28th November 1999
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Medical MeasuresStrikes: GMOA must not play God

Second Opinion

The past few weeks saw some ugly altercations among health sector professionals and the coming weeks are likely to see more trade union action by doctors, signalling turbulent times for this sector.

The dispute between nurses and hospital minor staff over a uniform has been simmering for some time. The nurses' grouse is that the uniform now worn by hospital minor employees is similar to theirs and also that it has not been authorized for use.

The minor employees' argument is that the uniform has been sanctioned by the Ministry of Public Administration and that, because there is no cap, there should be no difficulty in identification.

We cannot pass judgement on such issues but what we can say is that whoever is right, the mere design of a uniform does not warrant trade union action by either sector that jeopardizes the lives of hapless patients.

And in this instance, the dispute did not end with trade union action either- the two sectors physically traded blows, several nurses were seriously injured and had to be hospitalized and state property was damaged- all over who should wear what.

The incident is a pointer to the lack of discipline in the health sector and this lack of discipline is not confined to the lower rungs of the service. Even medical administrators stand accused of ad hoc decisions and disregard for merit in decision-making and doctors themselves have earned notoriety in what was once a noble profession.

Presiding over all this, the politicians in charge of the sector have their own agendas regardless of the consequences of their decisions. Just to cite one example, the politicians say they will continue recruiting and training assistant medical officers when there is bound to be a glut of doctors soon- because the former is a politically more popular option.

Come next week, doctors are yet again poised to keep away from work, citing several grievances. Among them is the complaint that no decision has been taken about the hand-over of larger hospitals to the provincial councils, and that is a worthy cause.

One cannot deny a profession- even if they are doctors- trade union rights and it is probably their thinking that a strike closer to an election has a greater potential for success.

But in doing so- even in the past- it must be said that the medical profession has at times been less than considerate about the poor, sick patients whose lives are at their mercy.

If memory serves us right, the Government Medical Officers' Association (GMOA) once decided that certain major hospitals will maintain all services in future strikes. But this decision was not honoured in the last strike launched by the GMOA, though in fairness to the trade union it must be said that emergency services were truly maintained.

One cannot only blame the GMOA for all the ills in the health sector. But what the trade union must realize is that as long as this administration and its politicians and their advisors are in charge of health, strikes will be a regular feature.

In such a situation, the GMOA must not play God and endanger the lives of the sick. Strike, if you must but spare the major hospitals- the National Hospital and the major maternity and children's hospitals at least. That way, it will win public sympathy for their cause- not their wrath as it now does.


Is there a killer in you?

Alcohol is a major social and medical problem in this country and continues to be so, despite many public awareness campaigns launched against it.

What exactly is alcohol, how does it affect your body and why is it considered so harmful? If you are interested in finding out the answers to these questions read on.

All alcoholic beverages- from whisky to kasippu- contain ethyl alcohol which is rapidly absorbed into the blood and then carried to the brain where it slows its function.

At first, it affects those areas of the brain that control judgement and inhibition as a result of which people become less constrained, more talkative and more friendly. As their inner control breaks down they may feel relaxed, safe, self-confident and happy.

As more alcohol is taken it depresses the brain further and people become more confused, their speech is disorganized and rational judgement is impaired. Other activities are also affected and their walk becomes clumsy and they take longer to react to situations and begin to misjudge distances, which is why you should not drink and drive. If even more alcohol is taken, a person will lose consciousness, go into a coma or even die.

The effects of alcohol decline only as the alcohol concentration diminishes as the chemical is broken down by the liver into carbon dioxide and water which is excreted mostly in the breath and in urine- the former causing the characteristic smell of alcohol in the breath.

Most people will become intoxicated at least occasionally but some progress from 'casual' or 'social' drinking into uncontrollable alcohol consumption- this is alcoholism, alcohol abuse or alcohol dependence.

Alcoholics regularly drink excessive amounts of alcohol, feel unable to change their drinking habits and rely on alcohol to enable them to do things that would otherwise make them anxious. Their excessive drinking often affects work, social and family life and they may even have problems with law-enforcement authorities.

A percentage of these persons also experience a dramatic reaction within a few days of stopping or reducing drinking. They start seeing terrifying images, feel that they are being pursued by someone, they sweat and begin to shake, some will lose consciousness; others will have fits.

Continued excessive alcohol consumption can also damage physical well- being and over a quarter of patients in the medical wards in Sri Lankan hospitals suffer from alcohol related illnesses.

