PGIM making history

Indian doctors sit our family medicine examinations

FAMILY MEDICINE: Sri Lanka's postgraduate medical qualifications in family medicine are gaining popularity among the Indian doctors, that already there are 144 Indian doctors holding the Diploma in Family Medicine (DFM) qualification offered by the Postgraduate Institute of Medicine (PGIM) in Colombo.

The PGIM has been conducting their examinations in India in collaboration with the Indian Medical Association (IMA) from 1998 for eight years upto now.

The last examination was held on September 10-14 at IMA Headquarters, Hydrabad, India.

The examination team was headed by Prof. Rezvi Sheriff, Director PGIM.

Prof. Sheriff speaking to the HealthWatch on his return said: 22 candidates passed the Diploma in Family Medicine examination this year. This is the 8th year this examination was exported to India. The MD Examination in Family Medicine also commenced this year.

MD in family medicine too

In India, family practice by Allopathic doctors is not well organised and there are no specialist examinations in this discipline.

The IMA seeing the value of the PGIOM examinations and training course has made this important link and invite the PGIM every year. There is a big demand for this examination but our team can handle only 40 candidates because of the labour intensive innovative examination techniques like MEQ, MCQ, OSPE, OSCE and VIVA components are held in tandem over 4 days.

The Sri Lankan team consisted of Prof. Rezvi Sheriff (Director), Prof. Leela Karunarathne (Chief Examiner), Prof. M.S.A. Perera, Dr. Dennis Aloysius, Dr. W.A. Ferdinand, Dr. Preethi Wijegoonawardena, Dr. Neil Abeysekera and Prof. Sivayogan (Workshop Resource Person), Kapila Gunasinghe (Assistant Registrar/Exams), Ms. Inoka and Palitha came from PGIM Examination Department. Dr. Arul Raj (Tuticorin/National IMA Co-ordinator) and Dr. Pulla Rao (Hyderabad/Andra Pradesh IMA Co-ordinator) played key role s from the Indian side.

In SAARC region too

The PGIM considers this idea of exporting our examinations a prestigious collaborative activity which has earned a lot of respect in the region where efforts are being made to expand the specialty of family practice especially in the SAARC countries.

Dr. G.M. Heennilame and Dennis J. Aloysus writing on the history of these examinations in Sri Lanka family physician issue in 2005 state:

In 1980 general practice/family medicine was officially recognised as a specialty in Sri Lanka by the PGIM and a Board of Study in Family Medicine was established. How this came about is interesting.

In 1979, the Institute of Postgraduate Medicine began to function actively under its new name the Postgraduate Institute of Medicine. General Practice was not listed as one of the specialities in the ordinance under which the PGIM was to be administered.

First Board of Study

The fist Board of Study in Family Medicine was appointed in 1981 and it comprised Dr. A.M. Fernando (Chairman), Dr. G.M. Heennilame (Secretary), Dr. Leela de A. Karunaratne, Dr. Dennis J. Aloysius, Dr. George Wijegooneratne, Prof. Herbert A. Aponso and Dr. Narada Warnasuriya. This board spearheaded the creation of a year-long course of study leading to the Diploma in Family Medicine (DFM).

To the organisers of this course, this was a daunting challenge in view of the inexperience of family physicians in formal teaching. In a paradoxical way this proved to be an asset because those conducting the course became keenly interested in mastering educational methodology. They called upon reputed medical educationist both local and foreign for assistance in curriculum design, evaluation and examination mythology.

The first course

In 1981, the first course for the DFM was inaugurated at the PGIM. The course was formulated at a well attended 5-day workshop conducted in August 1980, by Prof. David Metcalfe of the University of Manchester.

The first DFM examination was held in March 1982 after decisions on the content and structure of the examination were made at a two day workshop conducted in March 1981 by Dr. Wes Fabb, the Director, Family Medicine Programme of Australia.

The DFM has been conducted annually, and today there are 822 diplomates in family medicine. Medical educationists and trainees have described the DFM course as well designed and relevant, and the DFM examination as realistic, valid and reliable.

Foreign external examiners have made an outstanding contribution. The DF is registrable with the Sri Lanka Medical Council and it is also a qualification conferring eligibility for promotion of medical officers to grade I in the State health sector.

