SLMA Theme 2018 01 President's Message Shifting Focus from Page No. 04-05 Diseases to Patients: 02 SLMA Monthly Clinical Meeting Today's Vision, Page No. 05 Tomorrow's Reality 03 World Health Day 2018

Page No. 06 04 What are Minimum Standards in Medical Education?

Page No. 07 05 Prof Carlo Fonseka’s essays of a lifetime

Page 08-10 06 SLMA guest lecture - 'Swedish healthcare - reflecting democratic values'

Page No. 10 07 Call for applications: Dr. C.G. Uragoda History of Medicine Lecture 2019

Page No. 12 08 Management of fever during pregnancy and the postpartum period

Page No. 12 09 Swedish HealthCare and Academia

Page No. 13-14

10 Devices: Are they always sterile?

Page No. 14-16

11 The Natural Order of Things

Page No. 16-17 Our Advertisers 12 SLMA Guest Lecture: Zen, stigma and mental health

Page No. 17 OUR ADVERTISERS 13 Call for applications: Desmond Fernando Memorial Lecture ANTI-MALARIA CAMPAIGN. GLAXOSMITHKLINE PHARMACEUTICALS LTD. Page No. 18 JLANKA TECHNOLOGIES (PVT) LTD. RECKITT BENCKISER (LANKA) LTD. TOKYO CEMENT COMPANY (LANKA) PLC.

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SLMA Newsletter | April 2018 3 President's Message

Dear Member, Health of The Maldives, on the side-lines , submitted its observations and The month of April 2018 was an extremely of the World Health Day celebrations. views on the draft declaration on primary important one for Sri Lanka and the The Commonwealth Heads of Government care. It will be taken up for discussion by Sri Lankan health sector in terms of Meeting (CHOGM) took place in London world leaders later this year. international exposure. This was because under the patronage of Her Majesty In the meantime the routine academic the WHO made an announcement at its Queen Elizabeth II this month. Prof Vajira activities of the SLMA continued. We had 142nd Session of the Executive Board held H W Dissanayake the President of the a Guest Lecture on the topic Swedish in January 2018 that the World Health Day Commonwealth Medical Association Healthcare-Reflecting Democratic 2018 will be celebrated in , Sri (CMA) and a Past President of the SLMA, Values by Prof Göran Kurlberg from the Lanka on the 6th of April 2018. In making participated at the inauguration of this Sahlgrenska Academy, University of this announcement Dr Tedros Adhanom meeting at Buckingham Palace on the Gothenburg, Sweden on 3rd April. After the Ghebreyesus, the Director General of the 19th of April 2018. Professor Dissanayake well-attended lecture the SLMA hosted WHO had this to say “..there is no more also chaired the meeting on Global Health Prof Kurlberg to a traditional Sri Lankan fitting place for this event, as you know Security and the Digital Health Society lunch in our meeting room. The special Sri Lanka has a long history of providing 2030 – Innovation and Investment for invitees at the lunch were Prof Carlo free healthcare for its people”. Sri Lanka One Planetary Health and Universal Health Fonseka and Prof Colvin Goonaratna. of course was providing universal Coverage, held on 20th April 2018 as a Our monthly clinical meeting, held free access to healthcare through an special event of CHOGM. His Excellency in collaboration with the College of extensive network of preventive and President Maithripala Sirisena attended Pulmonologists of Sri Lanka, was on the curative government healthcare facilities the event as a Special Guest. The outcome topic Diagnosis and Management of throughout the country since the 1930’s, of the meeting was a proud moment Common Interstitial Lung Diseases. The long before the global discourse on for Sri Lanka as the Commonwealth Expert Committee on Communicable Universal Health Coverage/Care (UHC) resolved that Sri Lanka should lead the Diseases of the SLMA organized a well- started. The theme for this year’s World Commonwealth Centre for Digital Health. attended symposium on Chickungunya: Health Day was Universal Health Coverage: On behalf of the SLMA membership I Another viral fever spread by Aedes Everyone, everywhere. It was indeed a extend our congratulations to Professor mosquitoes which was held on 26th April. satisfying coincidence that the SLMA also Dissnanayake for keeping the flag of the The deadlines for submissions of abstracts had decided to make the concept of UHC Sri Lankan medical fraternity flying high at and orations for the year expired on the through Primary Care its theme for the this global event. 18th April 2018. We have received 277 year 2018 by adopting the theme- Shifting The 40th Anniversary of the Declaration abstracts for review and the Editors of the focus from diseases to patients: Today’s of Alma-Ata also falls this year. The Alma- Ceylon Medical Journal are coordinating vision, tomorrow’s reality. Ata declaration was a land mark which the review of the abstracts. I am pleased to The World Health Day event itself, held at called for a Primary Care led approach note that the online abstract submission the Nelum Pokuna Theatre, was a grand for Universal Health Care. The WHO and system is now fully operational and has affair. It was held under the patronage of the UNICEF in collaboration with the increased the efficiency of the abstract His Excellency the President, Honourable President of Kazakhstan is organizing the submission process. Applications for the Prime Minister, Honourable Minsters of 2nd International Conference on Primary Research Awards and Travel Grants given Health of The Maldives and Sri Lanka with Health Care scheduled to be held in by the SLMA and applications for the the participation of the Director General Astana, Kazakhstan in October this year. Desmond Fernando Memorial Lecture of the WHO, the Regional Director WHO/ Member states, people, civil society and close on 30th June 2018 (Please refer SLMA SEAR and other distinguished invitees. The international development partners are web site for details). I wish to bring to the event served as a platform to showcase being invited to commit to transforming kind attention of the membership that to the world the history of medicine in Sri this new vision into a practical reality- a we have called for an ordinary general Lanka and the health milestones we as a reality that everyone can share, believe meeting of the SLMA to be held on 1st June nation have achieved by adoption of the in, take action upon and benefit from. 2018 for the purpose of seeking approval concept of UHC long before it became a The WHO launched a public consultation of the membership to grant Honorary buzz-word in international health circles. on the new Declaration on Primary Life Membership to Dr Malik Fernando The SLMA had the privilege of presenting Health Care and had sought the views of and Dr J B Peiris, two distinguished Past its recent publication 'The History of member states, people and civil society. Presidents, in recognition of their services Medicine in Sri Lanka 1948- 2017' to the The SLMA, which took a lead role in the to the SLMA. Director General of the WHO, The Regional Health Ministry led World Bank project I conclude by once again reminding Director WHO/SEAR and the Minister of of Reorganising Primary Health Care in all members that the 131st Anniversary