An excessive intake of alcohol overworks the liver eventually leading to 'Cirrhosis' which can eventually be fatal. This is the commonest alcohol related medical complication in this country. Alcohol also damages the heart, lungs, and pancreas and may cause bleeding stomach ulcers.

For someone who is an alcohol abuser all this information may be of little use in convincing him that he should not drink.

More often than not, they are aware that they are slowly but surely killing themselves- but they are unable to control the habit.

They should then seek professional help. Such help is available at the Psychiatry Clinics at all major hospitals and also at Mel Medura at 60B, Horton Place, Colombo 7 (Tel. 693460). More information about alcohol abuse and facilities for treatment may also be obtained from the Alcohol and Drug Information Centre, 40/18, Park Road, Colombo 5 (Tel. 508484).

The many myths about dieting

Dieting has always been good business. Being obese or even slightly overweight- is not fashionable and there are always people who would pay to reduce their waistline.

Supply serves demand and therefore there have always been various ways and means offered to reduce weight. They include courses of dieting, special 'magic pills' and even belts that claim to reduce weight. But how effective are all these?. To find out, consider these five myths about dieting:.

* Weight reduction can be achieved overnight: No programme which offers this solution is likely to be very effective.

This is biologically impossible. Any weight reduction programme must offer only a weight loss of a kilogram per week, at most. If the weight loss is more than that, that itself is unhealthy! Therefore, the only thing that crashes in 'crash courses' for weight reduction is the course itself.

* Weight reduction can be achieved without exercise: This too is highly improbably. There are programmes which boast that they involve 'no workouts, no sweat' but they must be taken with a pinch of salt. Regular exercise- which may be in the form of jogging in the park or even your day to day work if that is sufficiently vigorous- is the cornerstone of any weight reduction programme.

* Reducing sugar alone will reduce weight: Reducing sugars alone will not help lose a large amount of excess weight. The amount of fatty foods consumed as well as the total amount of food consumed are also important which is why a supervised diet drawn up by nutritionists on a scientific basis is essential for the success of any weight reduction programme.

* Once reduced, the weight will be just right for a long time: No and this is the trick played on many overweight people. Many diets and programmes do fulfil their expectations- the target weight is achieved in the target period. But the real problem begins six months later when slowly but surely the lost weight is added on again. A weight reduction programme can be said to be successful if the weight is static after a year- and this depends not only on the programme but also on the continuing eating habits of the person! .

* Drugs are a more scientific way to lose weight: Drugs are perhaps the most harmful way to lose weight. If there was a drug that would cause loss of weight in a scientific manner, doctors would have developed it and it would be freely prescribed by medical professionals. That this is not done can only mean one thing- it is not scientific and it is not healthy. Magic pills offering a cure for obesity have something in common with magic pills that improve memory- they are both unhealthy and they both don't work, really!

Vitamins: Dos and don'ts

If you are healthy and having a balanced diet, you should be getting all the vitamins that your body needs for normal daily living.

However, not getting enough vitamins can affect your health but unless symptoms are a direct result of insufficient vitamins, taking more will not help.

Some take very large doses of vitamins- just to keep "healthy"- but remember that vitamins in large doses can be harmful.

There are two types of vitamins- fat-soluble and water-soluble. The fat-soluble vitamins, (A, D, E and K) are more easily stored in the body because they are deposited in fat tissues from which they are slowly used.

The water-soluble vitamins (vitamins B and C) are lost quickly from your body because they are not easily stored. They are also easily removed in cooking, so a regular daily intake of these vitamins is essential.

You are at risk of vitamin deficiency, if you are a vegetarian, consume alcohol on a regular basis, are pregnant or breast-feeding, are recovering from a serious illness or surgery, are on long-term medication (the 'pill', laxatives, and long-term antibiotics). 

To prevent vitamin deficiencies, you could adopt a few strategies that will enhance your vitamin intake without having to pop pills on a regular basis. Try to store fruits and vegetables in the refrigerator or in a cool dark place, to minimize loss of vitamins, prepare food just before serving, as much as possible, cook vegetables for the shortest time possible, in a little amount of water, eat whole-meal bread, refrigerate milk as soon as it is bought, eat a variety of foods etc.

And, always remember, resist being tempted into taking vitamins because they are "good for you". Too much of anything is harmful- even vitamins!
Your Mental Health{tc "Your Mental Health"}

Your Mental Health

What is Schizophrenia?

Schizophrenia is a common but serious mental illness that affects both sexes. It usually starts in young adulthood (15 to 30 years) but people of middle and old age too can suffer from this illness. 

