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1st November 1998

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Medical MeasuresWhen to immunize your child

The recent immunisation campaign against polio has created a greater public awareness about vaccines among parents.

Here we briefly trace the history of immunisation in Sri Lanka and consider some new vaccines that are available in the country.

* How did it all start?

Immunisation in Sri Lanka started way back in 1886, under British rule. A "Vaccination Ordinance" was introduced for the purpose of vaccination against smallpox. Thereafter, immunisation was carried out against many more diseases at different times.

In 1977, just over twenty years ago an "Expanded Programme of Immunisation" (EPI) was introduced, coordinating the immunisation programmes for many diseases and bringing them under a single schedule.

* What is the EPI schedule?

Under the EPI programme of vaccination for children, the "busiest' year is the first year of a baby.

The first vaccine that is given is the ECG, best given before leaving hospital after the delivery of the baby.

If it was not so given for some reason, it could be given during the first four weeks.

Then, at the third, fifth and seventh months, the Polio vaccine and the 'Triple' vaccine (for Diphtheria, Whooping Cough and Tetanus) is repeated for a total of three doses.

Vaccines given at the fifth and seventh months should be six to eight weeks after the previous dose.

Then, at the ninth month, the Measles vaccine should be given. This completes the immunisation for the first year of life.

In the second year, at about one and a half years a fourth ('Booster') dose of the Triple Vaccine is given, along with the Polio vaccine.

When the child enters school, at about five years, a fifth 'Booster' for Polio and for Diphtheria and Tetanus is given.

At school, between ten to fourteen years of age a Tetanus Toxoid is given. Ideally a Rubella Vaccine could also be given between eleven to fifteen years of age.

* Who else gets vaccines?

Pregnant women are given the Tetanus Toxoid. This is now regularly administered under the maternal health care system.

* Why is the Polio vaccine repeatedly given now?

No, there is no threat of a polio outbreak in the country. In fact, polio, is close to being eradicated in Sri Lanka. And that is the aim of repeatedly organising 'Vaccination days' for Polio.

Repeatedly immunising your child against this disease certainly does no harm, in fact it increases the chance of eradicating the disease from the country.

* Is there a vaccine against Cholera?

The Cholera vaccine is not routinely administered because the protection it offers is not very good and anyway lasts for only about six months. However, it is available in the government sector.

* Should children be vaccinated against Japanese Encephalitis?

Yes, more so if you are living in a 'high risk' area or in an area where a case of this disease has been reported. This vaccine consists of three doses at an interval of four weeks between the first and second doses and one year between the second and third doses.

A "booster" should be given every four years after the first immunisation. This vaccine is available in both the government and private sector.

* What is the 'MMR' vaccine?

This is a vaccine that protects children against three diseases:

Mumps, Measles and Rubella. It is usually given at about fifteen months of age. The immunisation against Rubella is especially important in girls. This is because when they later become adults, they could get the disease while being pregnant, causing congenital defects in their children.

* What other vaccines are available?

At present vaccines against Hepatitis A, Hepatitis B, Chicken Pox, Typhoid Fever and some types of Meningitis are available in Sri Lanka, at specialised centres.

* What should you do after vaccination?

A slight fever is usual after most vaccinations.

However, if you feel that your child is becoming restless or not behaving normally or if there are any physical signs of a reaction to the vaccination, seeking the help of a doctor is always advisable. Do not "wait and see".

And, even if all is well, do not forget to keep a record of the dates of vaccination and what vaccines were given and by whom etc.

Medical News

* Murugesar Sinnetamby Oration:

"Poisoning: Dissemination of life saving information - activities and experience over a decade" will be the title of the 1998 Murugesar Sinnetamby Oration, to be delivered by the Sri Lanka Medical Association, Foundation Session on November 6.

The orator is Prof. Ravindra Fernando, Professor of Forensic Medicine and Toxicology, University of Colombo and the Head of the National Poisons Information Centre, National Hospital, Colombo.

The oration highlights the pioneering work of the Poisons Centre in the last decade, the first of its kind in South East Asia and emphasises the need to reduce the incidence of mobidity and mortality from poisoning in Sri Lanka.

The oration is in memory of Dr. Murugesar Sinnetamby, who was the first Ceylonese to become Fellow of the Royal College of Surgeons in Edinburgh.

* A Course in Practical Dermatology for Doctors

The Sri Lanka Dermatological Association will conduct a course in Practical Dermatology for Doctors at the Sri Lanka Medical Association, Wijerama Mawatha, Colombo on December 3, 1998.

Registration for the Course, available at the Dermatological Association office at the SLMA closes on November 10.

