Leading Cardiologist suggests inclusion of Ayurvedha doctors in to the FPS scheme

One of the leading consultant Cardiologists in the country. Dr. D.P. Atukorala, wants Ayurvedha doctors also included in the new - 'Family Practitioner Service! now under consideration by a special Committee in the Ministry of Health, appointed by the Minister Nimal Siripala de Silva.

Dr. Atukorala writing to the Health Watch on this new proposal of Prof. Herbert Aponso from Kandy, gives one of the main reasons why he wants the inclusion of Ayurvedha doctors also into the new FPS scheme as they have better public relations (PR) with the people than some of the Allopathic doctors. He writes -

"The Health Ministry should give incentives to medical practitioners to serve the rural poor and arrange to provide lab facilities and facilities to get good quality and cheap SPC drugs without travelling long distances.

FPS should recognize the fact that at present majority of poor and middle class patients have a great faith in Ayurvedic doctors who have a better PR than some of our allopathic doctors.

It is advisable for AC to include the Ayurvedic doctors also in their FPS." Commenting on this new FPS proposal which the Health Watch exclusively carried as the main story on June 30 under the heading-Affordable Family Practitioner Service in the Offing, Dr. Atukorala continues.

Congratulations

My congratulations and best wishes to Prof. Herbert Aponso and his colleagues for their new and original proposals for the affordable "Family Practioner Service" (FPS) they have proposed to the Ministry of Health Care and Nutrition.

While wishing the Aponso Committee (A.C.) every success in their endeavour, I would like to discuss a few problems the A.C. will face during its attempts to make F.P.S. a total success.

It is common knowledge that majority of Sri Lankans (about 70 per cent of the population) lives in the rural areas and for F.P.S. to be successful, A.C. Should take this rural 70 per cent into account when they plan the F.P.S. for the whole island.

Why majority attend OPDs

At present majority of Sri Lankans don't have their General Practitioners (including their family physicians and registered medical practitioners). Even in the city of Colombo majority of the people belonging to middle and poor class don't have their GPs and when they fall ill they first attend the government dispensaries or out patient departments (OPD) of government hospitals and only a small percentage of people contact their GP in the urban areas.

Advantages that the poor and middle class patients have, when they attend the OPD are (a) government doctors and RMPS don't charge money for the consultation and (b) they are given free drugs. Majority of the poor can't afford to buy drugs from the SPC outlets and private pharmacies at present.

Shortage of medical Practitioners in the rural areas

At present there is an acute shortage of qualified medical practitioners (GPs, family physicians and R.M.P.'s) in rural areas. I come from a rural area where there are 3 qualified medical practitioners to serve 10 villages and for a patient to consult a qualified practioner he or she has to travel about 10 to 20 miles by one or two buses. For any F.P.S. to be successful, there should be sufficient number of qualified practioners for a given population and a given area.

Shortage of S.P.C. outlets

In rural areas, a person may have to travel about 20 to 30 miles if he or she wants to buy drugs from a SPC outlet, of course by buses or by cycles. It is common knowledge that SPC outlets in rural areas don't have some of the common essential drugs at present. Laboratory Facilities in rural areas.

In rural areas, lab. facilities are very scarce and even to get common lab, tests such as blood count, E.S.R. or an E.C.G. patient has to travel about 10 to 20 miles using one or two buses and to get a test such as liver function test, SAT, renal function tests, SE, and chest x-ray the patient may have to travel about 40 miles.

Not Cost - Effective

In rural areas, it is not cost - effective for a G.P. to see an ill patient in patients home because, of following reasons.

(a) As majority of people (over 95 per cent) in rural areas don't have telephone facilities it is not easy for a GP to trace the address of the patient especially during a night emergency.

(b) No female GP will like to visit a patient in patient's home in her vehicle at night as some of the patient's houses are not accessible by a vehicle. What can a female GP do if there, is a problem in her vehicle when she drives in the night to see a night emergency?

Channel Practice

Channel practice has become part and parcel of our medical, culture and as Prof. Aponso may be aware, majority of patients (over 90 percent) approach the consultant without going through the patient's GP This type of consultation practice had been there in Sri Lanka for more than 50 years unlike in more developed countries such as U.K. It will be a Herculean task to abolish the present channel practice.

