Sumith Fernando had with Mr Sunimal Peiris, People's Health Movement.

Childhood obesity

Childhood obesity ‘can be predicted by check at birth’ Researchers say a baby's chance of being obese in childhood can be predicted at birth using a simple formula. Childhood obesity can lead to many health problems, including Type 2 diabetes and heart disease.

Researchers from Imperial College London looked at 4,032 Finnish children born in 1986 and at data from two further studies of 1,503 Italian children and 1,032 US children.

They found that looking at a few simple measurements, such as a child's birthweight and whether the mother smoked, was enough to predict obesity.

Previously it had been thought that genetic factors would give bigger clues to later weight problems, but only about one in 10 cases of obesity is the result of a rare gene mutation that affects appetite.

Obesity in children is rising, with the NHS estimating that 17% of boys and 15% of girls in England are now obese.

The risk factors for obesity are already well known, but this is the first time these factors have been put together in a formula.

Prof Philippe Froguel from Imperial College London, who led the study, said that prevention was the best strategy. Once obese, a child can find it difficult to lose weight.

“The equation is based on data everyone can obtain from a newborn, and we found it can predict around 80% of obese children.

“Unfortunately, public prevention campaigns have been rather ineffective at preventing obesity in school-age children. Teaching parents about the dangers of overfeeding and bad nutritional habits at a young age would be much more effective.

“The message is simple. All at-risk children should be identified, monitored and given good advice, but this costs money.”

Prof Paul Gately, a specialist in childhood obesity at Leeds Metropolitan University, said a tool like this would help the NHS target specific people at risk rather than the “scattergun one-size-fits-all approach, which we know does not work”.

“Rather than spending money on a huge number of people, we can be more specific and spend appropriately. We may not save money in the short-term but it will be spent more wisely and could reduce [obesity-related] NHS bills in the future. “We've done a great job of outlining that obesity is a serious issue but we have made the general public paranoid that everyone is at risk.

“Tools like this will help change that attitude. Once we use the tool, we need intervention programmes for children at a greater risk.”

BBC