Battling the sting

The National Poisons Information Centre not only answers any queries but also conducts research studies on Toxicology

Poisoning is the sixth leading cause of death in Sri Lanka. Every year, around 3000 people die as a result of poisoning. Sri Lanka being a country with an exceptionally high suicide rate, poisoning has become a major cause of death. "However, even in developed countries, medical professionals lack skill and knowledge on management of patients with poisoning, maybe due to the diversity of chemical structure of the toxic ingredients," says Prof. Ravindra Fernando, Professor of Forensic Medicine and Toxicology in the Colombo Medical Faculty and founder of the National Poisons Information Centre.

The setting up of poison information centres was identified as a necessity in developed countries to provide quick, accurate and tailor-made information on toxic ingredients of poisons, their chemical effects and complications. This was essential in the proper management of patients presenting with poisoning.

Established 20 years ago, the National Poisons Information Centre in the National Hospital Sri Lanka, provides information about poisoning and venomous snake bites and their management to doctors, and the general public. From 1988, the National Poisons Information Centre has answered nearly 10,000 queries from doctors, paramedical personnel and the general public. Over 94% of the queries were on management of poisoned patients. Over 90% of the callers were doctors in state hospitals. Over one third of the enquiries to the Centre were on pesticide poisoning while nearly one fourth were for drug overdoses.

"Because the staff in the poisons centre are trained and experienced specifically about management of patients with poisoning, they can provide specific tailormade information on such issues," explains Prof. Fernando. Prof. Fernando explained that the idea came to him during his postgraduate studies in the Dept. of Forensic Medicine at the Guy's Hospital Medical School of the University of London. "I had an opportunity to associate closely with the National Poisons Unit of Guy's Hospital, the first such unit established outside the USA," he reminisces. Returning to Sri Lanka, in 1988 he was able to start the National Poisons Information Centre. "Without the support of Dr. Daya Samarasinghe, the secretary of the Ministry of Teaching Hospitals and the Minister Sunethra Ranasinghe this would not have been a reality," says Prof. Fernando with gratitude.

It was the first National Poisons Information Centre in South East Asia. Now other countries such as Nepal and Pakistan have also set up centres. The National Poisons Information Centre is not only responsible for providing information; it is responsible for creating awareness on 'Toxicology', the study of toxins or poisons.

It carries out research studies on this subject and has already published several books, brochures, leaflets and posters to educate doctors and the general public. The book 'Management of Poisoning' is extremely popular in Sri Lankan state hospitals as well among medical students.

The Centre also organizes seminars, conferences and workshops for different groups of health care professionals and non-medical personnel who can in turn disseminate knowledge on first aid and prevention of poisoning. In July 1997, the Centre hosted the first SAARC meeting on poisoning in Colombo.

Two decades ago toxicology was not a popular speciality and training or postgraduate degrees in toxicology were not available in our country. A couple of years ago, Prof. Fernando started a multi-disciplinary post-graduate Diploma in Toxicology in the University of Colombo for medical officers and scientists. This year, an 'internet-based' MSc in clinical toxicology in the Post-Graduate Institute of Medicine for doctors will be commenced too.

The Presidential Task Force on 'Formulation of a National Health Policy' has suggested certain measures to reduce morbidity and mortality from pesticide poisoning in 1993. One was to strengthen the National Poisons Information Centre. If this recommendation is implemented, an efficient, high quality 24-hour information service for health care professionals can be provided with laboratory back-up service to analyse blood, urine and stomach contents of poisoned patients to assist them in the management. The Centre can also have facilities to supply antidotes to hospitals.

These activities alone can help to reduce the rising incidence of morbidity and mortality from poisoning."In addition to banning the import of toxic chemicals, improving treatment facilities in state hospitals can reduce morbidity and mortality from poisoning," Prof. Fernando added. Non-availability of intensive care facilities, essential drugs, and other equipment seems to be a drawback in some hospitals.

The Centre organized a "National Poisons Prevention Week" in May last year. The Ministries of Health, Education, Central Environment Authority, the WHO, pesticides and pharmaceutical industry, Registrar of Pesticides and his staff and many other organizations worked together to disseminate information on management and prevention of poisoning and first aid. The Centre plans to have a similar week from May 5 to 11, this year too.