People especially those in urban areas appear to be certain misconceptions regarding some of our GP's and because of these misconceptions, most of our patients avoid getting a referral letter from his or her GP when they want to consult a specialist.

Misconception 1

Some GP's appear to believe that they might lose their patients for good if they refer them to a consultant.

Misconception 2

Some GPs don't refer a patient to a specialist unless the patient is extremely ill and invariably the patients have to be admitted to a hospital if the consultant thinks that patient is in his or her last stage when he examines the patient.

Some consultants doing Channel Practice have no time to reply the GP and this is true of consultants who examine 40 to 100 patients per day. During the 23 years I served as a specialist in the Institute of Cardiology I used to refer back thousands of patients referred by GPs specialists, OPD doctors and even by Ayurvedic doctors giving my diagnosis and suggested treatment so that the GP can follow - up patients.

At present majority of patients (about 95 percent) consult me directly i.e. without a letter from a practitioner.

Ayurvedic Medical Practice

The Aponoso Committee has not mentioned a single word, about the Ayurvedic practioners ("native doctors") who are performing a wonderful service to the poor people especially those in the rural areas, where majority of patients first consult the Ayurvedic practioners who are easily accessible, who have a better PR, who are "with the people" and whose consultation fees are very much less than those of allopathic doctors.

As Prof. Aponso may be aware, most of the illnesses among the rural folk are tackled by the Ayurvedic practioners at present.

To conclude my long article,

i. The AC should try out the FPS first in the urban areas;

ii. AC should have a suitable plan to serve the rural people which includes majority of Sri Lankans.

iii. The AC should arrange to create a public opinion so that the patient does not by-pass the GP when he or she consults the specialist. At present the not-so-educated and the new rich people in urban areas channel a specialist even for illnesses such as a chest cold, viral fever, majority and any gastro - intestinal upsets and have to incur massive medical bills due to unnecessary and expensive investigations and expensive drugs.

Majority of our family physicians, GPs and other practitioners have a very good clinical sense, and are doing an excellent service in saving the lives of thousands of our patients especially in the urban and suburban areas of Sri Lanka.

Cardiac rehabilitation in Matara

Dr. S. Seneviratne Epa, Consultant Physician writes

A new Cardiac Rehabilitation Centre was opened in Matara recently. Speaking to Health Watch, Dr. Sunil Seneviratne Epa consultant physician and director of Matara Cardiac Rehabilitation Centre said cardiac rehabilitation (CR) is an essential part of treatment of patients recovering from heart attacks and of those who undergo by-pass surgery.

Medication alone is not sufficient for complete recovery of such patients. As heart is a dynamic organ with movement, recovery of the full functions of the heart as well as the other muscles of the body needs exercise. Main purpose of CR is to provide patients with graded exercise programme to suit the patients level of fitness. Such properly designed and delivered exercise programmes will facilitate fast and complete recovery of heart patients.

At this facility all heart patients are tested for exercise tolerance of Aerobic Fitness Level using state-of-the-art Tread Mill machine with dedicated Cardiac programme and heart rate monitoring. Depending on the patients fitness level an appropriate exercise prescription is given with a training heart rate. There is also in house facility for exercise training for those needing supervision.

In addition to the exercise training, patients are also given guideline based Cholesterol management with screening for Metabolic Syndrome.

Those who are overweight are given dietary counselling with a copy of a booklet with calorie values of all Sri Lankan cooked foods which helps them to identify and avoid high calorie foods.

As the mind plays a major role in the recovery of heart patients all patients are given a Mind-Body counselling. This is a unique feature in a Sri Lankan hospital as patients are taught how they can empower their own minds to assist their healing. This counselling is based on the latest acceptance in western medicine that mind can influence the physical body in its healing.

As this is a novel approach of treating heart patients in this country, Dr. Epa said this facility is gaining increasing popularity among heart patients.

Explaining Homoeopathic diagnosis

by Dr. Mass R. Usuf (Senior Vice President NAH&A)

There was this patient who was physically examined by me and who was questioned at length as to his condition.

At the end of the session he eagerly asked me: Doctor, what is your diagnosis? I unhesitatingly said: Arsenic.

Of course he expected me to say food poisoning or some such thing. He gaped at me in total incomprehension and asked: What doctor? I again said: Arsenic.

He was completely bowled over and asked me with total apprehension: You mean I have been poisoned by Arsenic?

