REGISTERED AT THE DEPARTMENT OF POST QD/138/NEWS/2021 NEWS+ SLMAThe Official Magazine Of The Sri Lanka Medical Association WWW.SLMA.LK JUNE 2021 VOLUME 14 ISSUE 06 ISSN: 1800-4016 (PRINTED) eeISSN: 2550-2778 (ONLINE) Editorial: Etiquette in Medical Practice: A Forgotten Entry? Page 2 The X-Press Pearl & Perils to the Pearl of the Indian Ocean Page 08 Airborne Micro-plastics and COVID-19 Page 11 Management of COVID-19 in Sri Lanka Page 14 “Delusional parasitosis” Page 16 The Editor’s Choice: COVID-19 & autopsy practice in SL: Erroneous without a comprehensive autopsy? Page 24 134th Medical Congress – postponed Page 28 The SLMA COVID ‘SAHANA’ Monthly theme: Support COVID care! ‘Environment Page 25 and health’ SLMANEWS+ ISSN : 1800-4016 (PrINted) eISSN :2550-2778 (ONLINe) “Wijerama House”, No. 6, Wijerama Mawatha, Colombo 07, Telephone: +94 112 693 324, Email: [email protected] SLMA News Editorial Committee 2021 CONTENTS Editorial 2 =EDITOR-IN-CHIEF Professor Hasini Banneheke President’s Message 3 SLMA News-in-Brief 4-6 =EDITORIAL COMMITTEE Dr. B.J.C. Perera Feature Articles Dr. Sarath Gamini De Silva The X-Press Pearl Fire; Health Perils to the Pearl Professor Jennifer Perera of the Indian Ocean 8-10 Professor A. Pathmeswaran Professor Nirmala Wijekoon Airborne Micro-plastics and COVID-19 Transmission 11-13 Dr. Achala Balasuriya Management of COVID-19 in Sri Lanka 14-16 Dr. Shehan Silva Parasites of the mind: “Delusional parasitosis” 16-18 Professor Sampath Gunawardana Dr. Chathurie Suraweera The outcome of Maternal Death Surveillance and Response – 2019 20-22 =COVER DESIGN Mr.Wasantha Siriwardena Case report SARS CoV-2 epidemic and autopsy practice in Sri Lanka: Can it be erroneous without a comprehensive autopsy? 24 =MAGAZINE DESIGN Mr.Wasantha Siriwardena Notices [email protected] The SLMA Covid ‘SAHANA’: Support COVID care !!! 25 =LAYOUT The list of donors contributed to The SLMA Covid Mr. U.R. Sampath ‘SAHANA’ fund 25 Pre-congress workshop 26 =PRINTING AND PUBLISHING ASSISTANCE 134th Annual International Medical Congress: postponement 28 RS Printek (Pvt) Ltd. Miscellany 765/2, Lake Crescent, Waduwegama Road, The joy of ageing 28 Biyagama, Sri Lanka (Gen.) +94-011-2488434, +94-011-2488339 Mobile: 0712690275 SLMA President OUR ADVERTISERS Dr. Padma Gunaratne =D Samson Industries (Pvt) Ltd. MBBS, MD(SL), FRCP =Blue Ocean Group of Companies (Edin, Glasg, Lond), =Anti-Malaria Campaign FCCP, Hon FRACP, =Lanka Hospitals FAAN, FWSO =Prime Group President, Sri Lanka Medical Association =Ministry of Health SLMA NEWS+ is published by the Sri Lanka Medical Association (SLMA). The views expressed in it are not necessarily those of the SLMA. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the Editor. Permission may be sought directly from the SLMA, Wijerama House, No. 6, Wijerama Mawatha, Colombo 07, via telephone +94 112 693 324 or E-mail: [email protected] SLMANEWS+ JUNE 2021 | 01 Editorial Etiquette in Medical Practice: A Forgotten Entity? “During my own recent hospitalization, I found the Old- to the patient for the interruption. Sometimes, indi- World manners of my European-born surgeon, and my re- cation to the patient that it is an important call would action to them, revealing in this regard. Whatever he might suffice and please the patient and relatives as well. actually have been feeling, his behaviour, dress, manners, What is mostly neglected is the respect and sensi- body language, and eye contact, were impeccable. I wasn’t tivity towards the values of patients’ time and their left thinking, “What compassion.” Instead, I found myself other obligations and commitments. Late arrival, for thinking, “What a professional,” and even (unexpectedly), whatever reason, should be acknowledged with an “What a gentleman.” The impression he made was remark- apology. In the eyes of a patient, it is one of the nicest ably calming, and it helped to confirm my suspicion that pa- forms of behaviour. tients may care less about whether their doctors are reflec- It is also the responsibility of the doctor that his tive and empathetic than whether they are respectful and or her staff members are properly attired and behave attentive.” in a professionally acceptable manner. Any issues or (*Kahn MW. Etiquette-based medicine. N Engl J Med lapses on the part of the staff should be handled tact- 2008;358:1988-89) fully, without causing any embarrassment to either party. The use of the mobile phone by staff, while at- The Oxford dictionary defines ‘etiquette’ as “the tending to patients, should be discouraged as much as customary code of polite behaviour in society or possible. among members of a particular profession or group”. Medical etiquette towards colleagues, irrespec- Practice of ‘Etiquette-based Medicine’ is as