Health Wise

Listen to your heart , follow its beat

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'Work with heart', the theme set by the World Heart Federation for 2009, emphasizes on the heart healthiness of the working environment. Each year, the last Sunday of the month of September is the World Heart Day. Dr. Ruwan Ekanayake, Consultant Cardiologist, Colombo National Hospital says primary prevention would be the best solution.

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by Dhaneshi YATAWARA

Haven't you noticed that we are spending more time in the office and have we turned our home into a temporary shelter?

The alternated modern day life styles of the earth dwellers are, no doubt, spent not with the family but in the work place. Except for a housewife almost all of us spend a larger part of our day in the office, if not, time is wasted on the roads either travelling to office or returning from office being stuck in the traffic for hours.

Thus the office environment has become a vital part of a persons' health, says Dr. Ruwan Ekanayake, Consultant Cardiologist of the Colombo National Hospital.

"Since the entire world, not just in Sri Lanka, is facing this change in life styles the World Heart Federation has brought the 'Work with Heart' concept in to focus. Considering environment factors that affect heart diseases the work environment must be healthy since we are living in the office," Doctor Ruwan Ekanayake said.

As experts emphasize the first and foremost would be a totally smoke free environment. "Most of the offices are closed environments with the air conditioning thus the air gets polluted very easily.

It is not just the working environment but the environment in travelling to and from the office should also be free from smoking," he added emphasizing on the necessity of cohesive strategy in order to implement our aims.

"Secondly the focus should be on the canteens. The food served may not be the simple healthy food in all points of view. There would be loads of short eats and oil used in cooking may not be the high cost heart healthy varieties since it is not economical for a business. In addition plenty of salt is added to make the food tastier.

Thus, we end up with a very unhealthy meal," said Dr. Ekanayake. According to health experts the oil and fat should only be 10% of a meal.

" If fruits and nuts can be provided as snacks and provide green gram, chickpea, cowpea etc can be boiled and served it will be extremely healthy not just for those with heart problems but for diabetic and hypertension as well. It doesn't cause gastritis. And therefore menu of the canteen of the work place should become our focus," he stressed.

Recreation

According to Dr. Ekanayake the space for recreation activities and exercise during a lunch break or in the free hours would be another plus point.

"If the employees can be encouraged to use such facilities, provided in the office environment, instead of wasting the entire lunch hour eating and chatting it would be healthier," he explained.

Though the modern life style gives little space for a person to relax it is only the brain that is doing more work than the body. Recreation and exercises seem to be not in our routines - yet it should not be so.

"Providing such facilities in an office can make exercise and recreation a part and parcel of their lives," he said - definitely a practical and positive healthy approach.

Dignity of human being

It never occurs in our mind that respecting the dignity of a human being could lead to a healthy heart. "Respecting the human beings working in an office or a factory a person should not be forced with unreasonable work load or dead lines," he added stressing the fact that administration and management of a work place must pay attention to these factors.

"This was proven during a research done based on bus drivers in London where they were facing tight schedules which were difficult to maintain. This has shown an increase in heart diseases among these drivers," he added. In any corner of the world people react in similar manner and unfortunately records of a local research is not well known among the professionals.

Yet, the results may not be far different and we ourselves feel the impact of being overloaded with stress. "Research on Air traffic controllers in USA has also shown that if they are not provided with adequate number of assistance staff the instances of myocardiac problems increases," he added.

Give and take policy

The employees have to put their heart into their work while working - workers also needs to work in a manner meeting the targets of the institute as well as taking care of their health, Doctor Ekanayake explained saying that the worker must work with a dedication and a sense of vocation.

Doctors have found that smoking, High blood pressure, diabetes mellitus, family inheritance tendency, obesity, lack of exercises and high stress levels are the traditional risk factors for ischemic heart diseases. Yet factors need not be limited to these.

"These traditional risk factors can flourish in a person depending on the mentality of that person," Doctor explained. The way you take life and handle day to day chaos is an important point that decides worsening or making the condition better.

The personality factors also come into play along with the environment risk factors. "Altering the personal approaches in life is also important to have a healthy heart.

Generally doctors recommend clinical check ups for heart diseases for an average person at the age of 40 and for a person with family inheritance at around 30 years. "But the healthy habit can only be inculcated in to a person only from childhood. So it is the entire process of growing up with proper values is what matters," he added.