Of the 822 diplomates, 144 are Indian nationals who sat the examination in India. To clarify the last statement attention is drawn to an unrivalled an achievement namely the conduct of the DFM (Colombo) examination in Chennai, India. The main persons who made this possible were Dr. Desmond Fernando and Dr. J.B. Peiris from Sri Lanka and Dr. S. Arulrhaj from India.

This was the first time that the PGIM conducted a postgraduate medical examination in another country for foreign nationals. This was possible due to collaboration between the College of General Practitioners of the Indian Medical Association (CGPIMA) and the PGIM. A Memorandum of Understanding (MOU) was signed between the Indian Medical Association and the University of Colombo.

The CGPIMA arranges the course of study in India for the Sri Lankan DFM, similar to the DFM course in Sri Lanka and the examination is held in India in the same format of the DFM held in Colombo. The first DFM examination of the PGIM in India was held in August 1999 in Chennai.

The original Sri Lankan examiners were Drs. G. M. Heennilame, Desmond Fernando (Co-ordinator and Chief Examiner) prof. Leela de A. Karunaratne and Dr. Dennis J. Aloysius.

Centenarian and a lover of music

LONG LIFE: Does love for music helps one to lead a healthy and a long life? It appears so when you look into the life of Don Laurie Seneviratne former Deputy Director of the Department of Government Supplies who was born on October 1, 1906 turns a centenarian - 100 years old this Sunday - October 1, 2006.

HealthWatch coordinated Prof. Colvin Goonaratne Centenarian study team met him at his home at No. 291, Havelock Gardens last week and found him though physically somewhat weak yet cheerful and healthy for his age.

His was a love marriage; finding his partner at a church choir. Recalling this he said that, music was his main recreation as he was a fine violinist. He was a young man and quite eligible and his thoughts turned to love. His idea of his perfect soulmate was that she should be a Christian, a good pianist and have looks that would appeal to him.

Laurie was a regular worshipper at St. John's Church, Nugegoda and one Sunday he saw the pretty face of a visitor in the congregation and he was smitten. She had come with her relatives and he made some inquiries.

He learnt that she was Stella Rodrigo, an accomplished pianist from Nawalapitiya but did not get a chance to meet her. Undaunted, he travelled up the next Sunday to St. Andrew's Church, Nawalapitiya, and he was pleasantly surprised to see that she was the organist.

He enlisted the help of a Mr. Setunge, a friend of her family, and was introduced to her. Over the next several months he used to travel up regularly and very soon she accepted his proposal. he had got the girl of his dreams and they got married in August 1934 and lived in his ancestral home in Nugegoda.

He recalls with nostalgia the musical evenings they had with their friends. she on the piano and he with the violin. Their favourite number was "I'll string along with you".

The chorus was:
You may not be an angel
'Cause angels are so few
But until the day that one comes along
I'll string along with you.

In due course they had four children, a girl and three boys. In fond remembrance of his boyhood home town in Malaya, he named his home 'Seremban'. In those far off days it was the practice to give children an annual 'opening dose' to rid them of worms.

He recalls with much amusement how he used to force them to swallow the thick nauseating castor oil which had the desired effect. The larger Seneviratne clan were referred to as 'Singapore Seneviratnes' by the people of the area.

Medical study was done by Dr. Viraj Peramuna and Medical student Kelum Pelpola.

HealthWatch wishes Laurie good health and happiness.

Smoking during pregnancy harms infant immune system

Smoking during pregnancy can affect the baby's immune system which may explain why asthma and respiratory problems are more common in children whose mothers smoke, Australian scientists said in a study.

Babies of smokers are more likely to suffer from respiratory infections than children of non-smokers but until now it has not been clear why. The scientists said it may be due to changes to biological receptors in the baby's immune system that are responsible for recognising and fighting infections and bacteria.

"This is the first prospective study to examine the effect of smoking during pregnancy in terms of these aspects of newborn innate immune function," said Paul Noakes of the University of Western Australia in Perth.

The researchers, who reported the findings in the European Respiratory Journal, compared 60 newborn babies whose mothers had smoked during pregnancy and 62 other infants born to non-smokers or women who had quit.

