Health
Strikes:
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.
Alcohol
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 |