A storm of protest over medical college -  Second opinion

Medical students are justifiably concerned having seen the consequences of privately funded medical education in this country, which resulted in the nationalisation of the North Colombo Medical College (NCMC) into the Medical Faculty of the University of Kelaniya. 

But, for all intents and purposes the proposed International Medical School (IMS) is very different from what the NCMC was. Hence, the issues it raises are also vastly different. Perhaps the parallel is that both institutions are fee levying medical schools, but the similarity ends there.

The NCMC was under the dictates of the Higher Education Ministry and hence its students could lay claim to recognition of its degree, provided the college satisfied criteria laid down by the local Medical Council.

The IMS in contrast, by its own admission, is not under the purview of the Higher Education Ministry. Instead its status is that of a BOI approved company, which operates on the simple principle that it levies a fee and renders a service. 

That raises the question as to what would happen to an IMS graduate after he qualifies? The stated position is that he will be treated as a "foreign qualified" graduate as the IMS is affiliated to the University of Aberdeen, reports say and be asked to sit the 'Act 16' qualifying examination. 

This must be viewed in the perspective of five years from now, when even state educated medical graduates will find no job guarantee from the government. 

Then, most probably, the IMS graduates will be provided with internship but little else, by the state health service. What implications this would have and what crisis this could set in motion we cannot foresee but it is a fair guess that this would cause a serious division in the medical sector. Already state faculties have expressed fears that their staff would be lured to the 'new' school by offers of better remuneration! 

On the other hand, when it has been claimed that the quality of clinical teaching at the new school is questionable, the Sri Lanka Medical Council becomes culpable ofthe charge of accepting degrees from many overseas universities if only a candidate passes the "Act 16" examination - and oral exam which is not the best yardstick on which to assess a doctor's suitability to practise. 

It is not for us to judge whether the creation of an International Medical School is "good" or "bad'. In retrospect even eminent academics who opposed the NCMC on principle have conceded that college produced some of the finest young doctors of recent times. 

Nevertheless, in the light of the NCMC experience, it is imperative that all concerned - the government, the Sri Lanka Medical Council, the Health and Higher Education Ministries, the BOI, the International Medical school, the State Medical Faculties, students representatives, parents and the Government Medical Officers Association more specifically discuss the issue frankly and fully before giving the green light to the IMS. 

Or else five years from now, we could be grappling with another university crisis or who knows, even the birth of another insurrection! 

Can I have the salt, please?

Does salt really raise blood pressure? 

Many studies suggest that yes, it does. It probably works like this: salt or sodium causes the body to retain fluid. This increases the volume of blood. If the blood vessels cannot compensate by dilating sufficiently, either because they are too stiff or because the volume is too great, the blood pressure can rise. 

Does a "low- salt" diet help? 

Again most studies suggest that when patients with high blood pressure reduce their salt intake, blood pressure falls significantly. It has also been found that in patients whose high blood pressure responds to a class of drugs called diuretics the change with a low-salt diet is more marked.

But how do you reduce salt intake? 

For a reduction in salt consumption to be great enough to lower your blood pressure, your daily salt intake must only be about a teaspoon or 2000 mg of sodium. 

Pregnancy: you need to plan it?

So, if you are keen to 'plan' a pregnancy, here's what you should know:

*About Birth Control: A visit to the doctor is best if a woman using a method of contraception decides to have a baby. Most doctors advise patients who have been taking birth control pills to wait about three months after discontinuing them before attempting to conceive. This is because women who become pregnant immediately after discontinuing the pill have an increased possibility of miscarriage or conceiving twins. 

Intra Uterine Devices (IUDs) however can be removed immediately before a woman wants to become pregnant. 

About Drugs: It is best to inform a doctor if a woman planning a pregnancy is on any long term drug treatment. Many such drugs may have an effect on the foetus and may require review or, in the case of some drugs, substitution by other drugs. 

About Alcohol and Smoking: These two habits are not common among women in Sri Lanka but women who do indulge in them should stop these "vices" not only after they become pregnant but while they are attempting to conceive. The first weeks after conception when the mother may not even know she is pregnant is when the baby's nervous system begins to form and both smoking and alcohol have adverse effect on it. 

About Vitamins: There is a tendency among would-be mothers to fortify themselves with vitamins on their own when they become pregnant to be "more strong". But remember, even vitamins, particularly fat soluble vitamins in excess can cause problems in pregnancy. However, a vitamin that is definitely useful (and now routinely prescribed is folic acid, which is known to prevent some birth defects in the baby, but that too should not be taken in excess!!

About Infections: It would be helpful to exclude certain infections before a pregnancy. These include Hepatitis B, German measles and sexually transmitted diseases in susceptible individuals. Detection of these diseases by screening is best done before pregnancy to minimise complications to the mother as well as the baby. 

About other diseases: A visit to the doctor is recommended strongly if a woman with a long-standing conditions plans on having a baby. Diabetes and high blood pressure are two of the commonest of such conditions. Remember, a significant number of these diseases are first detected at a routine screening before or during pregnancy! 

About food: It is well established that a mother's nutritional status before and during pregnancy has an effect on the baby. A balanced diet is a must for women planning pregnancies. It is something more than just eating more (for two people), for quality and not quantity is important. If you are a vegetarian, the advice of a doctor or a dietician is best!

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