They measured the expression of several signalling compounds in the immune system linked to specific cell receptors known as TLRs in the infants. In the babies of mothers who smoked, they discovered impaired production of two compounds, interleukin-6 and tumour necrosis factor-alpha (TNF-a).

The researchers said the findings show that foetal exposure to cigarette smoke is associated with changes that both weaken innate immune defences and slow the development of the acquired immune system.

LONDON (Reuters)

Sri Lanka's first programme in health professionals Neonatal Life Support training

The greatest risk of childhood death in Sri Lanka occurs during the neonatal period, which extends from birth, through the first month of life.

Birth asphyxia is a primary cause of neonatal death and long-term neuro development disability such as mental retardation, cerebral palsy and behavioural disorders.

Availability of an organised resuscitation programme is essential to prevent birth asphyxia.

To meet this problem, a four-day Neonatal Life Support Training Programme for core health professionals at national level was conducted at the Lady Ridgeway Hospital in Colombo recently.

This programme, the first of its kind in Sri Lanka was conducted by seven experts in Neonatology from the UK. It aims to build the capacity (skills in Neonatal resus citation) of 64 consultant paediatricians, 12 senior registrars and 4 medical officers in Neonatal units throughout the island.

At the end of the training, the participants will conduct similar training programmes in 15 training centres attached to two teaching hospitals and 13 provincial hospitals, throughout the country which currently handle 70-80 per cent of deliveries nationwide.

The programme is being carried out in partnership with the Family Health Bureau of Sri Lanka, Perinatal Society of Sri Lanka and the Resuscitation Council of UK, supported by UNICEF. In Sri Lanka, the Neonatal mortality rate is 12.9 per 1,000 live births whereas in developed countries it is approximately 5 per 1,000 live births. It is noteworthy that neonatal deaths accounted for 81.6 per cent of the infant deaths registered in 2003.

According to UNICEF's Representative in Sri Lanka, JoAnna VanGerpen, training in new born resuscitation is extremely important in reducing Neonatal deaths and in preventing neuro-developmental disability.

It contributes to reducing health costs by reducing the disease burden for Sri Lanka.

The fact that a significant number of paediatricians are attending this training programme along with participants from many districts such as Hambantota, Batticaloa, Ampara, Vavuniya and Mullativu is indeed a reflection of the great enthusiasm of the medical profession to improve quality care delivered to the newborn, pointed out Dr. Srilal de Silva, Joint Secretary, Perinatal Society, Sri Lanka.

The training programme was part of the Government of Sri Lanka/UNICEF. Early Childhood Programme whose overall goal is to develop the full potential of the child by improving survival and nutrition and maximising cognitive and psychosocial development.

Vitamin C may help to...

*Lessen the severity and duration of colds and flu.

Taking Vitamin C at the first sign of a cold or the flu may keep the illness from fully developing, and you'll probably recover faster. In a 1995 review of studies investigating the effect of Vitamin C on colds, researchers concluded that doses of 1,000 to 6,000 mg a day at the onset of symptoms reduced a cold's duration by 21 per cent, and shortened its duration by one day on average. Taking Vitamin C doesn't prevent colds, however.

* Speed wound healing and minimize the effects of bruising

Vitamin C helps the body to repair and maintain itself by reinforcing cell walls and helping to strengthen tiny blood vessels called capillaries. It further accelerates healing by inhabiting inflammation.

*Keep gums strong and healthy

When taken daily, Vitamin C protects gum tissues against cell damage and speeds healing in this delicate area. It's often taken with flavonoids for this purpose. Brushing the gums with Vitamin C powder can also minimise inflammation and bleeding.

*Increase resistance to heart disease (and angina) by improving cholesterol levels

Several studies have linked the presence of low levels of Vitamin C to a greater risk of angina and heart attacks in people with existing heart disease. Research also indicates that, when taken with Vitamin E, Vitamin C helps protect LDL (bad) cholesterol from oxidation, thus preventing plaque build-up in coronary arteries.

Vitamin C may also boost blood levels of HDL (good) cholesterol; studies are ongoing to provide definitive evidence of this action.

*Prevent certain cancers

As a powerful antioxidant, Vitamin C may help to fight cancer by protecting healthy cells from free-radical damage and inhibiting the proliferation of cancerous cells.