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Medical doctors and self-treatment

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by Dr. Lakshman Abeyagunawardene

At the outset, I wish to define who a “Medical Doctor” is for purposes of this article. This definition applies only to this article and nowhere else. By way of explanation, I would consider a “General Physician” (or any physician for that matter) as quite capable of treating any illness that could afflict anyone. But on the other hand, some doctors in the finer specialties like Pathologists, Radiologists and Community Medicine, would not do so with such confidence unless they have made a special effort to stay in touch with clinical medicine.

In general, it is as a General Practitioner that the average medical doctor is called upon to act when it comes to self-treatment or treatment of a relative or friend or in an emergency. Ayurvedic physicians and all other native doctors who are not registered in the Sri Lanka Medical Council have not been considered at all. Neither are Homeopathic doctors although they claim to have their own council. Needless to say, the many thousands of quacks who still enjoy a roaring practice in rural areas, rule themselves out!

Although I am an avid reader of feature articles and letters to the Editor especially on Sundays in the English newspapers, I have hardly seen any material dealing with the subject of “Medical Doctors and Self-treatment”. The reason may be that very few in the medical profession have the inclination to indulge in Sunday reading and the few who are talented and able to do so, do not have the time to engage in writing even as a hobby.

As a rule, I don’t even attempt to treat myself unless it is for a very common ailment. More importantly, what is required is the ability to differentiate a minor symptom from one that would be more serious and call for a specialist’s opinion.

 

Part time clinical work

There was a time when I was doing a job in my chosen field with absolutely no clinical work. But I always had a longing to stay in touch with patients and clinical work. It was also at a time when private practice for government doctors had just been introduced. I was the regular locum for a friend on most evenings.

My own rule on self-treatment applies not only to my own family but to the extended family as well. There was a time when the first person to contact in the case of my ageing parents, sister and brother would naturally be myself, but that responsibility has dwindled since my parents are now dead and gone, my sister is married with a grown son who is himself a doctor and my brother has lived in the US since the mid-seventies. Since my marriage, I had to look after my mother-in-law who was living with us, but that was only temporarily.

Under certain circumstances, especially for minor ailments, I treat myself and my family. In my own case, it is not difficult to decide when I should see a specialist doctor. But as far as possible, I encourage my family members to seek treatment from some other doctor (often a specialist). A medical doctor should also be well versed in first aid.

 

Follow-up of patients

To me, my part-time work was not merely a job that brought in extra remuneration. I often went out of my way to follow-up patients that I had referred to the major hospital in the area. Unlike the regular GP, due to the part-time nature of my work, I had much fewer patients to deal with. Thus patient follow-up was conveniently done, particularly as my own place of residence at that time was very close to the Colombo South Hospital to which the more serious patients were often referred.

 

Executive in distress

This is a little story that I will not forget easily and well-worth recalling when writing about my work as a part-time family practitioner. A middle-aged male patient was brought in very late one evening when we were about to pull down shutters for the day. He had laboured breathing and a noisy wheeze. But despite his apparent distress, he looked smart and was well-dressed. At first sight, even a qualified doctor would be inclined to think of the typical asthmatic that is regularly seen with the same symptoms.

However, a little bit of the history ascertained from the accompanying family members, often make the doctor think twice before coming to any conclusion regarding a probable diagnosis. In this case, the patient’s wife kept telling me in fluent English that her husband had never had such a problem before. That proved to be a crucial point. A quick physical examination and use of the stethoscope virtually confirmed my worst fears. The blood pressure being elevated, I was already thinking of a more serious condition than an ordinary attack of bronchial asthma. Having suspected acute left ventricular failure (LVF) commonly referred to as “cardiac asthma”, I lost no time in rushing off the patient immediately to hospital. I was well-aware of the limited facilities and resources available in a GP’s clinic to tackle such emergencies, and that time was of essence.

Without washing my hands off the case, I followed the patient in my own car as I was heading home in that same direction in any case. The doctor in the OPD at Kalubowila Hospital confirmed my tentative diagnosis, and after administering the urgently needed treatment in the OPD itself, admitted the patient to a medical ward immediately. Being a former employee of the hospital, I was able to facilitate the entire process.

The Consultant Physician who happened to be a friend told me later that the patient would have definitely died had treatment been delayed any longer. The heart condition that manifested itself as a full-blown illness at such a relatively early age was due to undetected, untreated and hence uncontrolled hypertension (high blood pressure), which he had been living with for several years. The patient (who made a full recovery) and his wife were later virtually falling over each other in expressing to me their genuine appreciation and gratitude. Some years later, I heard that my patient, who was a top executive in a reputed mercantile establishment at the time of his illness, had later been made a Director in the same company!

