Private medical education, boon to country

By Nilma DOLE

The inclusion of private medical educational institutions in the country has raised some questions and doubts as to how the standard of medical education has been in Sri Lanka. However, there shouldn't be any cause for concern as the College of General Practitioners (CGPSL) whole-heartedly supports the development of private sector medical education in the country.

Speaking to the Sunday Observer was president of the CGPSL, Dr. Eugene Corea. He said, "As long as they are registered medical schools with the Sri Lanka Medical Council (SLMC), I don't see a problem with private medical colleges coming up in Sri Lanka."

There is heavy competition to enter local medical colleges and more often than not, depending on the marks obtained by students, they have to be happy with what they were selected.

The doctor said that the CGPSL has played and will continue to play a pivotal role in private sector medical education.

"The North Colombo Medical College (NCMC) was created by the CGPSL and the College handed back infrastructure for teaching and training including a new library, several large buildings, a professional wing and hospital that had been vastly improved when the NCMC was vested in the Government," said Dr. Corea. The CGPSL has never received anything in compensation but their tireless efforts have garnered an 800-strong Alumnus.

Dr. Corea said, "Taking on board the lessons that history taught us, the CGPSL now has clear policy on private sector medical education in Sri Lanka. Our policy is that we support private medical education that is socially responsible, socially accountable and regulated by the SLMC."

According to research done by SLMC, there are 20,000 to 23,000 active registered medical officers working in the country. Out of them nearly 14,000-16,000 are employed in the government sector. Usual cardre expansion comes around 650 medical officers annually, to government sector. Since 1,165 medical students are recruited annually to local medical faculties, they can supply the government requirement without any difficulty with an excess. Hence, it is questionable whether there is a genuine requirement of medical graduates from local or international private medical colleges.

As for international medical graduates of Sri Lankan origin, there are about 800 to 900 graduates who have a wealth of experience and usually pass the local exams well.

There are problems when these graduates register locally and work in the government sector but such issues will be minimised if there is exposure within the country to private education.

However, this doesn't mean that money will go out of the country in the form of international education fees but will help the country's medical industry by churning out doctors who are passionate about their career.

The doctor said, "There shouldn't be any divide between Sri Lankan doctors who have graduated abroad and local medical graduates. They all work together to serve society and help cure people." Dr. Corea said, "Social responsibility will foster developments for the private sector in which great care is taken to prevent any harm to the free medical local education colleges."

He said that it would also include the development of hospital facilities which are made available free of charge to people and the provision of scholarships for qualified under-privileged students.

The doctor said, "Social accountability would include issues of relevance, equity, quality and safety of training and research with regard to the community in which the private sector is facilitated.

"The SLMC is the statutory body, established by the Medical Ordinance No. 24 of 1924, in order to safeguard and maintain the standards of medical education and medical practice. By authorising this task to SLMC, the government fulfils its obligation to the safety of patient care delivery system.

It is the ultimate responsibility of the SLMC to ensure that the qualified medical graduates, whom they entrust with medical practising rights, are "safe doctors" who can be posted not only in Sri Lanka but anywhere in the country.

To accomplish this, they make sure the standards are well maintained in the field of medicine from medical education onwards.

The role of the SLMC is vital for the regulation and registration of medical education institutes and registration of foreign medical graduates.

"The SLMC is the statutory body which is vital for the maintaining of good professional standards and safety of our people," said Dr. Corea. He said the CGPSL fervently appeals to the powers that be and to those intending to set up private medical educational institutions in the country to pay heed to the recommendations and the guidance of the SLMC in these matters.

Today, Sri Lankan medical graduates are recognised all over the world and they are not questioned about their credibility.

This is due to the mere fact that only best students pass local examinations and are selected to medical faculties.

They are given a comprehensive and thorough training as under-graduates but we have to ensure that private medical institutes also offer the same level of teaching to Sri Lankan medical students who want similar opportunities

References CGPSL and GMOA

Recurrent miscarriages may be prevented by removal of fibroids

Researchers have found the first, firm evidence that fibroids are associated with recurrent miscarriages. They have also discovered that if they removed the fibroids that distorted the inside of the womb, the risk of miscarriage in the second trimester of pregnancy was reduced dramatically - to zero.

The study, which is published online in Europe's leading reproductive medicine journal Human Reproduction is the culmination of 20 years of investigation into recurrent miscarriage by Professor Tin-Chiu Li and his team at the recurrent miscarriage clinic at the University of Sheffield and Sheffield Teaching Hospitals (Sheffield, UK).

In addition, for the first time it has given a reliable estimate of the prevalence of fibroids in women who have recurrent miscarriages.

Fibroids in or around the womb (uterus) are benign tumours composed of muscle and fibrous tissue. Although they have been associated with spontaneous miscarriage, until now there has been no evidence of their role in recurrent miscarriages (RM). The prevalence of fibroids has been estimated to be between 3-10% in women of reproductive age, but the prevalence is unknown in women who experience RM, which is defined as three or more consecutive miscarriages.