4 SLMA Newsletter | April 2018 International Congress of the SLMA will be For these events to be successful, it is events. held from the 26th to the 29th of July 2018 imperative that the SLMA membership With kind regards. at the Galadari Hotel, Colombo and the should participate in their numbers. Please SLMA Run and Walk 2018 under the theme make a note of these days in your diary, Dr Ruvaiz Haniffa 'Eat Wise and Drop a Size' is scheduled to if you have not already done so. I look President SLMA be held on 24th June 2018 at the BMICH. forward to seeing all of you at both these SLMA Monthly Clinical Meeting

Dr. Sajith Edirisinghe, Assistant Secretary-SLMA he monthly clinical meeting of the SLMA for March, 2018, organised Tin collaboration with the College of Anaesthesiologists & Intensivists of Sri Lanka, was held on 20th March 2018 at the Lionel Memorial Auditorium, SLMA. The meeting commenced with a case discussion on ‘Sepsis in Action’ by Dr. Anushka Mudalige, Senior Registrar in Critical Care Medicine, National Hospital of Sri Lanka (NHSL). Following the case discussion, a review lecture on the topic ‘Update in Sepsis – Fine- tuning the Management’, was delivered by Prof. Vasanthi Pinto, Professor in Anaesthesiology and Critical Care, Head of Department of Anaesthesiology & Critical Care, Faculty of Medicine, University of Peradeniya. The event ended with a quiz titled “Controversies in Management of Sepsis – Your Choice” by Dr. Nuwan Ranawaka, Acting Consultant in Critical Care Medicine, Cardiology Unit, NHSL. The discussion was interactive and well attended by medical officers and post graduate trainees. The meeting was chaired by Professor Ariaranee Gnanathasan, Professor in Medicine, Faculty of Medicine, .

SLMA Newsletter | April 2018 5 World Health Day 2018

orld Health Day, which falls on 7th April of each year, was of Wspecial significance to Sri Lanka this year following the decision made by the Director General of the World Health Organization to visit the country on this day. The decision to celebrate the day in Sri Lanka was based on the long standing commitment of the country to Universal Health Coverage, the theme of the World

Health Day this year. Dr. Ruvaiz Haniffa presenting the book to Dr. Poonam Khetrapal Singh, Regional Director, The day was marked by a grand event WHO/SEAR at the Nelum Pokuna Theatre, graced Indigenous Medicine Dr. Rajitha Senaratne The Sri Lanka Medical Association had the by Dr. Tedros Adhanom Ghebreyesus, and several other dignitaries. opportunity of presenting copies of the the Director General of the WHO, In their individual speeches, both the recent publication ‘A History of Medicine His Excellency President of Sri Lanka Director General, WHO and the Regional in Sri Lanka – from 1948 to 2017’ to both Maithripala Sirisena, Prime Minister of Sri Director, WHO/SEAR commended Sri the Director General, WHO and Regional Lanka Honourable Ranil Wickramasinghe, Lanka for its commitment to Universal Director, WHO/SEAR at this event. These Dr. Poonam Khetrapal Singh, Regional Health Coverage. In her address, Dr. Singh were presented by members of the Director WHO/SEAR, Honourable Minister commented, “It is fitting that this event Editorial Board, both Past Presidents of the of Health, Maldives, Mr. Abdulla Nazim should be held here in Sri Lanka - a country SLMA, Dr. Iyanthi Abeyewickreme and Dr. Ibrahim, Honourable Minister of Health, that has long championed revolutionary Palitha Abeykoon and President SLMA, Dr. Nutrition and Indigenous Medicine & power & the potential of Universal Health Ruvaiz Haniffa. Coverage.”

