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Making
babies
Naomi Gunasekara talks to Sri Lanka's
first Clinical Embryologist
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Who
is an embryologist?
The embryologist is the person who fertilises chosen egg and
sperm samples in a test-tube or a petri dish and looks after
the fertilised eggs until they are transferred to the uterus.
According to Dr. Wimalananda, it is a difficult job for it
requires maximum concentration and caution. If the sperm or
egg samples of a couple are mixed with the wrong egg or sperm
sample, the embryologist is held responsible. Further, the
embryologist has to take great care with the sperm and fertilise
it with the best egg available.
To fertilise
eggs successfully, an embryologist needs steady hands, a good
sense of judgement and good eyesight since sperm and egg samples
cannot be detected with the naked eye. "A human egg is
about 110 micro-metres and everything is done through the
use of a microscope," says Dr. Wimalananda. "Sometimes
husbands do not produce the necessary sperm because they are
under pressure and it becomes difficult for the embryologist
who has to inject a good sperm sample to the wife's egg. We
also have to work under dim yellow lights which is not easy."
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Dressed
in black pants
and a blue shirt she looks every inch a career woman: intelligent,
tough and determined to reach her dreams. As Sri Lanka's first Clinical
Embryo-logist, Dr. Thanuja Wimala-nanda faces many challenges, but
she looks forward to them with pleasure, for she will in the process,
be helping many desperate couples achieve their greatest wish; to
have a child.
Seated in her simple, artistically furnished living room, she recalled
how disappointedshe was to give up her studies at the North Colombo
Medical Faculty in 1989. "Universities were closed because
of the JVP troubles and my parents were determined to send me abroad.
It was difficult for me to get a place at a British university for
medicine so I had to settle for a B.Sc. in micro-biology at Aberdeen."
After her B.Sc., she was awarded a scholarship to follow her Ph.D.
at the Department of Molecular and Cell Biology of Aberdeen University,
where she worked under the guidance of Prof. Neil Gow, an expert
in molecular and cell biology.
Molecular biology, according to Dr. Wimalananda, deals with fungal
diseases that adapt to every drug administered to patients who suffer
from fungal diseases. "These diseases are unique because they
cause thrush when the female reproductive system goes down,"
said Dr. Wimalananda, who concentrated on finding an anti-fungal
cure therapy to resist fungus as part of her Ph.D.
Having completed her Ph.D., she returned to Sri Lanka and worked
in Kandy for a group carrying out research on malaria. "I decided
to come back for six months because I realised that a lot of Sri
Lankans who go abroad for higher studies settle abroad and the country
was in need of professionals." But after nearly two years in
Kandy, having turned down an offer made by the Colombo University
to become a biology lecturer, Dr. Wimalananda had second thoughts
on her choice to drop medicine. "I was good at comforting people
from a very young age. For some reason I didn't feel content with
the work I was doing and was looking for something challenging and
more fulfilling."
It is during this time that she learnt of the work of Sri Lankan-born
Singaporean Prof. Ariff Bongso, Research Professor and Director
of the Assisted Reproductive Techniques (Test-tube technology) Programme
at the Department of Obstetrics and Gynaecology at the National
University Hospital of Singapore. When she contacted him, he advised
her to follow a course in clinical embryology at the National Hospital
of Singapore.
Only ten students from around the world are enrolled for the course.
"Infertility is not a problem that can be cured overnight or
by bed-rest for a couple of days. I had seen how people suffer,
the trauma and desperation because one of my cousins even sold her
house to seek fertility treatment in the UK. So I was determined
to follow the course at any cost," Dr. Wimalananda remembers.
Her decision to follow the one year Masters course was a difficult
one for she was just six weeks married when she was chosen by the
university. "But my husband was very supportive and encouraged
me to go. He understood my desire to do something good," she
says. Dr. Wimalananda went on to top her batch and having completed
her training in Singapore works with Dr. Rohana Haththotuwa in his
fertility clinic. She will soon be helping thousands of childless
couples in Sri Lanka in her work as an embryologist at the Ninewells
CARE Mother and Baby Hospital to be established at Kirimandala Mawa-tha.
"Right now I do sperm analyses of patients who are receiving
treatment under Dr. Haththotuwa. I'm just glad everything has worked
out for the best. I've always loved babies and even told my friends
that I would have 10 someday."
Rehabilitation
for stroke victims
Yet another chance to live
By Radhika Dandeniya
Nothing can be more physically and mentally traumatic than a stroke.
You
are left paralysed and literally speechless, totally isolated from
the rest of the world. The Ancient Greeks described it as apoplexy:
as if violently struck by a sudden thunderbolt. With 15 million
people worldwide suffering from a stroke and a third left handicapped,
the need for more rehabilitation services is urgent.
