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| Sunday, 6 July 2003 |
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Features |  |
| News Business Features Editorial
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Out of the shadows, into the light Epilepsy week began yesterday, July 5. This is the first Epilepsy week being observed at national level. During this week an island-wide Epilepsy awareness raising program will be implemented in schools, hospitals and in the community. Dr. Ranjanie Gamage, Chairperson of the Epilepsy Task Force which has organised this special week, discussed myths about the disease and the stigma that prevents a person with epilepsy from leading a normal life. She emphasises the point that epilepsy is one of the most common diseases in the world. The vast majority who have this disease can also lead a normal life - provided they have the support and understanding of society as a whole. Epilepsy is the commonest chronic neurological disease in the world and according to WHO estimates, it accounts for nearly 1 per cent of the worlds disease burden. Approximately 300,000 Sri Lankans are affected by the disease and they are mostly women in the childbearing age group, children and adults in the economically productive age group. However for economic and social reasons 3 out of 4 patients do not receive appropriate treatment. The majority of these patients (nearly 70 per cent) can be treated utilizing simple, cost effective methods and many others can be managed with special care like epilepsy surgery. Psychological and social support is the key to the well-being of most epilepsy patients. What is Epilepsy? Epilepsy is the commonest neurological disease in the world affecting nearly 1 per cent of the world's population. Around 300,000 Sri Lankans are affected by the disease, mostly women in the child bearing age group, children and young adults in the economically productive age group. Although the disease can be controlled, 3 out of 4 patients do not get appropriate treatment due to economic and social reasons. This is unfortunate since nearly 70 per cent of them can be treated using cost effective methods and others can be managed with special care like Epilepsy surgery which is now being done at the National Hospital in Colombo. Causes 5 per cent of the population have at least one seazure during their lifetime. . Most patients do not have any detectable brain disease. Level of Care . Primary Care - GP's, MO - peripheral units . Secondary Care- Neurologists, Physicians, Paediatricians, Psychiatrists. . Tertiary Care - was established at NHSL in February 2001 by the Epilepsy Task Force. Impact .Increased mortality; . increased morbidity; . Psychological, Social and Economic consequences; . Legal implications. Problems in control of seizures . Treatment Delay; . Treatment Gap - medical and surgical; Lack of streamlined referral system; . Inadequate diagnostic and treatment facilities specially for rural area; . Lack of continuous supply of medicine; . Inadequate trained staff primary and secondary; . Lack of uniform treatment protocols among medical practitioners. . 50-80 per cent of patients with epilepsy do not receive systematic treatment or do not contact any healthcare institution. . 40-70 per cent of people who are on treatment dropout at various stages of treatment resulting in recurrent seizures. The reasons for this treatment gap are: Low doctor; patient ratio; Poor patient compliance; No continuous supply of Anti Epileptic Drugs and Inadequate facilities for Investigations. Epilepsy is associated with an increased risk of morbidity and mortality often caused in daily activities. This may be due to Seizures in dangerous circumstances leading to drowning, burns or head injury e.g. - water source - unprotected wells and rivers, cooking. Status epilepticus - putting various metal objects, water, tablets into mouth when unconscious. Suicide - lack of psychosocial support The fate of epileptics is further compounded by myths and wrong beliefs concerning them. In example in Education, the common belief is that epileptic patients have subnormal IQ. Negative attitudes of school teachers towards students also have an adverse effect on such students, while effects of drugs can lead to poor concentration and performance. These factors result in a high school drop-out rate among young epileptics. In employment too an epileptics falls due various problems. They include: Over protection by family members; Employer prejudice against patients; High risk of dismissal after securing employment; Inadequate vocational training programmes and social support for school dropouts. In marriage the epileptic patient often faces mental problems due to: . Misconceptions about epilepsy and marriage; . Social stigma causes concealment of disease; Misbelieves regarding child bearing and epilepsy; . Fear that epilepsy can be hereditary. The latest services now available for epileptic patients include the following: . A tertiary care epilepsy clinic which was inaugurated in 2001 at the National Hospital of Sri Lanka. . Epilepsy surgeries for medically refractory temporal lobe seizures were started successfully in July 2002. . The national epilepsy day launched yesterday July 5 will be followed by a week of community awareness programme. We hope to establish a national epilepsy centre in the near future. ***** The Epilepsy Task Force The Epilepsy Task Force was established on 9 February 2001 bringing together committed