Dr. Ruvaiz Haniffa presenting the book to Mr. Abdulla Nazim Ibrahim, Honourable Minister of Health, Maldives

Dr. Iyanthi Abeyewickreme and Dr. Palitha Abeykoon presenting the book to Dr. Tedros Adhanom Ghebreyesus, Director General, WHO 6 SLMA Newsletter | April 2018 What are Minimum Standards in Medical Education?

Prof. Indika Karunathilake Therefore, the WFME guidelines on Basic Educationists under the guidance of Head, Department of Medical Education Medical Education are a global expert the President SLMC drafted the initial Faculty of Medicine consensus on the standards for medical document. The final document approved University of Colombo schools. The main domains (areas) by the council was gazetted in Gazette No. inimum Standards for Medical included in the WFME guidelines are; 1590/13 - 2009 25th February 2009. Education are a set of criteria 1. Mission and Objectives Regretfully this document ended up at a Mand requirements to guide how 2. Educational Programme parliamentary sub-committee. However, the 2009 Minimum Standards have been medical education could be delivered in 3. Assessment of Students line with the global standards and health in practice since then to date. Under a 4. Students needs of the country. mandate given by the council, the SLMC 5. Academic Staff/Faculty The need to determine global minimum published two comprehensive books 6. Educational Resources standards for medical education arose due based on the above standards. 7. Programme Evaluation to the rapid increase in the number of new 1. Guidelines and Specifications on Stan- medical schools in the last decades, many 8. Governance and Administration dards and Criteria for Accreditation of established on unacceptable grounds (e.g. 9. Continuous Renewal Medical Schools in Sri Lanka and Cours- some private schools "for profit”). es of Study provided by them, 2011 The standards under each domain are Minimum standards for undergraduate divided into basic standards (minimum 2. Guidelines and Standards, Criteria medical education have been used requirements) and quality improvement and Procedures for the Recognition of for many years in national systems of Degrees Awarded by Foreign Medical standards, accompanied by annotations evaluation and accreditation of medical Schools, 2010 and definitions. education. They are a necessary tool Recently, a committee appointed by the when external evaluation, recognition and Minimum Standards in the Sri Lankan SLMC has prepared a draft revision of accreditation of medical schools are carried context Minimum Standards, which was presented out. The main purpose is to establish a According to the Medical Ordinance, the to the Medical Council, and modifications system of national and/or international power to make regulations on minimum were made according to the feedback evaluation and accreditation of medical standards in Medical Education rests with obtained from several stakeholders schools to assure minimum quality the Sri Lanka Medical Council (SLMC). This including all the state Faculties of Medicine. standards for programmes. process is based on the recognition of the The finalised document was submitted to To achieve this purpose, standards technical expertise of SLMC in developing the Attorney General’s Department and must be clearly defined, meaningful, minimum standards and it is in-line with the Minister of Health. The Minister of appropriate, relevant, measurable, the best practices followed in reputed Health gazetted a Minimum Standards achievable and accepted by the users. institutions such as the General Medical document in December 2017. However, Council (GMC) in the UK. there are crucial differences between History of the process of development Minimum Standards in Medical Education the gazetted minimum standards and of global minimum standards in in Sri Lanka have been in existence the document finalised by SLMC and the Medical Education from 2006. The document on Minimum controversy is far from over. Edinburgh Declaration, 1988, which was adopted by the Standards drafted by SLMC was gazetted in World Health Assembly, WHA Resolution 42.38, 1989, and 2006 (Gazette of the Democratic Socialist References: the Recommendations of the World Summit on Medical Republic of Sri Lanka (Extraordinary) Education, 1993 No.1458/16 August 17, 2006 and WFME (2015) Global Standards for Quality Im- World Federation of Medical Education (WFME) Position No.1488/14 March 13, 2007). These were provement: Basic Medical Education. Paper (1998) regulations made by the then Minister of SLMC (2011) Guidelines and Specifications on  WFME project on International Standards in Medical Health, under section 19 of the Medical Education, approved by the World Health Organisation Ordinance (Chapter 105) in consultation Standards and Criteria for Accreditation of Medical (WHO) and the World Medical Association (WMA) with the Sri Lanka Medical Council. Schools in Sri Lanka and Courses of Study provided Executive Council of WFME in December 1998 appointed In 2009, Professor Lalitha Mendis, then by them an International Task Force consisting of a Working Party President of the SLMC took the initiative The final document on WFME guidelines on Basic Medical to revise the Minimum Standards in SLMC (2011) Guidelines and Standards, Crite- Education was adopted by the WFME Executive Council Medical Education to be in line with the ria and procedures for the recognition of Degrees June 2001 WFME guidelines. A team of Medical Awarded by Foreign Medical Schools, 2010 SLMA Newsletter | April 2018 7 Prof Carlo Fonseka’s essays of a lifetime