The researchers analysed data from 966 women who attended the Sheffield RM clinic.

The women were scanned for uterine anomalies, including fibroids, via transvaginal ultrasound and radiology, and 79 were found to have fibroids. "This enabled us to calculate that the prevalence of fibroids was 8.2% among women with recurrent miscarriages; this has never been accurately reported before," said one of the researchers, Dr. Sotirios Saravelos, who is a clinical research Fellow at the University of Sheffield.

Fibroids were diagnosed and grouped into three classifications:

* Submucosal - these grow in the muscle beneath the inner lining of the womb wall and grow into the middle of the womb, distorting the cavity

* Intramural - these develop in the muscle wall of the womb and are the most common type of fibroid. They do not distort the cavity and have less than 50% protrusion into the serosal surface - the outer membrane lining the womb

* Subserosal - these grow outside the wall of the womb into the pelvis, do not distort the womb cavity, and have a greater than 50% protrusion out of the serosal surface.

Prof Li used minimally invasive surgery (hysteroscopy) to remove cavity-distorting (submucosal) fibroids from 25 women; 54 women with fibroids that did not distort the cavity had no surgery and they were matched with a control group of 285 women whose recurrent miscarriages were still unexplained after all investigations found nothing abnormal; these women also had no intervention.

In the 25 women who had undergone surgery, miscarriage rates in subsequent pregnancies during the second trimester fell from 21.7% to 0%.

This translated to an increase in the live birth rate from 23.3% to 52%.

Dr. Saravelos said: "This is the first time that it has been shown that removing fibroids that distort the uterine cavity may increase the chances of a subsequent live birth in women with recurrent miscarriages."

The 54 women with fibroids not distorting the uterine cavity and who had had no surgery also did better after referral to the RM clinic. Pre-referral, the miscarriage rate during the second trimester was 17.6% and this fell to 0% after referral. Live birth rates went up from 20.6% to 70.4% in subsequent pregnancies. This was similar to results from the 285 women with unexplained RM; the second trimester miscarriage rate was 8% pre-referral to the clinic, falling to 1.8% post-referral, while live birth rates increased from 20.6% to 71.9% after referral.

Dr. Saravelos said: "These results are interesting because they suggest that the finding of fibroids in women with recurrent miscarriage does not necessarily imply that the fibroids are the only cause of the miscarriage. In addition, they suggest that surgical intervention is not the only means whereby patients with recurrent miscarriage benefit from attending a specialised, dedicated clinic. However, for women with fibroids that distort the uterine cavity, our work shows that removing the fibroids can eliminate miscarriage during the second trimester and double the live birth rate in subsequent pregnancies.

"It has been recognised since the 1980s that women with unexplained recurrent miscarriage have very good pregnancy outcomes following referral to a dedicated clinic without the need for any intervention, and with psychological supportive care, i.e. tender loving care, alone. This usually takes the form of regular visits to a dedicated recurrent miscarriage clinic, regular antenatal scans to check the condition of the baby, reassurance to the mother from the specialist that everything is progressing well and specialist antenatal counselling throughout the pregnancy.

"Interestingly, although women may increase their live birth rate by up to 50% after psychological supportive care, the exact underlying mechanisms involved in this process are not entirely understood.

In the present study, the fact that women with fibroids not distorting the uterine cavity do so well, suggests that they also do not have an underlying cause for recurrent miscarriage. As a result, they can also be considered as having 'unexplained recurrent miscarriage', and should be counselled that they have very good chances of a successful pregnancy without the need for any intervention or surgery and with the psychological supportive care offered by a dedicated recurrent miscarriage clinic."

The main limitation of the study is that there was no control group for the women who had their fibroids removed and so it is not possible to tell whether they would have done better without surgery, after referral to the RM clinic.

The researchers say that their work highlights the need to perform a randomised controlled trial to investigate this. "The definitive study requires the recruitment of a rather large number of patients to be randomised between intervention and no intervention.

This would require the input of several clinics in a multi-centre randomised controlled trial and its success would depend on the support of all clinics along with that of Sheffield," said Dr. Saravelos.

- MNT

The largest and most affordable source of potassium is in potatoes

A frequently expressed concern in the ongoing public health debate is that fresh fruits and vegetables, particularly those that are nutrient dense, are not affordable to the average consumer. Research presented at the American Dietetic Association's (ADA) Food and Nutrition Conference and Expo (FNCE) demonstrates that potatoes are one of the best nutritional values in the produce department, providing significantly better nutritional value per dollar than most other raw vegetables. Per serving, white potatoes were the largest and most affordable source of potassium of any vegetable or fruit.