professionals as part of the largest multi disciplinary team in Sri Lanka to provide optimal care for patients with Epilepsy. Among the many activities undertaken by the Epilepsy Task Force, is the launch of the islandwide multi focus awareness campaign. The campaign aims to control Epilepsy in the country by controlling the causes and effects of the disease which are economical, psychological and social. The task force comprises psytherapist, medical officers, nurses psychatrists, occupational therapists and social workers. The other activities of the Epilepsy Task Force include the following: 1. Establishment of the Epilepsy Advisory service 2. Selecting and undertaking Epilepsy surgery for the first time in Sri Lanka 3. Construction of a fully equipped Epilepsy center at the NHSL. The fund raising for which will be launched at the Epilepsy day ceremony to be held at the BMICH tomorrow, July 7. Through these planned activities the Epilepsy Task force hopes to
deliver a powerful message to people with Epilepsy who feel isolated,
misunderstood and neglected and to create conditions in which people with
Epilepsy can seek help without fear of prejudice or penalty and begin to
have normal lives. If your child has suffered sexual abuse... by Dr. R. A. R. Perera, Consultant Psychologist Adults with a history of child sexual abuse are found to have higher levels of psychological problems and problems with social, interpersonal and sexual function. The incidence of depressive and anxiety disorders is increased in these people. Multiple personality and periods of amnesia are more common in these individuals. Some eating disorders are seen in people who are sexually abused in their childhood. Suicidal and self-harm behaviour as well as drug and alcohol abuse are more prevalent in these people. Sexual abuse in childhood is associated with disturb sexuality in later life. Difficulties range from a fear of sexual contact to a tendency to engage in multiple brief relationships. Problems with self-esteem and with establishing and maintaining intimate relationships are also increased, with a tendency to form insecure and disorganized attachment. Sexually abused individuals feel those actual, or potential partners as uncaring and inquisitive. Early pregnancy (not as a consequence of abuse) early marriage, marital breakdown, educational failure and decline in social status are all associated with a history of sexual abuse. The incidence of physical complaints including chronic pain particularly in the pelvic region and irritable bowel syndrome, also appears to be higher. It has been established by several researches conducted on volunteers recruited from media appeals that more extensive and intrusive forms of abuse are associated with greater disturbances in adult life. Most of those reporting sexual abuse in the community studies do not, however, attribute long-term damage to this abuse. This is noted to minimize the effects of abuse, but to make clear that abuse is not destiny. Post abuse syndrome - This involves post-traumatic features like sleep disturbances (dreams, nightmares), flashbacks (repeated sense of reliving the event), avoidance of incidents associated with the trauma. This is due to the unmasking of the repressed memory of the incident and generally this lasts for about one month after the sexual abuse. Social background sexual abuse can occur among the privileged as well as the poor, and in apparently stable as well as obviously unstable families. But it is more among children from disrupted and disturbed homes. A history of sexual abuse in childhood also tends to be accompanied by histories of physical and emotional abuse. This can create difficulties in separating the possible long-term effects of sexual abuse from the long-term influences of these coexisting problems. Those who experienced sexual abuse in childhood and who show significant adult difficulties are more likely to have also had poor relationships with their parents, a poor academic, sporting and social performance at school, and to have failed to establish satisfactory long-term emotional and sexual relationships as adults. Lack of recall - the relationship between giving a history of sexual abuse in childhood and having actually being a victim is of course complex. Some abuse occurs early in childhood and is lost to recall and some victims understandably decline to reveal their abuse. Some abuses may be forgotten or actively repressed. The long-term effects of sexual abuse in childhood can cause distress
and disturbances which can reverberates for years. Amnesia and dual
personality with eating problems can be seen in survivors. Currently,
there is increasing tendency to understand the long-term effects in terms