Essays of a lifetime which are essential for scientific thinking By Carlo Fonseka and philosophical approach of problem 2016, S.Godage & Brothers (Pvt) Ltd. solving and understanding of life. All these concepts together are not to be found in Reviewed by Dr Anuruddha Abeygunasekera one single reference book and certainly Consultant Urologist, the simpler descriptions given in this book Colombo South Teaching Hospital cannot be found elsewhere. His arguments n the recent past, Sri Lanka has seen a on complex issues are lucid, sharp and rapid increase in the number of books precise and yet simple to understand. CF Ipublished in Sinhala, Tamil and English displays his ability to explain and discuss languages, in differing proportions. any topic without dispiriting verbiages so Though some of them are of excellent that the reader will be glued to the book quality literary-wise, most of the topics are until its end. I am curious to know how aimed at the average reader. The number CF developed this skill. I presume it is the of books containing material which are result of voracious reading and extensive intellectually stimulating and challenging writing in addition to having born with is very small. Whether it is due to lack of a bigger area designated for such skills writers with philosophical attributes or in his cerebral cortex. Being an expert their fear that such books would not neurophysiologist himself, CF may be able Kannangara, DA Rajapaksa, Albert Einstein, have an adequate readership is unknown. to answer this question better. Richard Dawkins, Charles Darwin and Karl Prof Carlo Fonseka’s (CF) book which is a The book also has sections about Marx are written so succinctly in relation collection of his writings over the years the impact of health economics, to their seminal work, one may infer falls into this rare category of books characteristics of an ideal doctor, universal that biographies of great men if written which addresses philosophical issues with suffrage and scientific basis of fire walking. properly are not just history alone but give rationality and depth written in a style that Some of the remarks he makes are us an opportunity to digress the fields of can be understood by the average reader. concise but profound. Being a socialist their expertise in depth. Of course not all chapters belong to that and a longstanding left-wing politician he The book teaches many important lessons genre. The wide range of topics covered describes capitalism as making money by to its readers in addition to its valuable in this book shows the array of talents CF fair means if possible and by foul means contents. It shows the wide range of style owns and displays as a medical doctor, if necessary. His critical evaluation of CF adopts when he writes to readers of physiology professor, music composer, Buddhism and humanity of Jesus clearly different intellectual understandings. song-writer, scientist, left-wing politician, shows us the importance of teaching Young intellectuals, who would like to be public speaker and a television talk- scientific method of verification of truth future academics, writers and researchers show personality as summarised in the among the younger generation to look at should appreciate the different writing publisher’s blurb. The contents of the book religious teachings in an objective manner styles used in different chapters to inform, educate, entertain, tantalise, and devoid of emotions and dogma. This would understand how one should change may even infuriate you by turns. inculcate religious harmony in the society. and adapt the style of writing to suit the This hard cover edition containing 368 It is this lack of skills in critical analysis readership. This is the secret why CF has pages and titled 'Essays of a lifetime' embedded in scientific empiricism that such high demand and earns respect records most of the basic principles has lead to fundamentalism and hatred of media and public equally. He shows related to science, philosophy, religion towards other religions in our society. In how to write briefly and clearly without and art. Many such principles are difficult this regard CF emphasises that scepticism using superfluous words and padding. He to understand but CF has explained such is logically impeccable but psychologically uses the most appropriate word for that facts simply and clearly even the amateur impossible. instance and some are literary marvels. The can comprehend after few attempts of He explains why we should abandon dexterity in using quotations of wisdom reading. extremist viewpoints of unbounded by CF is noteworthy – appropriately His ability to summarise important absolutism and out-and-out scepticism. and sparingly. The book has many such principles is exceptional. In the first few ‘No great man lives in vain, the history of impressive quotations and every young chapters CF elucidates rarely discussed the world is but the biography of great writer can use this book as a source book but important concepts like ontology, men’ said Thomas Carlyle. CF’s descriptions whenever they embark on writing a good epistomology, ethics, socio-biology, of N M Perera, W D Amaradeva, Lester quality article. I have tried and it has paid dialectic materialism, hypothetico- James Peiris, Martin Wickramasinghe, A T me the dividends. deductive approach and empiricism Kovoor, P R Anthonis, A P de Zoysa, CWW Contd. on page 10 8 SLMA Newsletter | April 2018