Dr. Adam Drewnowski and colleagues from the University of Washington merged nutrient composition data from the national food prices database. Frequency of consumption data was obtained from the National Health and Nutrition Examination Survey (NHANES 2003-4).

The Affordable Nutrition Index (ANI) was the metric used to assess nutritional value per dollar for potatoes and for other vegetables.

Potatoes were the lowest cost source of dietary potassium, a nutrient identified by the 2010 Dietary Guidelines as lacking in the American diet.

The high cost of meeting federal dietary guidelines for potassium, 4,700 mg per person per day, presents a challenge for consumers and health professionals, alike.

However, the cost of potassium-rich white potatoes was half that of most other vegetables.

"Potatoes deserve credit for contributing to higher diet quality and increasing vegetable consumption," said lead researcher Adam Drewnowski, PhD. "Potatoes also play an important role in providing affordable nutrition to Americans. You CAN afford to meet key dietary guidelines IF you include potatoes in your diet."

Further analyses of NHANES dietary intake showed that putting potatoes on the plate did improve overall diet quality.

Individuals who consumed potatoes (baked, boiled and roasted) had higher intakes of potassium and vitamin C and consumed more total vegetables in a day compared to those who did not consume potatoes.

- MNT

Seaweed does the heart good

Researchers have been investigating lipids from a variety of Irish and Canadian seaweed species for their heart-health properties.

In both Ireland and Canada, seaweeds have a long tradition of use.

In Ireland, for example, approximately 36,000 tonnes of seaweed are harvested annually. Seaweed species of commercial interest in Ireland include Laminaria digitata and Fucus species (Fucus vesiculosus, Fucus serratus and Fucus spiralis), which are harvested primarily for their valuable carbohydrates, Laminarin and Fucoidan, respectively.

The value-added sector of the seaweed industry in Ireland has emerged to produce attractive, high-quality products for use as functional body care products and cosmetics. However, there is, to date, limited activity aimed at exploiting Irish seaweed resources as materials for functional food ingredients with enhanced health benefits that go beyond basic nutrition for the consumer.The NutraMara Research Programme is currently working at developing the area of marine-origin functional foods in Ireland.

Seaweeds are known to contain a number of heart-health compounds, including ACE inhibitors, antioxidants and essential fatty acids (lipids).

As part of a research, Michelle Tierney and Dr Maria Hayes developed methods for the isolation of total lipids from a number of seaweed species.

"Seaweeds are a known source of essential fatty acids, which are thought to reduce thrombosis and atherosclerosis factors important in the reduction of the risk of heart disease," explains Dr Hayes.

Of the eight Irish and Newfoundland seaweed species used in this study, the Irish seaweed, Pelvetia canaliculata, had the highest percentage of total lipids per dry weight, followed by the sustainable Irish seaweed Ascophyllum nodosum. Further work is currently underway concerning the bioactivity profiles and bioactive component isolation of all seaweed lipid extracts. "These lipids could potentially be used in food vehicles such as bread and soup type products in the future," said Dr Hayes.

National Health Week October 3 - 9

The Ministry of Health will hold a National Health Week with the aim of promoting public awareness and value of Sri Lanka's health sector. Special programs will also be held in collaboration with government health authorities and health organisations.

October 3 - Public Employees Relationship Day Meeting of health service provider groups including Political Authority/Hospital Development Committees/Employee Advisory, Councils and promoting group relationships and collecting necessary data and information and submitting a report on such activities.

October 4 - Cleanliness Day: Cleaning the institutions through volunteer service, discarding unnecessary things in the workplace and systematic removal of goods with the participation of the entire staff.

October 5 - Awareness Day: Delivering a health lecture and conducting educational programs by Regional Medical Officers at the morning assembly in every school in association with the Ministry of Education with a view to keeping the schools aware of health problems.

October 6 - Observation Day: Launching of field surveys at rural, regional and divisional levels in collaboration with the Ministries of Public Administration/Provincial Councils and Local governments. Identification and reporting of special patients, disabled and those need relief.

October 7 - Elimination Day: To act as a field service day after organising awareness programs in association with the non-communicable disease unit, conducting of sports programs for development of health.

October 8 - Appreciation Day: Inventions, research, appreciation of service skills, collection of data and reporting of information with special reference to the health sector.

October 9 - Commemoration Day: Day to commemorate meritorious deeds, donation of blood, alms-giving, review of the entire health program and reporting of such progress.

October 4 to 9 - Mosquito Control Week: Awareness campaign on mosquito control for the benefit of the staff of the hospitals and health institutions, keeping the health staff including the MoH (Medical officer of Health) informed about the need to provide assistance for cleaning operations in hospitals and mosquito control activities. Conducting awareness campaigns on mosquito control for the benefit of students and teaching staff of all schools within a health division. Attending advisory assistance and rendering participation of the health staff including the medical officer of health to various cleaning programs.