of a developmental disruption. New hope for age related blindness Photo Dynamic Therapy (PDT), a revolutionary new treatment for neo-vascular Age-related Macular Degeneration or AMD, one of the leading causes of blindness in people over 50, has been successfully introduced for the first time in Sri Lanka at the Sri Jayewardenapura Hospital. The treatment, which involves infusion of a light reactive drug into the patient's blood and use of a sophisticated low-intensity laser to selectively seal off leaking abnormal blood vessels behind the retina, is supplied by Novartis Ophthalmics of Switzerland, through its local agent ABC Pharma Services (Pvt) Ltd. According to Sri Jayewardenapura Hospital Chairman Dr. H. H. R. Samarasinghe, six patients have undergone treatment at the hospital with satisfactory results. "We are proud to be the pioneers of this revolutionary form of treatment which offers new hope to a number of people prone to AMD" already he said. Prior to its introduction, there was no treatment available for the disease in Sri Lanka. The treatment uses Visudyne.... (generic name: verteporfin) an expensive light reactive drug that attaches itself selectively to the abnormal blood vessels that cause loss of central vision among older people or those afflicted with pathological myopia (severe shortsightedness). The drug is activated by the low intensity laser which triggers a photochemical reaction, and closes off the abnormal blood vessels without damaging the retina. "Visudyne therapy stabilises the patient's vision and prevents further deterioration," explained Dr. Dushyantha Wariyapola, the Sri Jayewardenapura Hospital's Consultant Ophthalmologist and head of the team that pioneered the use of PDT. "In ideal cases, Visudyne therapy doubles the patient's chances of maintaining vision in comparison with a patient who is not treated. It is a simple OPD procedure with minimal side effects," he explained. "The drug is infused into the patient's arm for 10 minutes, and after a five minute wait, the non-thermal laser is applied for 83 seconds. The entire procedure takes about half an hour. Patients who undergo the treatment would be photosensitive for 48 hours after the infusion and are advised to stay indoors and protect their eyes and skin from direct light and indoor halogen lighting for that period. Hospital sources said they had all the necessary equipment to conduct Fluorescein Angiography on patients prior to Visudyne therapy, to assess the extent of AMD and to determine whether the treatment was appropriate for the patient. Dr. Wariyapola said early detection of vulnerability to AMD significantly improves the patient's chances of maintaining vision. The early stages of AMD typically start with the appearance of sports beneath of retina. These spots called drusen can be spotted by an ophthalmologist at a routine check of the eye. Therefore, routine visits to an ophthalmologist at least once in two
years are recommended for people over 50 he stressed. World Population Day is on July 11 : Perils of adolescent pregnancy by K. G. Mapanga
The reproductive health of adolescents concerns sex-related health problems that affect their physical, social and psychological well-being. Health problems related to pregnancy in this particular age group are a major cause of concern. In a majority of cases, adolescents' pregnancies are unintended. In addition only a very small percentage of such pregnancies are the result of contraceptive failure. Not only are adolescents' first and subsequent pregnancies on the increase in several parts of the world but so too is early parenthood, leading to a situation where children are shouldering the responsibility for raising children. Most adolescents are either at school or training for a career. The likelihood of repeated pregnancy is further increased if the first pregnancy is carried to term. A recent study of unmarried first-time adolescent mothers indicated that 93 per cent of them were sexually active and that most of them did not use contraceptives regularly. Single adolescent mothers who have repeated pregnancies are likely to find that parenthood is a very heavy burden. Adolescent mothers are not only less able to take care of their own needs but, in consequence, are also less able to care for the needs of others. This can lead to adverse health effects both for themselves and for their children. Pregnancy in adolescence is associated with premature birth, low birth weight, perinatal mortality, increased infant mortality and maltreatment of children. The health-related disadvantages of adolescents who become parents heavily outweigh any advantages there may be. Unmarried mothers may feel stigmatized by becoming pregnant at such a young age. Later, the poorly educated and unemployed single mother is likely to feel a sense of guilt and loss. Prevention focuses on the need to plan and delay parenthood. This clearly calls for sex education and the advocacy either of abstinence or of the use of contraceptives. After the baby is born, postnatal care may be made more difficult not only by the young mother's lack of care-giving skills but also by the absence of emotional and financial support. Adolescent sexual activity leading to unintended pregnancies also predisposes youngsters to sexually transmitted diseases, although these can be prevented. Adolescents not only run the risk of being infected themselves but they may pass on sexually transmitted diseases to others, including their own children. A particular cause of concern is HIV/AIDS, since all too few young people know enough about the risk or the need for safe sex to avoid contracting the disease. HIV/AIDS is increasing among adolescents and the result in the near future may be an alarming proliferation of orphans who may themselves be infected. The reproductive health of adolescents requires urgent global attention. Midwives and community health nurses are particularly well placed to deal with this alarming situation and to endeavour to promote delayed parenthood. - (W H O) |
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| Editorial | Security Produced by Lake House |
One of the most common features of adolescence - the period of
development between the ages of 10 and 19 years - is engagement in sexual
activity.