Contd. from page 08 Prof Carlo Fonseka’s ... His ability to relate complex issues to daily that may keep their intellectual skills above philosopher from Sri Lanka who would events make the reading enjoyable. His average. When I finished reading CF’s be competent enough to challenge and fierce objectivity based on materialism as book I was captivated with the knowledge disprove such an argument. a rationalist is displayed in his writings and it imparted on me but I had one worry too. CF attempts to discern art and science. opinions. However he does not allow his It appears to me that CF is so intelligent, Accordingly a scientist discovers facts political opinions to that are existent but mar the science he unknown to mankind. professes. Every article The wide range of topics covered in this Newton’s law of has a comprehensive motion and Darwin’s bibliography on the book shows the array of talents CF owns theory of evolution topic and this makes are such examples. If the book an essential and displays as a medical doctor, physi- one does not discover, companion for all someone else is budding academics ology professor, music composer, song- bound to discover thirsty for references. such scientific truths. Even at the ripe writer, scientist, left-wing politician, public In comparison, an age of 83 years, CF art is a creation of seems to be having speaker and a television talk-show per- an individual. If the a better memory artist does not create than most of his sonality as summarised in the publisher’s the artistic work, it is students of university unlikely that someone days even though blurb. The contents of the book inform, ed- else will create the he describes himself exact product ever. as approaching the ucate, entertain, tantalise, and may even After reading CF’s undiscovered country book, I am not sure from whose bourn infuriate you by turns. which category the no traveller returns! book belongs to. I I presume people like CF are born with resourceful and philosophically apt he request the readers to make an attempt a large capacity brain that even after the could prove anything he wants including to answer this dilemma. For that you will gradual loss of cells due to ageing, they are things that may be factually incorrect! I have to read the book and I am certain left with an adequate number of brain cells am unable to think of a contemporary that you will never regret it.

SLMA Guest Lecture: 'Swedish healthcare - reflecting democratic values'

Dr. Sajith Edirisinghe Assistant Secretary, SLMA guest lecture titled ‘Swedish Healthcare – reflecting democratic values’ was A rd held on 3 April, 2018 at the Lionel Memorial Auditorium of the SLMA. The lecture was delivered by Prof. Göran Kurlberg, Associate Professor of Surgery, Sahlgrenska Academy, University of Gothenburg, Sweden and Visiting Professor, Research Department, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The lecture was followed by a lively discussion. The session was chaired by Dr. Ruvaiz Hannifa, President, SLMA. A synopsis of the lecture is included in this issue. 10 SLMA Newsletter | April 2018

Sri Lanka Medical Association Call for Applications Dr. C. G. Uragoda Lecture on the History of Medicine 2019

Hereby applications are called for the lecture to be delivered on 26th February 2019.

Applicants should submit, • A short abstract of the proposed lecture (no more than 1 A4 page). • A brief curriculum vita (no more than 3 pages). The speaker should have been considerably associated with and contributed to the field of medicine in his/her chosen topic. The SLMA wishes to encourage lectures in areas of medicine that have not been covered in previous lectures. A list of past lecture topics are available can be found on the SLMA website – http://www.slma.lk. The lecture is delivered on the 26th day of February - foundation day of the SLMA every year. Applicants should bear in mind that they must make themselves available the day of the lecture. Applications should be sent to Dr. Hasini Banneheke, Honorary Secretary, No.06, Wijerama Mawatha, Colombo 07. Deadline for applications 30th June 2018

Management of fever during pregnancy and the postpartum period ebrile illnesses during pregnancy first contact doctors has been identified the Ministry of Health and Indigenous and the postpartum period are as a main factor contributing towards Medicine and the Family Health Bureau Fsignificant causes of maternal mortality. regarding this matter and these can be mortality as evidenced by the findings Based on these findings, the Ministry accessed via the respective institutional of several Maternal Death Reviews in the of Health recommends that any female websites. All doctors are requested to recent past. In the year 2017, nearly 40 presenting with fever during pregnancy adhere to the guidelines stipulated in pregnant mothers lost their lives due to or the post-partum period, be referred these circulars. pneumonia and dengue haemorrhagic to a hospital on day 1 of the illness. They fever. This year, two maternal deaths due additionally emphasize the need for Ministry of Health circular – FHB/EH/26/14 to H1N1 pneumonia have been reported educating the general public regarding dated 06.10.2015 to the Maternal Death Surveillance and the importance of such patients seeking Family Health Bureau circular – FHB/MCS/ Response System of the Family Health hospital-based treatment on the first day MDG/2018 dated 02.04.2018 Bureau. In many cases delay in referral of of a febrile illness. such patients for in-ward treatment by The following are circulars issued by