 

Ulterior Motives

Under normal circumstances, such unusual dedication to the welfare of patients would have obviously aroused suspicion in the mind of the established doctor under whom the “locum” doctor worked. More often than not, “locums” did that with ulterior motives, “cultivating” patients for a practice that they themselves were planning to set up in the same area undercutting the erstwhile employer. But in my case, the employers being my personal friends who were well-aware of my life’s goals, ambitions and future plans, were convinced that I had no such ideas or tricks up my sleeve. My “follow-up” of patients only helped my friends with their own practice.

A few years prior to that, I consulted a Consultant Dermatologist who went through the routine of prescribing steroidal creams in the usual ascending order in terms of strength, and in the absence of progress, then went on to investigate further to rule out conditions like Bowen’s Disease (a form of skin cancer). The Consultant did a skin biopsy and various blood tests and although they proved to be negative, I was relieved. My objective right along had been to rule out such more serious condition. I stopped consulting the doctor, and was without a Dermatologist for a couple of years. I resorted to self-treatment again as I knew very well that skin ailments are difficult to treat and the best I could do was to keep it under control.

 

Summary

In summary, a medical doctor whatever field he or she has specialized in, should be confident enough to treat his or her own self initially and offer appropriate advice to family, friends and neighbours, including first aid. If not, the five years of training a medical doctor undergoes, would be in vain. I should know because when flying, I have heard that familiar announcement many times, calling for volunteers from medical doctors to help out the cabin crew as they have a passenger who is ill on board the aircraft.



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Credibility in governance through elections and not security forces

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Ranil Wickremesinghe

By Jehan Perera

President Ranil Wickremesinghe’s warning that he is prepared to declare a state of national emergency and use the military to suppress any public protests for change of government would reflect the pressures he is under. The manner in which he has used the security forces to deal with the protest movement has been unexpected. His words and deeds are contradictory to what he has previously stood for as a five-time former prime minister. This is especially true in the case of the ethnic and religious minorities who have consistently voted for him and his party at elections. They have felt safer and more secure under his governments which always sought to reduce the heavy hand of state oppression in which national security is given pride of place. He has always promised them much though he has been unable to deliver on much of what he promised.

Notwithstanding the unfortunate rhetoric and actions of the present time the belief still persists that President Wickremesinghe is the best of the available options. Recent pronouncements of the president have reignited hope that he will address the problems of the religious and ethnic minorities. He has stated that he does not want to leave this problem to the next generation. He has said that he wants to resolve this intractable national problem by the country’s 75th independence anniversary on February 4 next year. The hope that the president will make a fresh effort to resolve their problems has led the main Tamil party, the TNA, to desist from voting against the budget which passed with a relatively small majority. Their spokesperson, M A Sumanthiran said in Parliament that due to the president reaching out to them, stretching out his hand, they did not vote against the budget although they disagreed with it.

It is not only in words that the president has reached out to the ethnic and religious minorities. Reports from the north and east indicate that the Maveer (Heroes) Day commemorations this year took place without incident. During the past two years scores of people were arrested and a massive presence of security forces blocked the people from participating in public events. On this occasion the security forces did not get involved in any attempt to stop the commemorations. University students distributed sweets and even cut a birthday cake to celebrate slain LTTE leader Velupillai Prabhakaran’s birthday. The analogy that the president drew to himself being seen as a Hitler who exterminated ethnic and religious minorities is misplaced. The release of those held under the Prevention of Terrorism Act for engaging in similar acts in the past would further contribute to the reconciliation process.

WORSENING CRISIS

In this context, the president’s use of militaristic rhetoric can only be understood in relation to the growing economic crisis that shows no sign of abating. The anticipated IMF bailout package is at risk of getting indefinitely delayed. It was initially anticipated to come in September then in November but now January is being targeted. Japan’s top brokerage and investment bank, Nomura Holdings Inc, has warned that seven countries – Egypt, Romania, Sri Lanka, Turkey, Czech Republic, Pakistan and Hungary – are now at a high risk of currency crises. Sri Lanka is in third place on the table of risk. The next devaluation of the rupee could see another spike in inflation that will make the cost of living even more unbearable to the masses of people.

The president is on record as having said that the economic crisis will get worse before it improves. Both anecdotal and statistical evidence indicates that it is indeed worsening. University teachers at the University of Sabaragamuwa reported that attendance in their classes was down by at least a quarter. Students who come from other parts of the country are unable to afford the cost of meals and so they stay at home. A study by the Institute of Policy Studies has shown that about four percent of primary, 20 percent of secondary and 26 percent of collegiate students had dropped out of school in the estate sector, which is the worst affected. The future costs to the country of a less well educated population is incalculable and inhumane.

