Sri Jayewardenepura General Hospital:

Panacean hospice for the infirm

by N.W.E.Wijewantha

Sri Lanka ranks high as a country with a rapidly aging population. According to the national survey on elders 2003/2004, out of the population of 21m over 10% is estimated to be over 60 years of age.

Out of the people over 60 years of age, the proportion of elders over 70 years who are generally known as old is about 44%, those how have reached 80 years or more is over 11%.

The composition of elders by gender is 48% male and 52% female. Though adequate data on morbidity among elders are not available, number of older persons with non-communicable diseases like cancer, neurological diseases, cardiac failures, dementia and chronic disabilities are increasing among the above category of older persons.

These life-threatening health hazards are bound to make life miserable for the elders suffering such ailments and their families. New strategies must be found to target this category of older men and women and their dependants. It is very unfortunate that our health system does not have adequate medical care facilities for older persons suffering from geriatric conditions.

Therefore there is an urgent need to develop clinical specialities pertaining to the problem of elders suffering from geriatric conditions and organise relevant services and make them more accessible to the elderly with their decreasing mobility due to extreme old age.

In developed countries there are medical care services such as hospices which provide palliative care for older persons suffering from terminal illnesses.

Hospice Movement which was originated in United Kingdom in 1960 has become a specialist medical care service for oldest persons suffering from chronic diseases. Hospice types of care treatment need lot of resources such as trained medical providers and other supportive services.

However considering the increasing number of the older persons in the category of 70 - 80 years suffering from some kind of disability related to old age.

The majority of these elderly are women 80% of whom are widowed. At present it has become almost impossible for families to look after these elders since traditional family support systems have collapsed due to modernisation and adult female leaving the female for employment.

As a result many elders ailing from age-related diseases are abandoned without care and medical treatment.

Though attempts have been made to provide healthcare by the Ministry of Social Services to initiate healthcare program the Ministry of Health much has not been achieved. There is a need for manpower training and resource allocation accompanied by re-orientation of health services for the need of the senior citizens.

Under these circumstances if the Sri Jayewardenepura General Hospital could adjust existing facilities to provide medical care for the elderly who could afford to pay for their medical treatment, Sri Jayewardenepura General Hospital could provide much needed medical care for the elderly to live a disease-free old age.

Above proposal has been approved by the Sri Jayewardenepura General Hospital Board and action had been taken to open a “Elders Well Being Clinic” on 1st of January, 2009 at the Sri Jayewardenepura General Hospital.

At this clinic old age medical problems such as - hypertension, diabetes, neurosurgical problems, eye problems, cancer, rheumatic, arthritis, orthopaedic problems will be dealt with by referring to appropriate specialists concerned.

Although this “Elders Well Being Clinic” is on an initial stage, action will be taken to undertake following activities in due course:-

* Physical examination to identify and categorise health problems

* General medical investigations to be performed on all patients: Full blood count, ESR, lipid profile, fasting blood sugar, renal functions tests, urine full report, stool AOC and Occult blood, chest X-ray, ECG, TSH.

* Special investigations to be performed depending on the clinical problems identified: CT scanning, doppler ultrasound scanning, mammography, ultrasound scanning, barium studies, endoscopy - upper and lower gastro intestinal tract, echocardiogram, EMG (Electromyography and Nerve Conduction Studies), exercise ECG, holder monitoring.

* Clinical problems to be referred to specialists when appropriate: cardiology, cardiothoracic, haematology, neurology, neuro-surgery, rheumatology, ENT, ophthalmology, dermatology, orthopaedic surgery, general surgery, psychiatry, gynaecology.

* Identification of social problems: Utilisation of the Social Services Department in order to provide carers to look after patients at home.

* Identification of occupational problems

* Physiotherapy and rehabilitation

* Cancer screening

* Speech therapy

* Mobile services by medical officers to homes: Elective visits by medical officer to evaluate patient’s progress at home. Emergency treatment to be provided in the hospital by means of an efficient transport service (Ambulance Service) and 24-hour contact service.

* Special Geriatric Ward: To provide short and long-term stay patients with medical and auxiliary nursing care.

* Health Education: Educating patients and carers regarding common medical problems.Further details on the project could be obtained from Sri Jayewardenepura General Hospital, Thalapathpitiya, Nugegoda, Tel. 011-2778610 - Ext. 3010.

(The writer of this article is the present Chairman of the Sri Jayewardenepura General Hospital Board and retired Senior Member - Class I of the Sri Lanka Administrative Services, Ex-Director, Social Services Ministry and the Executive Director, HelpAge Sri Lanka.)