Relaxation

Relaxation plays a major role in making a condition of a patient better.

Mind does play a major part.

"The heart and the lung are under neural control. Whenever we become anxious or stressed the heart beat increases and increases the blood circulation as well as the respiratory rates. Always there should be a balance between the parasympathetic and the sympathetic nervous systems of our body thus the heart and respiratory rates can be lowered," Doctor Ekanayake explained. According to a research done at the Radcliff Hospital in UK under the Cardiology Department of the Oxford University by Professor Peter Sleight it was experimentally proven that the 'ragadari' and slow classical western music has shown the greatest effect in lowering heart and respiratory rates to healthy levels. This is regardless of the music knowledge of a person or their taste.

Proper goals

"The solution lies in setting proper goals in life," said Doctor Ekanayake.

Stress levels, depression all result due to the over enthusiasm of achieving goals and the insecurity feeling associated with present day life style associated with unnecessary consumerism.

The pace of life has become very rapid infested with an unhealthy competitiveness causing a lot of stress wearing the precious heart.

Medicine is not a complete therapy. "People should know what is worth sacrificing and what is worth retaining," Dr. Ekanayake stressed.

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Since the beginning of the century infectious diseases were the leading causes of death.

In the present day non communicable diseases have become the main killer. In Sri Lanka 35% of deaths caused due to non communicable diseases are due to heart diseases.

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What the community should know and could do:

Dengue in Sri Lanka

by Dr. K. D. P. Jayatilaka

A female Aedes mosquito lays eggs in batches of 20 - 60 at a time on the wet surface above the water level and in contact with water these eggs float in singles till the 1st instar larva emerges in 2 -3 days. The mosquito larva goes through 4 stages of development and feeds on various organic matters like bacteria, protozoa, algae, etc., present in water till it turns to the non-feeding stage of the pupa which lasts for a day or two to finally come out as the adult mosquito.

The whole process from egg to adult takes 7 - 11 days depending on the outside temperature. Usually in a batch of eggs there are about 50% male and 50% female mosquitoes. So, any collection of water which lasts for more then 7 days is a possible breeding place for Aedes mosquito.

The eggs of Aedes mosquitoe have the property of sticking to the surface of the container which holds the water or the ground water pool and could withstand even desiccation up to several months.

It is important to know this property of the Aedes eggs in the control program as these desiccated eggs lying dormant especially in dried up ground pools could become viable in coming into contact with water again.

Hence, it is important to scrub and clean the sides of the containers, vases, drums, tanks, bird-baths, etc., when emptying and refilling with water. It is also known that infective female Aedes mosquito could pass the dengue virus through the eggs to the next generation. However, this does not have much of an influence in causing or/and continuing a dengue epidemic.

Breeding sites

The common breeding places of the Aedes mosquito are so varied and many. We normally speak about discarded plastic cups, coconut shells, empty bottles, containers used as ant traps in houses, discarded tyres, tree holes, drums and containers used for collection and store water, temporary man made pools at building sites, etc., sheaths of some plants like bromeliad and bananas, etc.. Broken places of roadside drains where water stagnates, in large masses of water like ponds especially the edges and small rock pools and animal hoof marks which form to collect water during the rain are favourite places for the female mosquito to lay eggs. Fallen leaves like those in teak plantations and even the pieces of bottles fixed to parapet walls to prevent burglars climbing can be temporary breeding places during the rainy season. There are also so many unsuspected places in our garden or surrounding where water remains for more than 7 days and these could be Aedes mosquito breeding places.

Dengue control

We in Sri Lanka are fortunate in not having many major problems like rain water collection receptacles for drinking, except in few areas, extensive ground water - Aedes breeding places, inaccessible areas during rain and floods etc., faced by many other countries where dengue and other mosquito borne diseases are a problem. However, we have few problems which are manageable, sometimes with difficulty but not impossible. The unfortunate thing is that a moderate Dengue Epidemic (caused mainly with D2 & D3) has occurred these days causing many deaths (about 250) and sensitizing many (20,000 - 50,000) to those dengue serotype viruses. The problem will arise if another serotype (D1 or D4) becomes predominant with the next epidemic. This was discussed in my previous article appeared last month. The only way to prevent this unfortunate situation is to have a sustainable, community friendly, community helpful dengue control program with the full participation and cooperation of the community. The assistance, participation and cooperation of other parties mentioned below are very essential to apply all possible and appropriate control measures. Dengue control should be build into the people's daily life like the grow more food 'Api Wawamu Rata Nagamu' program which is functioning at different degrees practically in every house in the country today. Dengue control is not synonymous with proper garbage management, but proper garbage management helps tremendously to a successful dengue control program.