* Fourth International Medical Congress, Peradeniya Medical School Alumni Association

The Peradeniya Medical School Alumni Association (PEMSAA) will conduct a series of lectures, discussions, workshops on the theme "Technology for Health Care Beyond the Year 2000" at the Plant Genetic Research Centre, Gannoruwa from December 16 to 18, 1998.

Registration for the Congress, available at the PEMSAA office at the Peradeniya Medical Faculty closes on November 15.

* Ceylon College of Physicians Fellowships

Seven eminent doctors were awarded Fellowships of the Ceylon College of Physicians annual academic sessions recently.

They are Dr. N. Chandra Silva, Consultant Physician, General Hospital, Kalutara, Dr. Soma de Sylva, former Consultant Physician, National Hospital of Sri Lanka, Prof. Devaka Fernando, Professor of Medicine, Sri Jayawardenepura University, Prof. Gita Fernando, Professor of Pharmacology, Sri Jayewardenepura University, Dr. H.A.W. Gunawardana, Consultant Physician, Prof. Dr. Diyanath Samarasinghe, Associate Professor of Psychiatry, University of Colombo and Dr. H.S.R. Wijemanne Consultant Physician, General Hospital Kandy.

The fellowships were awarded by Prof. Ravindra Fernando, President of the College on behalf of the Council.

Emphasis on empathy and sympathy

By Roshan Peiris

Sir Ravi PonniahThe World Congress of New Medicine for the Third Millennium, affiliated to the International University for Complementary Medicine is now being held in Colombo.

Professor Dr. Sir Ravi Ponniah from London, a youthful man with a tooth brush moustache, is here for the sessions.

His motto, he says is patients come first. One wonders what motivates an eminent doctor such as he is, with MD, MA, PhD, DSc qualifications to go around the Third World countries treating the poor and helping those with cleft palates and hare lips. He also brings gifts and sweets to the suffering children.

He smiles, ''Nothing special but my love and concern for suffering people. I think I am fortunate to be able to do so. I run my clinic in London and then travel around the world.''

Sir Ravi is an iriodologist. Many of our own doctors could not tell me what it meant. An iriodologist, he says, diagnoses through the Iris of the eye, a very sensitive spot.

One can analyse from the eyes fairly accurately and inexpensively certain conditions and thereby prevent chronic manifestation of the disease later.

Sir Ravi continued, "for example one can detect oncoming heart trouble or cardiac defects, arteriosclerosis, and even the onset of diabetes in a patient.

Sir Ravi explained, ''Thus we can nip these in the bud and reverse these often inherited conditions and detect the genetic reason.''

"When getting married, if such possible conditions are found one can advise the couple to use preventive measures. Essentially we categorise symptoms of the patient for example say it is arteriosclerosis, arthritis.

"With holistic medicine we notice and note defects say in the pancreas, liver or kidney. We detect and address the problem on both mental and physical levels.''

He explained that holistic medicine is complementary and an alternative to allopathic medicine. "There is homeopathy, acupuncture, osteopathy and I must emphasise most important, for the patient is empathy and sympathy.

Sir Ravi also uses chelation intravenous therapy. Sir Ravi at one time was alternative medical advisor to the late Princess Diana. Asked about it he said, "It is unethical for me to discuss a patient even though she is dead. I also by nature, do not like celebrities and she was to me the same as any patient."

Children flock to him in the countries he visits and call him Santa Claus because he brings them gifts and sweets. In Sri Lanka Sir Ravi has treated many a child with a cleft palate or harelip.

His motto seems to be "fear not, life still leaves human effort scope to heal.''

Dr. Anton Jayasuriya and he were the main organising geniuses of this World Congress. Over four hundred doctors and others interested in healing were due to attend.

At the Kalubowila acupuncture clinic I must mention that 5000 brain tumour cases have been healed with acupuncture and medicine given free.

Sir Ravi is married and when asked how many children he had he guffawed and said "enough." Typical of him. To Sir Ravi sick people and treating them is almost a religion and sacrosanct.

Vitamins: facts or just fad?

It has now become fashionable to take some vitamins for each and every ailment. Prescribing vitamins keeps the doctor busy and both the pharmacist and patient equally happy. But are they really necessary? If you are healthy and have a well balanced diet, then you should be getting all the vitamins that your body needs for normal daily living.

Not getting enough vitamins can affect your health, but unless symptoms are a direct result of not enough vitamins, taking extra won't help.

And remember, vitamins in large doses can sometimes be harmful. So before you pop your next vitamin pill, ask your doctor. And as always remember that natural sources of vitamins are better than pills or syrups.