Let’s keep Sri Lanka Malaria free

10

12 SLMA Newsletter | April 2018 Swedish Healthcare and Academia - High quality – Reflecting Democratic Values Göran Kurlberg, MD, PhD cardiovascular disease as well as different turn up on a very high position. However, Clinical Professor, Sahlgrenska University malignancies are dominating. There is accessibility Is a problem with sometimes Hospital, Gothenburg, Sweden a fairly high prevalence of psychiatric long waiting times for e.g. different Associate Professor, Sahlgrenska Academy, disorders also in the young population. surgical procedures. To overcome this GU, Gothenburg, Sweden We see few chronic infections. In trauma problem the Ministry of Health in 2005 Visiting Professor, Institute of Medicine, hip fractures stand out as common created a Health Care Guarantee trying TUTH, Kathmandu, Nepal diagnosis. There has been a considerable to force the county councils to improve Director Sahlgrenska Asian Network improvement in the outcome of treatment accessibility. Every citizen should be able Based on the SLMA Guest Lecture held of cardiovascular disease, mainly due to get in contact with a Health Care Centre on 3rd April, 2018. to increased attention to the condition the same day or get an appointment with among the public, quick recognition, a GP within seven days. Furthermore, the he Swedish welfare state was built interventional radiology and emergency patient should on referral be allowed to up during the 20th century with an surgery in particular for patients with see a specialist within 90 days and have Temphasis on a strong public sector, myocardial infarction. In spite of increased surgery, if needed, within another 90 days. based on an "equal for all" social security emphasis on detection and treatment of This guarantee is reflecting the urge to system. This ideology is also reflected in malignant conditions we have not seen strengthen the right of the patient. the Health Care system, overseen by the a considerable improvement in survival. Another trend in health care is in government and the Ministry of Health There are varying opinions on the benefit technological development during the through the National Board of Health and of available screening programs and the last decades. Digital Health Centres Welfare “to ensure good health, social only program with national coverage is for can be reached through an app in your welfare and high-quality health and social breast cancer. smartphone and a doctor will call you care on equal terms for the whole Swedish Regarding basic health care demographics in 20 minutes for a consultation where population”. Among other central agencies Sweden takes a leading position in the you at least can look at one another. are the Food and Drug Administration as world: maternal mortality is 4 per 100000 Although the physical examination is well as the Swedish Agency for Health deliveries, infant mortality 2.6 per 1000 live inadequate, this is often a way to get a Technology Assessment, which seeks to births and under 5 mortalities 3 per 1000. quick referral to a specialist. Laparoscopy identify the best and most cost-effective Those interested in health statistics may is practised in nearly every area of surgery, treatment methods. look at the www.gapminder.org website. with shortened hospital stay and quicker However, management of the health care Primary Health Care has for some decades recovery as the main gain. Lately robotics has a decentralised structure governed by been suffering from a lack of GP:s since has been added to the arsenal of surgical 20 different county councils and regions. working as a specialist is more popular techniques. These councils are financially responsible among the doctors. The health authorities IT has also conquered medicine. All for the running of primary health care have therefore opened up space for medical records are computer based, centres and hospitals in each county or private initiatives. Public Health initiatives unfortunately with less user friendly region. Sweden spend 11% of the Gross have contributed much to improve health often “home-made” software. This has led Domestic Product on health care, which level in the country and has been using to oversized documentation, increased is in par with other European countries. different health centres as their basis. administration and bureaucracy. However, Health care, including medication is There is also a strong trend towards caring there are benefits for the patients with heavily subsidised; to see a GP is 12 USD for the elderly, chronically ill patients in computerised medical record: through and an appointment with a specialist their homes. internet and with the use of a specific comes to 35 USD. Hospital stay is 12 USD/ During the 70’s there was a substantial personal id-number and identification day for the patient. There is also a high- expansion in number of hospitals in the process they can gain access to their cost ceiling for consultations of 140 USD country and there are now 70 county and own medical records. But, in a recent per year and 280 USD for every year spent district hospitals as well as 7 university study from one of the bigger hospitals it on medications. centres in Sweden. We have also had a big was found that the nurses in most wards The disease pattern is that of the elderly, increase in number of health personnel only spent 20% of their working hours on since the average life span reaches 81.4 in the last decades with 35000 medical direct patient care and 50% of their time years for females and 80.3 for men; 20% doctors in 2011, among the highest on documentation. This has generated a of the population is older than 65 years number In Europe. great loss in cost-efficiency throughout of age. Non-Communicable Diseases In international rankings of health care the entire health care sector!! like hypertension, diabetes mellitus, and patient safety, Swedish hospitals Contd. on page 14 SLMA Newsletter | April 2018 13 Contd. from page 13 Swedish Healthcare... 18 different health educational programs, appreciated. Some hospitals are now trying to turn this including medical school, dentistry Medical school course is followed by 20 trend in a sort of cultural revolution, but and nursing. There are also six different months of internship and 4-5 years of found this to be easier said than done. The research institutions in biomedicine, post-graduation, both these programs run medical profession has lost the power over medicine, neuroscience, clinical sciences, as employments at a hospital. health care to politicians, administrators odontology and caring sciences. Well The different institutions of the and bureaucrats. It has to be taken back. known inventions are the dental implants Sahlgrenska Academy are organising Academia has a long tradition in Sweden pioneered by prof Brånemark in the 70’s. masters as well as PhD training programs. and the first university was established in The dopamine research by Prof Carlsson The latter could run as an employment, Uppsala in 1477. Initially the theological earned him a well-deserved Nobel mainly for basic scientists, but for clinicians faculty was the dominating institution, prize. Losec, a protein pump inhibitor, with hospital employment, is regarded followed by science and medicine. developed in a collaboration between as “spare-time” research. If anyone opts Renowned scientists are Linnaeus, clinical pharmacologist, gastro surgeons for an academic career; to become an mapping the plants and Celsius and Astra was the number one selling associate professor requires at least 20 discovering the centigrade system. Lately, drug during the late 20th century. publications in recognized international Niklas Zennström invented Skype, now Medical School Course runs for 5.5 years, journals plus educational credentials sold to Microsoft with worldwide use. 11 semesters and is following the European and a professorship demands at least 40 There are seven major universities in accreditation system. Education is free publications, supervision of PhD students, Sweden and 30 university colleges. and in addition the students can apply research funding and active research. Higher education is entirely under for scholarships from the government In conclusion, Swedish health care is the government and the Ministry of basically covering living expenses. In mostly public, goes with high quality, but Education. There are no private universities each semester of 20 weeks, 140 students with insufficient accessibility. The aim set in Sweden, but research is undertaken in enter this training program. During the by the health authorities is to promote collaboration with the industry, especially tenth semester, they do a degree project good health for the entire population. the pharmaceutical companies supported in public health, basic sciences or clinical Sweden has a strong academic tradition as well by private funds. medicine. They can choose subjects from and is one of the top nations in research. The Karolinska Institute is the flagship of a website and around 20% of the students Lessons to be learnt; let the Doctors be Swedish academia and ranked number perform their small research project in a in control, do not lose the power over ten of medical universities in the world. low/mid income country. The Gothenburg health care to bureaucrats and watch KI is the home of the Nobel assembly, University has an MoU with both Rajarata out for computerised medical records. since 1901 awarding great minds with the and Sri Jayewardenepura Universities. This Try to adapt your national, personalised Nobel prize. means that students have come and will ID- number to be used in health care and In Gothenburg, the second largest city in come to Sri Lanka for their degree projects, introduce quality registries for initially the country, the Sahlgrenska Academy is a collaboration which has been highly malignant diseases. the health associated university, running Devices: Are they always sterile? Dr. Jananie Kottahachchi Chairman of the Expert Committee on Committee Member – SLMA Expert Com- Communicable Diseases of SLMA. Dr. mittee on Communicable Diseases Jananie Kottahachchi, Senior Lecturer he Expert Committee on and Consultant Microbiologist and Communicable Diseases of the a Committee Member of the Expert TSLMA organised a symposium Committee on Communicable Diseases of titled “Devices: are they always sterile?”, SLMA moderated the meeting. which was held on 22nd March 2018 Dr. K. Umapathy, Consultant Orthopaedic from 12.00 noon to 1.30 pm at the SLMA Surgeon, Teaching Hospital, Karapitiya, presented a very comprehensive Auditorium. Device related infections spoke on “Management of device related introduction on “Devices and infections” are ever increasing and this symposium infections”. The final lecture was delivered and furthermore, discussed the sequelae updated the doctors and medical by Dr. Shirani Chandrasiri, Consultant of infections related to orthopaedic students’ knowledge about reducing such Microbiologist, CSTH on “Laboratory appliances. Dr. Nuwan Ranawaka, Acting infections. diagnosis and prevention of device related Consultant in Critical Care Medicine, The symposium began with the Welcome infections”. Address delivered by Dr. Ranjith Perera, CCU/ICCU – Cardiology Unit, NHSL, Contd. on page 16 14 SLMA Newsletter | April 2018

