A heart to heal

A new Cardiology Unit at Lady Ridgeway Hospital for children

By Roshan Peiris

By January 2000, the Lady Ridgeway Hospital for children will have the biggest non-paying treatment facility for children with heart disease in this country. The Chinese team is busy with the building which will give children whose lives virtually hang on a string, new hope and cures which are not available now.

At present only the National Hospital and the Sri Jayawardenepura Hospital have all the facilities required for heart surgery and intensive heart treatment for children.

Dr. R. Wimal Jayantha, Director, Lady Ridgeway Hospital said however that they never turn away a patient.

"We do what we can, and if the little patient needs surgery we refer the child to the two National Hospitals.

"The new ten-storied building that is coming up will have all the facilities required for cardiology treatment, be it surgery or otherwise."

At present cardiologist Dr. S. Narenthiran who has opted to come over from the National Hospital does whatever is possible to save the lives of young children who do not require cardio-thoracic surgery.

The heart unit, as it is at, present, with Dr Suresh Jayasundera and Dr. Narenthiran is a place where a lump never leaves one's throat as one watches smiling yet very sick young children. The Ridegeway only admits those under ten.

There was the baby just two-and-a-half months-old nestling in her mother's arms, another chubby ten-year-old girl lying unconcerned on the examination bed blissfully unaware how sick she was.

"She has a vascular defects - muscle defect of the heart and intensive breathlessness on exertion," said Dr. Narenthiran as he gently examined her.

He applied a glue-like white substance on her chest and used the transducer over her chest, the findings being recorded in the echo machine.

A concerned matron Samaradivakran smiled at the young patient while watching the echo machine. The doctor explained that the glue-like substance helps to transmit sounds from the child's heart and the transducer reflects the muscle, valve and heart functions in the echo machine.

The cardiology clinic at the Ridgeway has been in existence for only the last seven months and already 2,500 little patients have been treated. Between 500 to 600 heart surgical cases come to the Ridgeway, said Dr. Narenthiran.

"We often do work that in any foreign hospital would take a year in just seven months. Little children are brought with much difficulty by anxious parents from all over the country. Hospitals in Galle, Kandy and Kurunegala have cardio-thoracic facilities but no facilities for surgery. The OPD of the cardiology section was over-crowded when we visited the hospital last Wednesday.

"Often," said the doctor and matron, "the hospital admits 700 critical patients a day. This amazing number they said, baffles the foreign doctors who visit the hospital.

The Lady Ridgeway Hospital for Children does a king size job catering to very sick children, not only those with heart disease but also with other ailments as well. It is a busy hospital where dedicated service seems to be the keynote.

AIDS is a problem

Empowering women as a preventive measure against STDs

By Dr. Usha Perera

The World Health Organisation (WHO) recently identified a disturbing new trend that has emerged in developing countries - the increase in the number of HIV infected women. This number, it was revealed, is growing faster than the number of men affected by the disease.

It is well known that women are more susceptible to the virus than men during sexual intercourse because of the larger mucosal surface area exposed in women, and the greater viral innoculum present in semen as compared to vaginal secretions. Young girls are particularly vulnerable because of the lack of maturation of the cervix and due to low vaginal mucous production.

Women are also more likely to have untreated sexually transmitted diseases particularly because they do not recognise low grade infections specially when it is due to their partner's behaviour.

Women are also more susceptible to contracting HIV through blood transmission and blood products that are given as correction of anaemia during childbirth and also during major operations such as a hysterectomy in the developing world. Fortunately this particular situation is rare in Sri Lanka due to an extremely vigilant surveillance system that was evolved in the blood banks throughout the country from the very beginning of the epidemic.

But the real enemy of women in this region is the gender disparity between men and women.

As prevention is the only way to control the infection still, it is vital to have prevention programmes targeted specially at women which would improve their decision-making power. It is also very necessary that women's health issues as well as specific HIV/AIDS/STD and sex education programmes be directed at men in their roles as husband's and lover.

As a doctor who conducts a family planning clinic in an area where the majority of the people belong to a specific religious community, I find it extremely hard to persuade the women to practise a family planning method even when their own lives are in danger from a further pregnancy. I have seen first-hand how their decision-making power depends heavily on their economic status, level of education, family status etc.

Education programmes targeted at women must concentrate on such vulnerable groups and also address the issue of self-esteem. Most of the women I counsel on family planning have pointed out that men need to change their perception that women are responsible for all aspects of health education and preventing pregnancies. Men need to take an active role in practising safe sex for prevention of pregnancies as well as prevention of STDs.

At present condoms have become the mainstay of "safe sex". But the question must be asked whether in our unique cultural background, indiscriminate distribution of condoms is acceptable. Perhaps with certain high risk groups like the commercial sex workers, condom distribution should be the mainstay of prevention.

But the overall condom distribution programme should be incorporated with an education programme to make it more acceptable. The goal of condom distribution in HIV/AIDS prevention is increasing condom accessibility to individuals at high risk of HIV infection, and in family planning to prevent unwanted pregnancies as part of the safe motherhood initiative.

Since HIV/AIDS is dramatically increasing the morbidity and mortality in women of reproductive age in developing countries, it is undermining the pathway through which the safe motherhood initiative operates. It is also compromising the efforts to improve women's survival. Therefore the epidemic is demanding a correlation between family planning activities and the HIV/AIDS prevention programmes.

Firstly, the aim of such a programme ought to be to empower women to take responsibility for their own health. It is a fallacy to believe that only young girls and women who come from rural areas need to be educated in the areas of safe sex and birth control.

Secondly, any such combined family planning and HIV/AIDS prevention programmes must work by gradually changing the social and cultural perception in society that prevents women's ability to protect themselves. Such a programme will be most effective if placed within the context of women's physical, mental, social, economic, cultural and spiritual health and wellbeing. It is imperative that women and men together understand and recognize women's rights to health safety and reproductive freedom.

Since our country consists of multi-religious and multi-ethnic communities, all such programmes should recognize the unique circumstances of women from these different groups. As in many other Asian countries, there is still in Sri Lanka a tendency to deny that AIDS is a problem. Therefore the promotion of safe sex messages and condom distribution are seen as going against culture, religion and tradition. Education programmes have to be sensitive to these perceptions.

Since family planning services have access to women in the reproductive age and their partners, family planning, counselling and HIV/AIDS prevention programmes should go hand in hand. Open discussions on sex should be promoted. The reproductive productive and community related roles of women should be the focus of such discussions and this a long-term basis would promote the empowerment of women.

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