The basic principles in a Dengue Control Program should be -

Reduce the breeding places to prevent build up of mosquito (vector) densities. Reduce the survival rate or the longevity of the mosquito.

Reduce or prevent man vector (mosquito) contact.

Identification and early management

Dengue control is vector control. To prevent Aedes mosquitoes breeding at different localities and different situations, different methods have to be applied. Some of these cannot be carried out by the community alone and neither can it be done by the Ministry of Health alone, even though it has the responsibility of preventing dengue epidemics. Some methods or procedures could easily be carried out by individual house-holders and some by the community in groups. Some need the assistance of a central organization like the Dengue Control Unit of the Ministry of Health and even that will have to get the cooperation, assistance and guidance from other Ministries like Education, Agriculture, Environment, Local Government, Irrigation, Roads and Highways, private Organizations like Builders, Architects, etc. and even private entrepreneurs. In short it is a team work build into the life of the community. Any person irrespective of the social status in Sri Lanka could become a dengue patient and even die of the disease. The first step in the dengue control activity begin at home and that is proper collection/disposal of household waste and reduction/elimination of other possible Aedes breeding/resting places. Teaching school children the basic ideas of dengue control is very important and will go a long way. Motivate the children at school and let them take the subject to their homes.

They are the best resource to change the knowledge, attitudes and practices of elders at home. Or, when the children become adults and start running their own homes, they will practice what they learned at school. Mosquitoe breeding and people getting mosquito borne diseases is a natural thing in any tropical part of the world.

Control measures

Source reduction and cleaning up operations, * Biological control, * Insecticide spraying (larvicides and adulticides), * Environment modification and manipulation, * Personal & family protection, etc. * Get immediate medical assistance in case of suspicion of dengue complications.

It is very encouraging to note, that so many organizations, non governmental, government, security forces, media, business, etc., have come forward with different activities to help to fight the current dengue epidemic and all these are very useful. The important thing is to continue them in the same way and make it a part of the people's daily life. We hear many community education and community mobilization talks on the TV/radio, see many interesting articles in the newspapers and leaflets distributed by some organizations on dengue control and that too is very encouraging.

A common theme everyone talk is of 'destroy' and 'eliminate' Aedes mosquito breeding places and this is what should be done to reduce the vector densities. This is easily said than done. Community education is very essential in the dengue control program but the correct facts in a way acceptable to the community should be given. Also when problems are discussed the solutions should be practical

To be continued.

[ Health News]

Latest Digital X-Ray technology now in Sri Lanka

by Nadira GUNATILLEKE

The Healthcare and Nutrition Ministry introduced high tech `Digital X-Ray Technology' to Sri Lankan State hospitals last week at a cost of Rs. 150 million. This is the first time this technology is available in Sri Lanka.

The new technology was launched at Ragama Teaching Hospital and Welisara Chest Hospital. The value of one unit is Rs.75 million and both units cost Rs. 150 million.

At the moment ordinary X-ray technology is being used in Sri Lanka with the help of films.

It is very difficult to use this technology because X-ray images with high resolutions cannot be taken using this old technology.

The side effects of this technology are also very high.

But the latest high tech new technology, `Digital X-Ray' does not need films and the side effects are also minimum.

The radiation is minimal and image zooming can be done. It is also possible to store data and images for future use.

The data and images can be sent very quickly and easily to another hospital via Internet when the patient need to be transferred to another hospital for further treatment.

The machines can be operated using remote control.

The Sri Lankan public can now enjoy this latest new technology free of charge.

The Ministry will introduce more latest high tech medical equipment and new International level technology for all the other State hospitals under its `State hospitals upgrading project' to be launched in 2010 at a cost of Rs. 2,875 million.