I assured him that he has not been poisoned by Arsenic but that the indicated drug as per symptoms manifested by him pointed to Arsenic Album - a homeopathic drug made from Arsenic but so highly potentised to an extent that no gross molecule of Arsenic can be traced in the drug! It is one of the many wonderfully effective drugs in the homoeopathic pharmacopoeia.

The above example illustrates that homoeopathy does not treat disorders (diseases). A deranged internal economy would manifest physical and mental symptoms along with peculiarities (eg: dashing the medicine on the ground saying it is useless taking medicine) and modalities (eg: better with warmth). Thus the totality of symptoms are evaluated and the apposite drug is then chosen - called the similimum.

The patient who was virtually petrified with fear when I said 'Arsenic' actually suffered from what orthodox medicine would call 'food poisoning'. Physical examination and questioning revealed:

Physical symptoms:

Tongue - dry and clean, skin - pale, stools - painless diarrhoea with small but offensive discharge, urine - scanty, febrile state, vomiting after ingestion of food/drink, abdomen - gnawing, burning pain (has history of peptic ulcer), lumbo-sacral pain.

Mental symptoms:

Restlessness

Peculiarities:

Great thirst - drinks water little at a time, sleeps with hands over head, needs many pillows to keep head raised.

Modalities:

Nocturnal aggravation (around midnight), prefers warm drinks, better with head elevated.

All these symptoms taken in its totality points to Arsenic Album as the drug of choice (similimum) ...... and ...... all these symptoms point to a diagnosis of 'food poisoning' under the orthodox system of medicine.

Just a mere drop of Arsenic Album (of the 30th potency sublingual) and another drop many hours later is all he took and he was relieved of his distressing symptoms within 24 hours!

No analgesics, antibiotics, antacids, H2 receptor antagonists, proton pump inhibitors, phenothiazine - just two seemingly innocuous and insignificant drops spread over some hours sans side effects!

Time bombs for heart disease

There is mounting evidence that fit people are at reduced risk of heart disease, even though they may be overweight or even obese based on their BMI, Despres and his team note in the Archives of Internal Medicine. At the same time, the researcher added, people of normal weight with bulging bellies can be "time bombs" for heart disease.

"Fat and fit" men are likely to have a lower risk of heart disease and diabetes because they're relatively trim around the waist, a new study shows.

The higher a man's cardiorespiratory fitness, the less fat he has in his abdominal cavity, Dr. Jean-Pierre Despres of Hopital Laval Research Centre in Quebec and colleagues found.

The relationship held true regardless of body mass index (BMI), a ratio of weight to height typically used to gauge overweight and obesity. "This is why it's so, so important for the doctor to measure waist circumference," said Despres, who told Reuters Health he is on a "crusade" to get family doctors to check their patients' waist size and triglyceride levels.

High waist circumference combined with high triglyceride levels signal a substantially increased risk of heart disease and diabetes, he explained. He and his colleagues hypothesized that fit individuals, regardless of BMI, would have less belly fat.

To investigate, they looked at 169 healthy men, comparing their cardiorespiratory fitness with their amount of belly fat as measured by computed tomography (CT) scanning.

As the researchers suspected, men's belly fat accumulation rose as their cardiorespiratory fitness fell. The relationship remained even after the researchers considered the effects of BMI and age.

Despres and his team conclude that physical activity should be promoted for everyone, regardless of age, gender or BMI, to trim belly fat and thus reduce heart disease risk.

The researchers are currently conducting a similar study in women, who are somewhat protected against the accumulation of deep abdominal fat until they reach menopause, he added.

People who don't see a change in their BMI after they have been exercising shouldn't be discouraged, Despres said, but should instead check to see if their waists are shrinking. This will indicate that their efforts are indeed having an effect.

SOURCE: Archives of Internal Medicine, July 23, 2007.

REUTERS

Dr. K.C. Tan in Colombo

Dr. K.C. Tan, liver transplant specialist National University Hospital, Singapore will be arriving in Colombo on July 25 to participate at the annual scientific sessions of the College of Surgeons, Sri Lanka.

The sessions will be held from July 26th to 28 at the Galadari Hotel, Colombo. Dr. Tan has performed the first living donor liver transplant operation in South East Asia in 1996 and 2001. So far he has done three liver transplant operations from Sri Lanka.

He is widely recognised as a leader in the field of hepatobiliary and liver transplant surgery.