Contd. from page 14 Devices: Are they...

The interactive discussion session was conducted by Dr. Lucian Jayasuriya, a senior member of the Expert Committee on Communicable Diseases of SLMA and Prof. Ariaranee Gnanathasan, the Vice President of SLMA. The session concluded with Dr. Ranjith Perera, the Chairman of the Expert Committee on Communicable Diseases of SLMA awarding certificates to the resource persons.

The Natural Order of Things t a fundraising dinner for a school my son was allowed to play, it would give the potential winning run was on base that serves children with learning him the much-needed sense of belonging and Shay was scheduled to be next at bat. Adisabilities, the father of one of and some confidence to be accepted by At this juncture, do they let Shay bat and the former students delivered a speech others in spite of his handicaps. give away their chance to win the game? that would never be forgotten by all who I approached one of the boys on the Surprisingly, Shay was given the bat. attended. After extolling the school and its field and asked, without expecting much, Everyone knew that a hit was all but dedicated staff, he offered a question: whether Shay could play. The boy looked impossible because Shay didn't even “When not interfered with by outside around for guidance and said, “We're know how to hold the bat properly, much influences, everything nature does, is done losing by six runs and the game is in the less connect with the ball. with perfection. Yet my son, Shay, could eighth inning. I guess he can be on our However, as Shay stepped up to the plate, not learn things as other children did. team and we'll try to put him in to bat in the pitcher, recognising that the other He could not understand things as other the ninth inning.” team was putting winning aside for this children did. Where was the natural order Shay struggled over to the team's bench moment in Shay's life, moved in a few of things in my son?” and, with a broad smile, put on a team steps to lob the ball in softly so Shay could The audience was stilled by the query. shirt. I watched with a small tear in my eye at least make contact. The father continued. “I believe that when and warmth in my heart. The boys saw my The first pitch came and Shay swung a child like Shay, who was mentally and joy at my son being accepted. clumsily and missed. physically disabled comes into the world, In the bottom of the eighth inning, Shay's The pitcher again took a few steps forward an opportunity to realise true human team scored a few runs, but was still to toss the ball softly towards Shay. nature presents itself, and it comes in the behind by three. In the top of the ninth As the pitch came in, Shay swung at the way other people treat that child.” inning, Shay put on a glove and played in ball and hit a slow ground ball right back Then he told the following story:- the right field. Even though no hits came to the pitcher. Shay and I had walked into a park where his way, he was obviously ecstatic just to The game would now be over. The pitcher some boys Shay knew were playing be in the game and on the field, grinning picked up the soft grounder and he could baseball. Shay asked, “Do you think they'll from ear to ear as I waved to him from the have easily thrown the ball to the first let me play?” stands. baseman. Shay would have been out and I knew that most of the boys would not In the bottom of the ninth inning, Shay's that would have been the end of the game want someone like Shay on their team, team scored again. and Shay’s team would have lost. but as a father I also understood that if Now, with two outs and the bases loaded, Contd. on page 17 16 SLMA Newsletter | April 2018 Contd. from page 16 The Natural Order...