Rev. Melancthlon fell victim to a stroke in 1989. He was 53-years-old
and subsequently died five years later. His daughter Katie painfully
recounts his five-year struggle with the repercussions of the stroke.
At the time in question, he was giving a lecture at a little hill
station in India. Three days before the stroke, he felt numbness
on the right side of his cheek, which then progressed to his being
unable to formulate words. Having alerted the doctor, he was simply
told that it was fatigue and he should take rest.
"The least he could have done was check his blood pressure,"
says Katie disapprovingly. The failure to spot the danger resulted
in her father becoming paralysed on the right side when he fell
off the bed the following night.
By the time he was admitted into hospital, 24 hours had been lost.
With the key drugs not administered on time he suffered extensive
injury including the impairment of his motor skills. "He was
continuously put on drugs fed through a Riles tube and was attached
to a catheter. The drugs were so strong that I think his stomach
lining was damaged and he was vomiting blood which was distressing
to see."
When sent home after a month in hospital, Mr. Melancthlon endured
extensive rehabilitation, involving daily physiotherapy, speech
therapy twice a week and a regulated diet. He was also taught to
write from scratch, starting with the alphabet. " It was painful
to see such a highly educated man being brought down to the level
of an infant," recalls Katie. The first year produced the most
progress. "He could say a few words and walk with the aid of
support."
However, as the years went on, he suffered a succession of mini
strokes, and finally died in hospital having been bedridden for
many months. Katie firmly believes that the rehabilitation did some
good and if it had not been for the unfortunate circumstances of
her father not being diagnosed in time, he could have survived.
The National Stroke Association of Sri Lanka celebrated its first
anniversary recently by holding a series of lectures on the separate
aspects of brain attacks. Amongst those who spoke was Consultant
Rheumatologist Dr. Lalith Wijayaratne, who outlined the various
elements of a stroke rehabilitation team.
The first problem that stroke patients face when left with paralysis
on one side of their body is the resumption of day -to- day activities
such as eating, washing, walking, talking etc. They cannot integrate
with their community, do their job or attend social functions, which
consequently leads to depression due to a loss in dignity. "They
confine themselves and live a solitary life," says Dr. Wijayratne.
Stroke rehabilitation entails the restoration of optimal levels
of physical, functional and social ability within the needs and
the desires of the individual and his/her family. It is a very structured
programme, which begins as soon as the diagnosis of a stroke is
established and life-threatening problems are under control. It
involves a close relationship between the patient and several members
of the health profession. (See star diagram). The coordinator of
this team is the doctor who is responsible for providing the best
possible rehabilitation depending on the nature of the patient's
neurological status. He liaises with the nurses and persons specialized
in occupational therapy, physiotherapy, and speech therapy.
Another problem with stroke patients is that often they are the
breadwinners in their family. Their inability to return to their
jobs leaves them and their loved ones financially unstable. This
is where Social Services features in the rehabilitation process.
In the case of the low-income group patients, the social worker
assists them in obtaining rehabilitative aids at a low cost.
The patient too plays a very important role as a team member. In
the selection of procedures and establishing goals, he makes the
final decisions. It is also important that his/her family is informed
so that if the patient is cognitively impaired they can take over
the responsibility.
Dr J. B. Peiris, senior neurologist, who also spoke at the seminar,
said that the patient needs "motivation" for the rehabilitation
process to be successful. The case of Mrs. Wickremasuriya certainly
supported this assertion; She herself suffered a stroke 13 months
ago yet made a near full recovery in two!
Being a care worker for 1200 stroke patients in Hambantota, Mrs.
Wickremasuriya was constantly on the move. She had no history of
diabetes, was a non-smoker and always checked her blood pressure.
On the day of her stroke she noticed when charging her mobile phone
that she could not coordinate her right hand and experienced speaking
difficulties. She then called her niece who was a nurse . The diagnosis
of a stroke was made when the doctor discovered that her blood pressure
was very high. Spending five hours in the ambulance was a frightening
experience for her. She said that many things went through her head
due to being so closely involved with stroke patients: "I'd
seen what had happened to them and I wondered what my outcome would
be." Yet there was no need to worry, for within a week she
had mostly recovered and left hospital. With much exercise and a
lot of motivation she returned to work within a month.
Mrs. Wickremasuriya's prognosis is very good. "I have learnt
how to avoid the second attack," she says. " I check my
blood pressure and do more relaxation exercises." She still
has residual numbness in the right hand but that is all. She is
very thankful for all the help she received throughout her rehabilitation
and concludes that if the "correct things are done at the correct
time" you can make a good recovery from a stroke.
Dr Jagath Wijesekera, President of the NSASL called for more stroke
rehabilitation teams and better care for patients. With a service
that has proved to be invaluable, allowing many to regain their
independence and dignity, this demand does not seem to be asking
for too much.
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