Good health culture will pave the way for a disciplined society

By Nilma DOLE

Passing the Cotta Road railway junction, motorists immediately catch sight of the refurbished Borella Dispensary that actually looks like a private hospital. Most can’t believe that it is in fact a government dispensary and actually feel like going and using the healthcare services.

Dr. Amal Harsha de Silva

Speaking to the Sunday Observer was Dr. Amal Harsha de Silva, Provincial Director of Health Services, Western Province and founder Secretary of the Private Health Services Regulatory Council. “A good refurbishment policy is important to set the standard of discipline in our society.”

It is evident to see that the refurbishment plays a major role in making a lasting impression not only on the patient but on their family members and loved ones who come with them.

“At every base hospital in Sri Lanka, we have about 1200 to 1500 people walking through the doors everyday because patients always come with a family member or their loved ones when they channel a doctor. Hence, it is imperative to create a good hospital culture.”

He said that people come to hospitals because they have to and they are always burdened by problems and mental anguish. “So it’s important to make them feel right at home when it comes to solving their medical problems and ailments,” he said.

With a reasonably large health budget and healthcare being at the foremost of the government’s interest, health is indeed our wealth.

“It is under the supervision of MP Basil Rajapaksa that we have ensured that a facelift for a majority of hospitals, clinics and dispensaries will be done promptly. Moreover, we will use the Western province health institutions to set an example for the rest of our Provinces to follow,” said the doctor. In addition, he said that already 100 new clinics will be set up and 78 will undergo refurbishment in the Gampaha district and long-term solutions in a short-term period is the priority.

In the health guide policy plan initiated will enlist the services of qualified building contractors and expert landscaped artistes. “In fact just like the Borella dispensary at Cotta Road, we are fully confident that we can finish the development of these health institutions can be done in a year,” said the doctor.

The first aspect would be maintaining strict hygiene and good practices in health quality. “We will first uplift the standards of the washrooms and clean them every three hours. Our aim is to create a quality culture whereby people will automatically be disciplined,” said the doctor.

The next stage is a nature-friendly environment with a strong emphasis on green belts to be setup as soon as the health institution is finished. “We will grow fruit trees that are of high-grade quality, protect it with fencing and landscape it around the hospitals to offer a peaceful and tranquil setting,” he said.

By making green environs, garbage disposal and waste management will be done accordance to standards and garbage bins will be set up and people will then feel like keeping it clean. The ultimate aim of the green belt system is to ensure that patients will also be inspired to grow a fruit tree at home. “In fact, bio-gas facilities have already been set up at the Homagama and Panadura Base Hospitals and the gas generated from these facilities helps save Rs. 60,000 every month as opposed using commercial gas,” said Dr. de Silva.

In fact, the flooding problems occurring at the Panadura Hospital will be solved when later this year, it will be converted and refurbished into a 9-storey fully-equipped building.

Doctor checking on a patient at Awissawella Base Hospital

Moreover, the Avissawella Base Hospital is already an example since it’s like a five-star hospital.

“The Avissawella Base Hospital is such a good hospital that it is affiliated to the Inha University in South Korea as a sister hospital where mutual exchange of knowledge and ideas takes place between the respective staff,” said the doctor.

This reveals that already Sri Lankan government hospitals are on par with international standards but only the question of discipline is the ultimate goal.

“The only way we can be proud of our hospital services is when we are happy to admit a foreigner to one.

In order to be happy, an ethical standard and good discipline should take precedence over just the medical cures,” said Dr. de Silva.

Training the health staff is also a national issue and this has to be dealt with too.

“We have 200,000 health staff working around the country to see that our health industry is propelled but we need better training to ensure that they are better educated in dealing with patients’ problems.

For example, we started by changing the dietary menu pertaining to diabetic patients, health patients and other patients who needed special vitamins in their diet for healing quickly,” he said. Furthermore, the doctor said that a patient should be happy when they leave the hospital after they have been cured.

“We want to instill values in our staff so that we have good feedback instead of complaint so it’s vital to train our staff on a frequent basis when it comes to patient satisfaction.” Dr. de Silva was also mindful of converting maternal health clinics into family clinics. “Maternity clinics have become a sort of cliche because fathers don’t go and they are sometimes chased away by our staff.

Hence we are giving training to our staff and changing the mindset of the fathers of newborns so that they also can be a part of the experience which is memorable.”

In international countries there is even three months paternity leave so why can’t a father be close to his baby especially during the delivery process? He said: "We are planning to introduce a colour-coded scheme where people can easily find the relevant medical departments for their benefit and maps to track it.

