Seven decades of independence have brought many changes in our lives:
Changes for the better and the worse. These changes have been reflected in almost every aspect in the way we live, behave, eat, drink, dress, exercise, our attitudes and general approach to life. Most importantly, they have impacted on our health. Good or bad, for better or worse, there is no doubt that since independence, many many changes have taken place in our physical, mental , psychological , social and economic areas that influence us. Our population has surged several times over , with a rapidly growing aging population of over 55 years, on the verge of overtaking the hitherto dominant young population. All these social determinants have forced various governments since 1948, to constantly review , adapt and change their laws, introduce new legislation to meet the new challenges that constantly confront them.
Health is one of them, perhaps, the most important of them all. Without health, everything else would pale in comparison; money in the bank , high flying jobs, good schools for children, a place of standing in society, acceptance by the community, respect from our leaders and security for the future. Being healthy, preventing our blood pressure, blood lipid profile, blood sugar, rising to unacceptable levels, with affordable drugs is thus the goal of every government.
Goals
These are not new goals. This long tradition of institutional and non institutional care for the sick goes back to 5th and 6th century A.D where there is evidence of hospitals built in Buddhist monasteries probably catering to the health needs of the royal families living at the time. Then, it was the traditional healing practitioners ( vedamahaththayas) who attended on them personally, tailoring their medicines according to the specific ailments of their patients. Today , the majority of Lankans in most urban and semi urban areas, prefer western treatment, a legacy inherited from our colonial masters since independence.
Demographic changes and epidemics of communicable diseases such as polio, measles , HIV, TB, leprosy, filariasis, congenital rubella, among others brought about new diseases of the modern century. Unhealthy fast food high in calories, carbohydrates, saturated fats, red meats, has further pushed this unhealthy trend to flood level. In their wake followed a host of diseases which spared no one.
Children under five, and pregnant women suffered the most. Repeated attacks of diarrhoea caused by unhygienically washed bottled milk by mothers who had switched from breast milk to powdered milk yielding to the false claims of big milk manufacturing companies was the leading cause of morbidity, mortality and hospitalization in very young children. Other illnesses followed including the rise of dengue.
Forward strides
Ironically, despite these gaps, Sri Lanka was surely and steadily making its name as a country with excellent health indices : a remarkable low infant mortality rate and low MMR ( Maternal mortality rate), compared to not South Asia alone, but even developed countries around the world. How did this rare and unusual achievement come about?
It was not a miracle that happened overnight. Many factors which began developing gradually since independence and gained momentum in the 21st century contributed to this.
Along with more scientific methods including the pill, IUD, sterilisation to encourage couples to practise family planning and halt the rise in unwanted babies and abortions in the 60s and 70s, men are now being encouraged to use condoms priced at give away rates and even free. The Sri Lanka Family Planning Association, from this year, also installed a condom wending machine for sexually active males, reluctant to visit pharmacies.
To meet the rising demand for women’s health needs, several postnatal and antenatal clinics have been introduced throughout the island.
The response from mothers to such moves however, has been both promising and disappointing.
Key findings in a survey in 2017 on antenatal care, revealed that 99 % of mothers received antenatal care from a skilled provider and 98% women with a live birth during five years received iron pills or capsules and intestinal parasitic drugs . Over 92% also had their blood pressure and blood sugar checks, The state also established Well Woman Clinics which mothers, mothers to be, and other women could attend to get themselves screened for all sorts of tests.
However, researchers found that only 42 % had made use of the free services they offered such as, pap smears and breast cancer and cervical cancer tests, which are gaps that need to be filled.
Vaccinations
The study also showed an encouraging improvement in the health of infants, with a reduction in the number of low birth weight babies and almost universal acceptance of vaccinations which prevented the six deadly preventable childhood diseases of diphtheria, whooping cough, tetanus, measles and polio, especially in children from 12-23 months, and TB.
NCDs
While most infectious diseases have now been quelled through the combined efforts of the Health Ministry and allied line ministries, with vaccines heading the list of most effective measures taken, today, seventy years post independence, the leading cause of mortality, morbidity and disability is currently the widespread torrent of non communicable diseases ( NCDs) in the country.
