Bridging knowledge gap in the use of medicine

Dr. Chamari Weeraratne, MBBS, MD, Specialist Physician and Clinical Pharmacologist, Senior Lecturer, Faculty of Medicine, University of Colombo.

Interviewed by Ranga CHANDRARATHNE

A book written in Sinhala language for the education of the general public regarding safe and effective use of medicines was launched recently at the Bandaranaike Memorial International Conference Hall (BMICH) at an event organized by the State Pharmaceutical Corporation (SPC) to commemorate the late professor Senaka Bibile. The book is titled "Awushadha bhawithayata athwelak" (a guide to the use of medicines).

Dr. Chamari Weeraratne

The author Dr. Chamari Weeraratne is a Specialist Physician and a Clinical Pharmacologist. She is a graduate of Faculty of Medicine, University of Colombo. She is a Senior Lecturer in Pharmacology at the Department of Pharmacology, Faculty of Medicine, University of Colombo.

The following is based on an interview with the author of the book.

Q: Why did you think of writing this book?

A: We as doctors have seen many patients suffer due to deficiencies in their knowledge, skills and attitudes regarding medicine use. Some people do not take the medicines according to instructions given by the doctors and pharmacists. As a result they do not get the expected benefits from the medicines they use. They also experience side effects and adverse drug reactions that sometimes even put their lives in danger. Some patients tend to buy prescription only medicines without a doctor's prescription at pharmacies. They attempt to save money and time by doing this. However, as a result they sometimes face serious consequences. Most of these problems could be avoided if general knowledge regarding medicines is improved in the general public.

Most of the doctors like to educate their patients regarding these issues but face difficulties due to poor knowledge of the patients regarding medicine use and the constrains on time during consultations. The patients' poor general knowledge regarding medicines makes it more difficult for the doctors to educate them on the relevant aspects of medicine use. Most of the time the patients do not know what to tell and ask the doctor regarding their illnesses and medicines they use. As a result they do not effectively utilize time with the doctor or get the maximum benefit from a medical consultation.

Q: Who should read this book?

A: This book is intended for all average citizens of Sri Lanka. I would be very happy if all secondary schoolchildren would read it. It is intended for the whole family. Mothers, fathers, grandparents and school teachers would also benefit from reading this book. Medical students, young doctors, allied health professionals such as pharmacists, physiotherapists, occupational therapists would also find it useful.

Q: What are the key topics covered in this book?

A: I have started from the very basics relevant to medicine use and tried to gradually build up the knowledge base of the reader as he progresses through the book.

The book has 5 sections.

Section one is a general guide to using medicines. Any average Sri Lankan should know what is included in this section.

It tells you what is meant by the term "medicine or drug" and reasons for using medicines; The similarities and differences between drugs marketed by the generic names and their Trade names; How to buy quality medicines at a pharmacy without spending unnecessarily.

What to know and what to ask the doctor and the pharmacist about the medicines that you use; How to avoid medicine related mishaps; Which drugs should be used only on the recommendation of a doctor (prescription only medicines); Which medicines are relatively safe to use even without a doctor's prescription (nonprescription medicines); How to minimize side effects of medicines etc. Section 2 details the techniques of using different medicine preparations such as tablets, capsules, oral liquids, eye drops and eye ointments, ear drops, skin creams and patches, nasal drops and sprays etc. You may have to use different kinds of medicine preparations from time to time depending on your health situation. You will get good results from them only if you use them properly. Incorrect use may lead to complications as well.

This section was written with a view to addressing these issues.

Section 3 deals with taking medicines during special periods of life. It is further divided into subsections of using medicines in pregnancy and breast feeding, giving medicines to children, issues related to use of medicines in old age. I have decided to write specially about these topics to fill some gaps in knowledge regarding medicine use during there periods of life.

Section 4 includes special notes regarding use of antibiotics properly, techniques of using inhalers for asthma and technique of giving insulin injections. I have written specially about using antibiotics because there are many inappropriate practices relating to this area. As a result the expected benefits do not occur. Complications arise. Resistance to antibiotics emerges.

People sometimes spend a lot of money to buy asthma inhalers. However they do not achieve good control of asthma due to faulty techniques of using inhalers. The subsection on inhalers for asthma was written to overcome this issue mainly.

Some patients with diabetes need to have insulin injections.