Implementing an organised system will be a formidable task but we are confident that it will pave the way for a disciplined society."

Speaking about donations to the hospital, the doctor said: "There are always happy patients leaving the hospital and so there are bound to be donations from any patients. But even when it comes to giving donations, we have to advice the public too."

For example, those who didn’t have much money used to give plastic buckets and chairs but the doctor said that they don’t have to spend it on that.

“We are trying to solve the plastic problem but another plastic chair or a bucket will add to our problems. So we would like an interlocking tile to modernise the hospital at a cost of Rs.50 per tile,” said the doctor.

Even people from the middle class or upper-class can ask the hospital authorities what kind of refurbishment or development is taking place and obtain advice instead of deciding for themselves what would be good for the hospital.

“Until today most doctors’ lounges and lunchrooms have been developed and fully-equipped with flat-screen televisions and canteens but when it comes to donations, sustainable things should be given,” he said. For example, the special hospital chairs that can’t be removed or tampered with, last for 15 to 20 years instead of the plastic chairs that are easily breakable, removable and contribute to the plastic problem.

So it’s vital in getting the right advice before venturing to buy things which the hospital doesn’t really require in the long-term. From the cradle to the grave, we need discipline.

Since a hospital is where we start our life to the time when it ends, it is vital to develop hospital etiquette in order to develop society.

Exercising caution when you have diabetes

by Karen Schroeder Kassel

Image for diabetes and exercise If you have diabetes, exercise can help keep blood sugar under control and promote good health. But, there are precautions you should know about. While exercise is beneficial because it can lower your blood sugar level, it can also be dangerous for the same reason. Exercise can lead to hypoglycemia - a quick drop in blood sugar.

Living with type 1 diabetes requires a balance of eating, exercising, and insulin usage to keep blood sugar levels within a desirable range.

People without diabetes rarely give blood sugar a thought.

This is because the pancreas automatically produces insulin to escort sugar out of the bloodstream and into body cells for use. Insulin production is naturally matched with the amount of sugar in the blood to keep levels stable.

A diabetic's foot

But, with type 1 diabetes your body does not produce insulin. So you must take over as the regulator of blood sugar. This is an important job, as both high and low blood sugar levels can have serious health consequences.

In type 2 diabetes, your body produces insulin, but your body either cannot use it properly or does not make enough.

People who manage type 2 diabetes with meal planning and exercise usually do not have problems with hypoglycemia. But if you use insulin injections, you may be at risk for exercise-induced hypoglycemia.

Hypoglycemia

During exercise, your muscles take up sugar from the bloodstream to convert into energy. This can decrease blood sugar to dangerously low levels (eg, below 70 mg/dL [3.9 mmol/L] depending on the meter and your doctor’s guidelines). Hypoglycemia can occur quickly. Symptoms include shakiness, dizziness, sweating, headache, hunger, pale skin, sudden moodiness, clumsy movements, confusion, and tingling around the mouth. Severe hypoglycemia can result in unconsciousness or seizures.

But do not let the risk of hypoglycemia keep you from the many benefits of exercise. With a few precautions, you can re-establish the balance of food, exercise, and insulin. The American Diabetes Association (ADA) and the Joslin Diabetes Center recommend these guidelines for safely incorporating exercise into your lifestyle: Talk to Your Healthcare Team

Your healthcare team can personalize your exercise goals. Depending on factors like how long you have had diabetes, your age, and other health problems, your doctor may do an exam and testing to find out the type of exercise that is safe for you.

Discuss with your doctor when the best time for you to exercise is.

Monitor your blood sugar closely

Check your blood sugar before, during, and after exercise, and record these numbers. You and your doctor can use these readings to determine any changes in your insulin dose. With regular exercise, your need for insulin may decrease.

Before exercise, check your blood sugar twice: 30 minutes before and a few minutes before.

This way, you will see if your blood sugar is decreasing. If it is dropping or it is 100 mg/dL (5.6 mmol/L) or less, have a small snack and wait for blood sugar to return to normal.

People with type 2 diabetes may be advised to avoid extra snacking because it may interfere with weight loss (ask your doctor).

If your blood sugar is high-250 mg/dL (13.9 mmol/L) or more-do not exercise.

Instead, check your urine for ketones. Do not exercise until both blood sugar and ketone levels return to normal.

During exercise, check every 30 minutes. If blood sugar levels drop too much (ask your doctor what level is too low), stop exercising and have a snack. Also, be aware of high levels. Ask your doctor when to check for ketones and how best to manage high blood sugar.