This is the most significant challenge that doctors now face .
To combat this flood of unhealthy diseases, the Ministry of Health and Indigenous Medicine came up with a National Multi-sectoral Action Plan for Prevention & Control of NCDs in 2016, targeted to reduce NCDs by 2020.
It is worth repeating some of the messages read at this historic event by the leading dignitaries of health in the country.
Prime Minister Ranil Wickremesinghe charged that many causes contributed to NCDs in Sri Lanka. These included the following:
* Adopting a more sedentary lifestyle with less exercise outdoors.
* Stress
* Change in food consumption with more emphasis on processed food instead of fresh vegetables .
* High intake of salt and sugar .
He said all these had led to high blood sugar, high blood lipid levels and obesity. Commending the Ministry for minimizing the risks taken in conjunction with other medical groups, civil organisations etc, he said it would decrease the cost of secondary care provided for NCDs, palliative care and rehabilitation.
Health Minister Dr Rajitha Senerathne speaking on the occasion, said Sri Lanka had achieved much in control of communicable diseases, eliminating vaccine preventable diseases to become exemplary among South East nations in its achievements in the area of maternal and child health.
He noted that today, NCDs were the dominant problem and biggest challenge to health officials in the country.
The solution was through health promoting partnerships and co-ordinating actions of many sectors beyond the health sector, partnering with NCG sectors and civil society organisations when necessary.
Former Director General Health Services, Dr P.G. Mahipala said 65% of all hospital deaths in Sri Lanka were due to NCDs with cardiovascular disease leading.
A Census Department survey in 2017 revealed that vascular diseases, cancer, chronic pulmonary disease, diabetes were among the major contributors to the NCD burden, and of the 138,000 deaths in 2017, 75% were due to NCDs. The use of tobacco, alcohol and unhealthy diets , lack of physical activity and risky behaviour, and air pollution contributed to chronic pulmonary disease.
Under the Plan a number of targets were set out to be achieved before 2025.
They include: 25% relative reduction in premature mortality for cardiovascular disease, cancer and chronic respiratory disease, 10% relative reduction in insufficient inactivity, a 30% relative reduction in the intake of salt ( sodium), 30% reduction of tobacco use in those over 15 years, 25’% reduction in the prevalence of raised BP, halt in the rise of diabetes, 80% availability of affordable base technicians and essential medicine including generic to treat major NCDs both in public and private facilities.
Today, the number of human resources have swelled to a new high , with nurses and medical doctors being given training in dealing with complications arising from dengue etc with the help of the World Health Organisation which has worked closely with the Lankan government for the past 60 years. As a result both the number of suspected cases of dengue which rose to 44,456 in 2012, has now fallen to a new low.
Many emerging and re emerging diseases have also been halted. There has been no cases of polio since 1993 and no reports of indigenous malaria since October 2012. Vaccine preventable diseases are rarely reported now due to high levels of acceptability.
Human rabies has also declined from 377 in 1973 to 28 in 2013,due to mass vaccinations by the Veterinary Department of the Health Ministry.
TB and leprosy are no longer a threat as they once were in the past.
More awareness and correct information using modern tools of communication like social media are among the key interventions responsible for these positive changes in the health sector.
New breakthroughs in medical research, science and other medical fields hitherto untrodden await the citizen of tomorrow. One, is Organ transplant. wA spokesman for the Organ Transplant Unit of the Sri Jayewardenepura Teaching Hospital which has all the facilities and also performs kidney transplant operations, told the Sunday Observer,” Kidney failure has now become endemic in our country and this burden continues to rise.
Although we have the man power and other resources, our main limiting factor is the lack of donors of organs. In most parts of the developed and in some developing nations organs are harvested from deceased donors, thus speeding up operations to save lives hanging on a thread. Unfortunately in Sri Lanka awareness regarding decease organ donations is lacking resulting in slowing down the program”.
To raise awareness and hopefully obtain more volunteer donors, the Unit together with the Ministry of Health will organise an Organ Donor Day on Feb. 18, which the organisers say will be a continuous event every year.
Come Independence Day 2019 Sri Lanka will be able to harness her huge volunteer base starting from grassroots level to ensure a healthier nation .