Sunday Times 2
Promoting geriatric care in Sri Lanka
Today nearly 10 percent of the Sri Lankan population is over 60 years of age and this will be 22 percent by 2020. More than 80 percent of Sri Lankan elders live in the rural areas of the country which are underdeveloped in many ways, especially in health care facilities.
With age most of these elderly will be less mobile. Traditionally, children are the care givers of the elderly in our country. But due to migration of the children to urban areas or to another country, most of the elders live alone without much social or financial support from the immediate family. The public transport system is not adequately developed to provide them comfortable, easy and safe transport. Tertiary care hospitals, which are inundated with unmanageable crowds are unable to provide priority care for them.
Meanwhile, the incidence of non communicable diseases is rising, making elderly people more vulnerable to these problems which need regular lifelong care. Therefore it is essential for them to have easily accessible health care facility which could cater to their routine health care needs in the vicinity where they live.
In Sri Lanka there is a good net work of health care facilities covering the whole island at various levels. But these peripheral units are inadequately staffed and lack many basic resources. Upgrading them with human and other resources would be the only way out of this emerging health care crisis.
It is important that all the health care professionals are specially trained to handle this vulnerable population. In time to come most of the population would live to very old ages such as over 80, 90 or even over 100 years. Towards the end of life most will have more than one non communicable disease or many such diseases. The majority of the elderly can have physical disability, problems in speech, hearing , vision or mental illnesses in addition to non communicable diseases. Therefore it is imperative that all the Universities need to strengthen the teaching of their undergraduates and postgraduates in health care fields to give special emphasis in training them to handle elderly in a multidisciplinary approach.
Model elder care programme
With this in mind, The Faculty of Medicine, University of Peradeniya decided to launch its elder care programme aiming to address this crucial problem in many ways.
*Curriculum was revised to add more topics to cover elderly care in different disciplines. Humane communication with the patient, empathy; providing care through total holistic approach; common diseases in old age and special ways to treat elderly population were included in the curriculum.
It was realised that treating elderly in a busy tertiary care set-up, treating only their disease condition without giving them any priority or total care is an artificial situation. Thus an elder care clinic (Geriatric clinic ) was set up at a unit peripheral to Peradeniya Teaching Hospital, the District Hospital , Kadugannawa, to overcome these inherent shortcomings.
This clinic was established on August 5, 2013 with the blessings and the support of the District Medical Officer , Kadugannawa, Department of Health , Central Province, Health Ministry and the Faculty of Medicine , University of Peradeniya. It became an instant success in attracting elderly patients and also providing students of the Faculty of Medicine an opportunity to provide total , humane , holistic care in a much relaxed atmosphere in one to one basis to these patients. Little did we know when we started the clinic that we created history by establishing the first geriatric clinic in a government hospital in the country. To our amazement not only the Health Ministry but the Social Services Ministry also came forward to provide support to our patients at this clinic. One by one many groups came forward to help and now our elderly patients are provided with dental care , skin care, social support , counselling and also a health drink ( Kolakenda) at the clinic; which is sponsored by the generous staff of the Kadugannawa hospital. The most important factor was that our clients neither need a particular disease nor a referral from another medical officer, which are the basic criteria to attend any clinic world wide. The only criteria was that they be over 60 years of age. News of the clinic spread through word of mouth and very soon it became popular among the senior citizens of the area and beyond.
Our collaborative team work highlighted that we can do much more than this if we can extend our services to peripheral hospitals further away. This thought flourished due to the dedication and the enthusiasm of the Director and the rest of the staff of the Department of Health , Central Province and the doctors working in these peripheral hospitals. Soon we established an elderly care cluster incorporating many close by peripheral hospitals and identifying the District Hospital Kadugannawa as the focal point in geriatric care and Peradeniya Teaching Hospital as the tertiary care referral centre.
Consultant staff of the Faculty of Medicine, and the Teaching Hospital Kandy with the coordination of the Department of Health Central Province and the Regional Health Professionals Training Centre at Kadugannawa , health professionals working in these peripheral hospitals were trained in elderly care medicine.
Two elder care wards, male and female and an emergency treatment unit at Kadugannawa Hospital were opened on October 1, 2014 on the International day for older persons. They were declared open by the Governor of the Central Province , Tikiri Kobbekaduwa. These are the first geriatric care wards in the country.
Future of this programme
This elder care cluster group of hospitals will function as one unit in serving elderly patients and training health care professionals in elderly care. The next step would be to extend the services to the community in collaboration with the Medical Officers of Health of the area and the officers of the social services ministry. This step will enable us to develop a model village for elder care where there will be a day care centre and also home visits by public health nurses and the medical officers to see home bound elderly.
In developing these programmes our primary motto would be equity – to include all elders. Our aim is to optimise opportunities, health and security of all senior citizens of this country and help them to age actively.
(The writer is attached to the Faculty of Medicine, University of Peradeniya)