However, some of them do not know how to self inject insulin. Their relatives like to help out but cannot because they themselves also do not have the necessary knowledge and skills to do so. Some patients do inject insulin but suffer unnecessarily from pain because they do not know how to minimize pain associated with insulin injections. The section on insulin was written to overcome these issues.

Section 5 is on what to tell the doctor regarding one's medical history and medicines used.

This section is intended for the patient to be maintained with the help of the doctor or the pharmacist. The idea is to make the patient take more responsibility and be actively involved in managing his or her health issues without solely relying on the health professionals. This concept may be strange for the majority of people of Sri Lanka at present who depend heavily on doctors for all decisions relating to their health.

Q: Who do you want to thank for helping you to do this.

A: First of all I want to thank my parents. My father Dr. W. G. Weeraratne is the Editor in Chief of the Buddhist Encyclopaedia. My mother Mrs. Yamuna Weeraratne is an educationist. They have written several books themselves and I have been motivated by them in a great way in doing this.

I also want to thank Professor Krishantha Weerarasooriya who was the former Head of the Department of Pharmacology, Faculty of medicine, University of Colombo, where I work. He is currently the South East Asian Regional Adviser for the World health Organization on Promoting Rational use of medicine.

He is my teacher, mentor and motivator who has helped me right along from my undergraduate days to date.

The State Pharmaceutical Corporation(SPC) sponsored the publication. I want to thank Dr. W. G. Gunawardena, Chairman of the (SPC) and Mrs. Sujathi Jayarathna, Promotion Manager of SPC regarding this. I was highly motivated and strengthened by Dr. W. G. Gunawardena's encouragement and appreciation of the book and his ready acceptance to sponsor the publication on behalf of the SPC. I want to thank Mr. Upasena Jayarathna who is a contemporary of Late Professor Senaka Bibile who holds the vision and principles of the late professor high. His support in writing and publishing this book is greatly appreciated. There were so many motivated academics that guided and helped me. Professor Kusum de Abrew, Professor Colvin Gunaratne, Professor Lal Jayakodi, Professor Rohini Fernandopulle, Dr. Priyadarshani Galappatthy and Dr. Shalini Sri Ranganathan in the Department of Pharmacology helped in many ways to improve the contents of the book. I want to thank Dr. Chathuri Liyanapathirana who designed the cover page of the book and did some lovely illustrations for the content pages. There were several others who helped to make this venture possible. I want to thank all of them.

Q: Are you planning to publish the book in other languages?

A: Yes. I have already made arrangements to translate the book to Tamil and English.

Q: Is an electronic version available?

A: At the moment I am in the process of making a special electronic publication of the book using the digital assistive information system (DAISY) medium that can be accessed by any body irrespective of their visual and hearing abilities. Mr. Ashoka Bandula Weerawardena is providing the technical assistance to do this.

I am also producing an audio CD and Talking book at the request of the Sri Lanka Council for the Blind. I have finished most of the voice recording necessary for the electronic versions. These versions are suitable for the average Sri Lankan and would be made available to the general public in the near future.

Q: Is a Braille version available as well?

A: Yes. I am very keen that the contents of my book reach all citizens of this country irrespective of their disabilities. The Principal for the school for the visually disabled students, Rathmalana, Mrs. Sandya Koduruarachchi, is very enthusiastic about this and has organized the publication of the Braille version. I thank her as well as the motivated and dedicated library staff at hers school for their enthusiasm in publishing the Braille version of the book.

The book would be handed over to the Sri Lanka Council for the Blind on November 14th, 2009.

The book would be made available to the special schools in Sri Lanka and the Universities where the visually disabled students study as well as some public libraries. The Sri Lanka Council for the blind has very enthusiastically agreed to distribute the book to these institutions. I specially thank the Executive Director of The Sri Lanka Council for the blind, Mr. S. L. Hettiarachchi regarding his ready acceptance to do so on behalf of his organization. This book is the first medicine related Sinhala Braille publication in Sri Lanka.

I want to have more copies made available later on to serve the needs of the other adult visually disabled Sri Lankans who are proficient in Braille. Once the Tamil and English versions of the book are completed I am planning to produce English and Tamil Braille versions as well.

Q: What are your main interests?

A: My main interest is promoting safe and effective medicine use in the general public. I have a special interest in improving medicine use in visually disabled and hearing impaired consumers of medicine.

I also have an interest in prevention and treatment of non communicable diseases such as diabetes and hypertension.

Q: How can you be contacted?

A: I welcome feedback and constructive criticism from the readers of my book. I can be contacted via email at [email protected].