After exercise, check again. If your exercise session is long, check regularly for several hours after, as blood sugar may continue to drop.

Be prepared

Always have blood testing equipment, insulin, and high carbohydrate snacks with you. Good snacks include juice, soft drinks, glucose tablets or gel, or hard candy. If hypoglycemia is a recurring problem, ask your doctor about a glucagon injection kit to treat a severe case.

Carry a water bottle and drink often.

Manage complications

To protect your feet, check for blisters or other changes after every workout. Buy footwear appropriate for the sport and that fit well to your feet. Wear clean, smooth-fitting socks (made with synthetic fibres).

Get moving!

There are many benefits to exercise, like reduced stress, decreased risk of diabetes-related complications, and overall better health. These benefits far outweigh the inconvenience of the precautions. So, find an activity you enjoy and get moving!

Courtesy: AHealthyMe

Blood pressure and exercise

UT Southwestern Medical Centre researchers have identified one reason people with hypertension experience an even greater increase in their blood pressure when they exercise, and they’ve learned how to prevent the rise.

A study in a March issue of the Journal of Physiology reported that hypertensive people who exercise undergo decreased blood flow and oxygen in muscles. The scientists also identified a specific type of blood pressure medication that minimizes this effect.

“While there are many hypertension medications effective at lowering blood pressure at rest, very few are effective during exercise,” said Dr. Wanpen Vongpatanasin, associate professor of internal medicine at UT Southwestern and lead author of the study. “People with high blood pressure need to exercise not only to help their blood pressure, but also their overall cardiovascular health.”

Dr. Vongpatanasin said that some people with high blood pressure stop exercising out of fear of heart attack or stroke, and that sometimes physicians counsel those patients to limit activity because of those concerns.While it’s been known that blood pressure increases during exercise in people with hypertension, a mechanism behind the action and a way to block it in humans hadn’t been identified previously.

Dr. Vongpatanasin and colleagues had 13 participants with mild hypertension and 13 with normal blood pressure perform hand grip exercises under regular conditions, followed by activity under conditions that affect a part of the nervous system that controls blood pressure.

They found increased nerve activity in hypertensive participants during exercise but not in those with normal blood pressure. Blood flow and oxygen levels in the arm muscles also fell more rapidly in the hypertensive group.

“In normal people, the body can increase blood flow to the working muscle despite increase in nerve activity, which tends to cause blood vessels to constrict,” Dr. Vongpatanasin said.

“Hypertensive patients have increased nerves and impaired ability to maintain muscle blood flow adequately.”Researchers then treated study participants with two types of blood pressure medications. An angiotensin receptor blocker, which prevents the hormone angiotensin from increasing blood pressure, increased blood flow during exercise.

A diuretic that reduces blood pressure by stimulating sodium loss did not.“Since nerve increases weren’t reduced during treatment, we believe the angiotensin receptor blocker works directly on blood vessels to improve blood flow,” Dr. Vongpatanasin said. The next step, she said, will be to see if other hormones associated with angiotensin are involved in similar responses. Sources: UT Southwestern Medical Center, AlphaGalileo Foundation

Understanding tuft cells’ function in the intestine

The intestinal epithelium consists of four main specialized cell lineages: absorptive enterocytes and three secretory cell types known as enteroendocrine, Paneth, and goblet cells. But a rare, fifth type of intestinal cell called tuft cells also exists.

Defined by the thick brush of long microvilli that project from their apical surface, tuft cells are seen in several epithelial tissues, yet little is known about their function due to a lack of tuft cell-specific markers.

In a recent issue of The Journal of Cell Biology, a team of French researchers led by Philippe Jay identified a unique “signature” of proteins expressed by tuft cells. Like other intestinal cell types, tuft cells turned over rapidly and were replaced by the differentiation of proliferative stem cells’ progeny in the intestinal crypts.

This differentiation was blocked in the absence of ATOH1 - a transcription factor required for the development of all intestinal secretory lineages. Yet tuft cell differentiation didn’t require other transcription factors that specify enteroendocrine, Paneth, and goblet cells, suggesting that tuft cells represent a distinct lineage of intestinal secretory cells.

The team found that tuft cells secrete opioids and produce enzymes that synthesize prostaglandins. The latter observation suggests that tuft cells may promote inflammation and tumorigenesis. Indeed, the researchers identified tuft cell-like cells in several early stage intestinal tumours.

To really understand tuft cells’ function, however, Jay hopes to identify transcription factors uniquely required for their development in order to generate mice that specifically lack tuft cells from their intestinal epithelium.

Source: University Press