Instead, the pitcher threw the ball right and far over the third baseman's head. being the hero and making me so happy, over the first baseman's head, out of reach Shay ran toward third base deliriously as and coming home and seeing his mother of all team mates. the runners ahead of him circled the bases tearfully embrace her little hero of the day!’ Everyone from the stands and both teams toward home. All were screaming, 'Shay, A LITTLE FOOTNOTE TO THIS started yelling, 'Shay, run to first! Run to Shay, Shay, all the way Shay'. STORY:- first!' Shay reached third base because the Never in his life had Shay ever run that far, opposing shortstop ran to help him by All of us have thousands of opportunities but he made it to first base. He scampered turning him in the direction of third base, every single day to help realise the 'natural down the baseline, wide-eyed and and shouted, 'Run to third! Shay, run to order of things.' startled. third!' Do we pass along a little spark of love Everyone yelled, 'Run to second, run As Shay rounded third, the boys from and humanity or do we pass up those to second!' Catching his breath, Shay both teams, and the spectators, were on opportunities and leave the world a little awkwardly ran towards second, gleaming their feet screaming, 'Shay, run home! Run bit colder in the process? and struggling to make it to the base. home!' A wise man once said, "Every society is By the time Shay rounded towards second Shay ran to home, stepped on the plate, judged by how it treats it's least fortunate base, the right fielder had the ball. The and was cheered as the hero who hit the amongst them". smallest guy on the opposing team now grand slam and won the game for his This is food for thought for the Sri Lankan had his first chance to be the hero for his team. medical profession. team. 'That day', said the father softly, with tears He could have thrown the ball to the now rolling down his face, 'the boys from Extracted and compiled by Dr. B. J. C. Perera second-baseman for the tag, and Shay both teams helped bring a piece of true from an e-mail sent by Professor Sanath P. would have been out. But the boy love and humanity into this world'. Lamabadusuriya understood the pitcher's intentions and ‘Shay didn't make it to another summer. He he too intentionally threw the ball high died that winter, having never forgotten

SLMA Guest Lecture – ‘Zen, stigma and mental health’ guest lecture was held on lecture titled ‘Dual diagnosis – the mind/ Consultant Psychiatrist and Senior Lecturer 14th March, 2018 at the Lionel body conundrum of addictions’ and was in Psychiatry, Faculty of Medical Sciences, AMemorial Auditorium, SLMA followed by an interactive session on the University of Sri Jayewardenepura, while by Dr. N. Yoganathan, College Tutor in topic of ‘Zen, stigma and mental health – the second was chaired by Professor Psychiatry (2010-2017); Member, Group a workshop on a dialectical approach to Ariaranee Gnanathasan, Professor in Analytic Society International; and stigma and psychiatry’. A large audience Medicine, Faculty of Medicine, University Consultant Psychiatrist, CNWL & SABP NHS participated in the event. The first of Colombo. Trusts, UK. The event commenced with a session was chaired by Dr. Dulshika Waas,

SLMA Newsletter | April 2018 17 18 SLMA Newsletter | April 2018 Sri Lanka Medical Association proudly organizes SLMA Health Run & Walk 2018 Sunday 24th June 2018 at BMICH premises • Health checks • T-shirt (first registered first served)

FREE • Healthy snacks & drinks Attractive Prizes for Winners PROGRAMME 6.15 am : Health Check for Runners 6.45 am : Warm Up Exercises 7.00 am : Commencement of Run 7.15 am : Commencement of Walk 8.15 am : Post-exercise Cool Down Session 8.30 am : Interactive & Entertainment Session 9.30 am : Prize Giving 10.00 am : Conclusion OTHER ATTRACTIONS • Exhibition of winning entries PRE-REGISTRATION OF RUNNERS of the Kids' Art Competition Hotline: 076 554 43 40 (call or send a text), https://www.facebook.com/SLMAonline/ Important: A fitness certificate signed by a medical practitioner is mandatory for all runners • Opportunity to meet celebrities • Magic show More Information : Email : [email protected], Tel: 011 269 33 24 • Bouncy castle for kids • Story telling for kids SRI LANKA’S PREMIER SOLAR PROVIDER

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