old as the tive of the hierarchy, is very important in day today Hippocratic Oath. practice. For example, when a referral comes from a In Sri Lanka, patients rarely, if ever, complain general practitioner, specialists at the receiving end about the competencies of doctors. Criticism is often should be humble enough to reply back with a thank- about their behaviour. Patients say that doctors do not ing note and provide advice on future management of look at their faces, or smile, or allow them to express the patient. If a patient expresses his or her displea- themselves well, or pay due attention to all of their sure as to how that patient was treated by a colleague complaints or spend adequate length of time with of the doctor or a colleague’s apparent mistakes during them. This list could be even longer. a consultation, a doctor should act professionally and Within the profession, there is an accusation appropriately, perhaps with appropriate body-lan- against the medical schools for not training the doc- guage (E.g.: need not go out of the way to defend the tors in this aspect. According to a psychiatrist*, com- colleague without knowing the correct facts or take passion-based medicine’ is difficult to ‘teach’ while an active part in the criticism). Unfortunately, there etiquette is easier because “it’s simpler to change are many anecdotes of specialists criticizing the treat- behaviour than attitudes”. Most medical faculties do ment given by the family doctor with the patient but make an effort to ‘teach’ etiquette, yet the practice of end up prescribing similar medicines in brand names. etiquette is not well reflected among doctors. This ultimately leads to family doctors referring pa- The practice of proper medical etiquette involves tients only to their friends but not to the most appro- not only the patients and their relatives but also co- priate specialist or the most convenient and cost-ef- workers, colleagues, and society at large. It is not a fective choice for the patient. practice that the lack of which can be challenged in Etiquette-based medicine is more about behaviour a court of law but it can simply make the consultation and character development. Professionalism and eth- a pleasant experience to all others involved including ics are key components of it too. It ultimately leads to the doctor himself or herself. higher patient satisfaction. So let’s emphasize on good Appropriate attire while on duty, greeting the pa- behaviour within the profession, and allowing our pa- tient, smiling when appropriate, welcoming any rela- tients to ponder ‘What a gentleman, tives attending, introducing anybody present with the (or a lady), my doctor really is’! doctor such as a trainee, and requesting the patient’s consent for their presence are a few simple things Editor-in-Chief that all of us can practice. Telephone calls are a major Professor Hasini Banneheke, disturbance to consultations and therefore the doctor MBBS (SJP), Pg Dip Med Micro (Col), should reduce the length of such calls and apologise MD-Med Parasitoloy (Col) 02 | JUNE 2021 SLMANEWS+ President’s Message ay 2021 was an im- had a seminal impact on the portant as well as Government arriving at deci- a historic month sions of national interest. There for the Sri Lanka is an unprecedented level of in- MMedical Association. For the terest in the media on the SLMA first time in its history, SLMA statements. The SLMA Satur- was able to bring all leading day talk, which is a brainchild doctors’ associations onto a of mine, has been well received single platform demanding by all medical students is- the Government of Sri Lanka land-wide. The average number to seriously consider declaring of participants exceeds 1000 per a lockdown as an immediate session in general. SLMA is now measure to control the rapidly known as a leading professional escalating number of cases of organization of doctors to each COVID-19. and every citizen of the country. The government quickly ‘SLMA COVID සහන’ is the acceded to our demand. By latest welfare project estab- the time the lockdown was lished by the SLMA to support declared, the number of ad- Government hospitals with fa- missions to hospitals was ex- cilities they are short of, to up- ceeding the capacity of the lift the care given to COVID wards and ICUs allocated for patients. The සහන project has COVID-19. Any further delay reached each and every corner in implementing the lockdown where there is a well-wisher would have pushed the health system to a calamity for COVID patients in Sri Lanka. SLMA has already and a state of collapse. As the President of the SLMA, received more than 10 million within lesser than a I appreciate the support extended by the GMOA, the month of establishing the project.