Schizophrenia is identified as a group of illnesses, having positive symptoms or negative symptoms. People with positive symptoms may be active or restless and people with negative symptoms may be passive or withdrawn. Symptoms may be varied with one or more symptoms of mild or severe intensity, physical or behavioural in nature. Some schizophrenics lead a normal social life while some are incarcerated in mental hospitals, but the modern trend is towards treatment within one's own family and in the community.

One important feature of this illness like in some other serious mental illnesses is lack of insight, as a result of which the person may not be aware that he or she is ill. (This is somewhat similar to a person who is intoxicated with alcohol but not aware that he is drunk.) 

As a result, there may be a lot of practical difficulties. They may not go to a doctor or clinic and even if medicines are given they may refuse to take them. This causes a difficulty for the family who is caring for the person. Also if they need in-patient care they may not be willing to be admitted. 

What are the symptoms?

Usually the symptoms develop gradually but in rare circumstances may develop suddenly. Common symptoms are: 

* Irrelevant talk or behaviour; due to disorganized thoughts or loss of inhibitions like in the case of a person who has consumed alcohol. 

* Smiling to self or talking to self; due to hearing voices.

*False beliefs, which are abnormal, unusual and not within rationality or the culture and an abnormal level of suspiciousness.

* Hearing voices (hallucinations) or seeing things or persons which are not visible to others.

* Change in levels of activity: Very restless, overactive or withdrawn. 

* Feeling that others can read their mind, insert or take away thoughts or being controlled by external forces. 

What are the causes?

In schizophrenia like in other serious mental illnesses no direct causative factors are known and usually there may be a number of factors contributing. 

* Biochemical: There are theories to suggest some biochemical changes in the central nervous system (specially in the brain amines).

* Familial: It tends to run in families indirectly so that people who have close relatives suffering from Schizophrenia may have a higher risk than the others (this does not mean that every one who has had a patient in the family will end up having this illness!!)

* Physical conditions like head injuries, viral infections and childbirth may very rarely precipitate the illness in those who are vulnerable. 

Misuse of addictive drugs like Alcohol, Cannabis, LSD, Heroin can precipitate conditions similar to Schizophrenia 

* Severe stressful factors may rarely precipitate the illness in those who are vulnerable. 

What could be done?

Schizophrenia can be treated and most of the patients respond well to treatment. Early treatment is essential and important to reduce the burden and suffering of the patient as well as the family. Also with early treatment, complications and disabilities may be reduced thus avoiding the need for hospitalization or rehabilitation. 

Almost all the patients can be treated as outdoor patients. Only those who refuse food or medicine or who are very aggressive or restless or suicidal need to be admitted to hospitals for short periods. 

What are the types of treatment?

Usually the drug treatment is the first in line and most drugs are given as tablets. Injections are available for emergency uses. Some drugs are available in colourless and odourless drop form, long acting injections that may be given once in two or four weeks are also available. Some of these drugs have unwanted effects, which may be minimized by reducing the dose, changing the medicines or giving other drugs to counter them. If the patients are severely disturbed and drugs could not be given or when they do not respond to drugs, electrical treatment (Electro Convulsive Therapy) can be given. Usually this is done in the wards but in some cases it can be given even in outpatients' clinics. There are a lot of myths about this treatment which is sometimes labelled as shock therapy, but the treatment is relatively harmless. 

What is the outcome of treatment?

In most patients symptoms subside or disappear with the types of treatment listed here but in some it is possible for the symptoms to reappear when the medicine is stopped. 

Therefore the present trend is to continue treatment even after the symptoms have disappeared for some time. This may be decided by the physician. The dose may be reduced gradually and this is done in follow-up clinics where the patients are seen once a month at least. Long acting injections are helpful in the follow-up, specially for the patient in normal daily activities. If there are difficulties in adapting to social situations they should undergo rehabilitation programmes to improve social interactions. It is known that the social background can also be important in relapses. Patients who are recovering can benefit from other forms of therapies like psychological treatment, which can be useful for reducing negative symptoms. 

Due to delay in treatment or improper or inadequate treatment, some patients get relapses and as a result may require prolonged hospitalization. But with early and adequate care and treatment, complete recovery is possible and, can lead to normal living in the community. 

The common attitude among the general public in developing countries like Sri Lanka is to stigmatize the person's suffering from schizophrenia as well as other mental illnesses and, to consider them as social outcasts. Therefore it is essential to educate the public on the myths surrounding these illnesses. 

All people have a right to engage in any capacity within the community such as in employment, education and social activities. 

- Courtesy: National Council for Mental Health, Sahanaya 

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