But, to start with here are some hints to ensure that you get the most of your vitamins from your food:

* Eat a variety of greens;

* When storing fruit and vegetables, store them for the minimum amount of time in a refrigerator or a cool, dark place;

* If possible, prepare food just before serving;

* Use as little as possible water when cooking vegetables;

* Cook frozen vegetables quickly without thawing;

* Refrigerate milk soon after buying it;

* Leave vegetables in large pieces. Don't cut them into pieces when storing;

* Avoid copper and brass cooking pots. Clay pots are better than Aluminium vessels;

* Ask a doctor about taking vitamin supplements when it is needed - when recovering from serious illness or surgery, pregnancy and in breast feeding;

* Be cautious and ask a doctor when taking drugs that change vitamin levels - the contraceptive pill, laxatives and long-term antibiotics.


Take your medicine

Your Health by Dr. Sanjiva Wijesinha

In the first decade of the 21st century, the world's population of diabetics is going to double. From 110 million known diabetics in 1994, current estimates predict this will climb to 221 million by 2010. To most of us, diabetes is simply an ailment caused by too much sugar in the body - brought on by eating too many sweets.

The disease however is much more serious. Elevated blood sugar - and the resulting passage of sugar in the urine - are simply the easily detected manifestations of a disorder which affects the basic biochemical processes by which the body converts food into energy and new tissues.

Although the prevalence varies - from less than 2% of the population among East Africa's rural Bantu people to nearly half the population in the Pacific Island of Nauru - the incidence is rising. In fact the disease is quite common in Sri Lanka.

Various explanations are put forward to account for this - inheritance, obesity and the lack of physical exercise - but the simple fact appears to be that the population which have inherited a genetic tendency for the disease (but did not up to now develop the symptoms) are now manifesting it because they have a plentiful supply of energy-rich food accompanied by a reduction in physical activity.

Essentially due to the body's lack of the hormone Insulin, which is responsible for converting glucose from the food we eat into energy, diabetes is much more than simply "high blood sugar". The disease process affects the very blood vessels which carry nutrition and body fluids to our vital organs, with the result that in due course complications set in - kidney failure, retinal damage, heart attacks, strokes and lack of circulation to the fingers and toes.

Measuring a person's blood sugar is the method doctors at present use to diagnose Diabetes. The current view of the American Diabetic Association is that an individual has Diabetes if the Fasting Blood sugar level (measured by taking a sample of blood after a person has fasted for 12 hours) is equal to or greater than 7.0 millimoles per litre. This figure corresponds reasonably well to the future incidence of diabetic complications.

In the US, diabetes is now known to be the leading cause of blindness, kidney failure and amputation in middle aged people.

The treatment of diabetes has always been a matter of debate - but recently some of the controversial questions have been answered, thanks to studies by the UK Prospective Diabetes Study Group.

The important findings come from an ongoing research project studying over a thousand diabetics attending 20 clinics in different parts of Great Britain. These patients have been carefully followed since 1989, the data collection and analysis being co-ordinated by Professor Robert Turner of Oxford University.

Some of the group's latest findings were published in the British Medical Journal last month. Until recently, the emphasis in treating diabetes has been to keep the level of sugar in the blood under 7 by using drugs such as artificial insulin (which has to be given by injection) and tablets (sold under various trade names like Rastinon, Daonil, Euglucon, Diabex, Diamicron and Metformin). Recently a new type of medicine called Acarbose - which acts by delaying the absorption of sugar from the intestine has come on the scene.

Since keeping blood sugar under control involves a lifelong commitment to taking a daily (or twice daily) dose of tablets or injections, one of the controversial questions even among doctors, has been whether tightly controlling blood glucose levels in Type 2 Diabetes (the more common form which usually affects middle aged and older patients) actually reduces the risk of complications.

"Yes it does," says Carl Erik Morgensen, professor of medicine at Denmark's Aarhus Kommune hospital "and as far as the risk of microvascular complications is concerned, equally good results are seen whether one uses sulphonylura tablets or insulin injections."

An even more significant finding from the study published last month has been the importance of regularly measuring blood pressure in diabetics - and preventing this pressure from becoming too high. Around half of all diabetics between 45 to 75 years have Hypertension (high blood pressure) - which unfortunately may creep higher and higher without causing any symptoms. "The management of blood pressure," observes Professor Turner "should have a high priority in the treatment of type 2 diabetes."

"Our study shows that treatment aiming for a blood pressure level of less than 150/85 substantially reduces the risk of death and complications due to the disease."

Adds physician Sanath Wickremesinghe, "The ideal goal in the treatment of hypertension is to keep the pressure around 140/85 - and the trend now is to start medication early before the pressure has the opportunity of becoming too high."

"Tight control of blood pressure achieves a significant reduction in the risk of deaths due to diabetes, progression of diabetic retinal damage and deterioration of eyesight."

For those who have already got diabetes, the message is now clear: Take your medication regularly and maintain your blood sugar within the normal range.

And make sure that you keep your blood pressure under control.

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