As it is the situation is a dire one for large swathes of the population. Research from the University of Peradeniya has revealed that close to half of Sri Lanka’s population, 42 percent (up from 14 percent in 2019) are living under the poverty line. Professor of Economics Wasantha Athukorala has said there is a dramatic increase in the poverty level of over three-hold across the past three years. In 2019, nearly 3 million people lived below the poverty line, but that number has increased to 9.6 million in October 2022. In these adverse circumstances stability in a polity can be ensured either through legitimacy or through force. It would be tragic if the latter is the choice that is made.

ELECTORAL SOLUTION

President Wickremesinghe has been stressing the importance of political stability to achieve economic development. His recent statement that the security forces will be used to negate any unauthorised protest is a sign that the government expects the conditions of economic hardship to escalate. The general public who are experiencing extreme economic hardship are appalled at the manner in which those who committed acts of corruption and violence in the past are being overlooked because they belong to the ruling party and its cliques. The IMF has made anti-corruption a prerequisite to qualify for a bailout, calling for “Reducing corruption vulnerabilities through improving fiscal transparency and public financial management, introducing a stronger anti-corruption legal framework, and conducting an in-depth governance diagnostic, supported by IMF technical assistance.”

It is morally unacceptable even if politically pragmatic that the president is failing to take action against the wrongdoers because he needs their votes in parliament. As a start, the president needs to appoint a credible and independent national procurement committee to ensure that major economic contracts are undertaken without corruption. Second, the president needs to bite the bullet on elections. The country’s burning issues would be better accepted by the country and world at large if they are being dealt with by a statesman than by a dictator. Government that is based on the people’s consent constitutes the sum and substance of democracy. This consent is manifested through free and fair elections that are regularly held. Local government elections have been postponed for a year and are reaching their legal maximum in terms of postponement. These elections need to be held before March next year.

Elections will enable the people to express their views in a democratic manner to elect their representatives for the present. This would provide the government with guidance in terms of the decisions it is being called to take to revive the economy and place the burden in a manner that will be acceptable to the people. The provincial council elections have been postponed since 2018. Democratically elected provincial councils share in the burdens of governance. The devolution of power that took place under the 13th Amendment was meant to promote ethnic harmony in the country. The president who has taken the position that he is for a solution to the ethnic conflict should seriously consider conducting the provincial council elections together with the local government elections se their financial costs. By doing so he will also gain legitimacy as a democratic statesman and not a dictator.

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WEDNESDAY – Movie Review

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The Addams Family is back with a new tale to tell! Originally created by Charles Addams as a comic strip published in The New Yorker, it offered readers a sarcastic take on the ‘typical nuclear family’ by substituting it with a more macabre bunch of strange and eerie individuals. Since then the titular family has been adapted on to the big screen many times, from live action movies to animated versions, the Addams Family has gained many fans throughout the years. Created by Alfred Gough and Miles Millar, with Tim Burton working on four episodes of the eight-part series, Wednesday is a welcoming tale for young fans, but unfortunately fails to think outside the box and remains anchored to the floor with a messy storyline.

Dead-eyed Wednesday Addams (Jenna Ortega) is a stubborn, independent and intelligent teenager in this new series. Her penchant for attracting trouble wherever she goes alarms her parents, Morticia (Catherine Zeta-Jones) and Gomez (Luis Guzmán). With an already strained relationship with her parents (specifically her mother), Wednesday is enrolled at Nevermore, an academy for outcasts like herself. Having attended the academy themselves, Morticia and Gomez are hopeful that their daughter will ‘fit right in’. Caught between trying to build her own identity and other teenage complexities, Wednesday soon finds herself in the middle of a twisted mystery.

This is the first time audiences are introduced to a teenage Wednesday, which allowed the creators to build a new world on their own terms, but while keeping true to the original nature of the character. The creators do a fair amount of world building by introducing other outcasts like the Fangs (vampires), Stoners (Gorgons), Scales (sirens) and Furs (werewolves), among others. Nevermore Academy itself is beautiful and comes with the classic package of creepy crypts, hidden rooms and secret societies. The series also offers a decent amount of gore, although they could have added more given Wednesday’s proclivity for gore-related activities. The series deals with classic young-adult tropes which includes teenage crushes, bullies, relationships and even prom, among other things. The series navigates through Wednesday’s journey of self-discovery, which is a new avenue for both the character and the fans. From understanding and displaying her emotions to discovering her identity and understanding her peers, the series takes a deep dive into heavy material.

Ortega’s performance as the titular character plays a major role in keeping audiences glued to the screen. This is also the first time viewers are shown a teenage Wednesday Addams, which works to Ortega’s benefit as she depicts more dimensions to the ghoulish, morose character many are associated with based on previous renditions. Her facial expressions and ability to deliver on seriously emotional moments strengthens her role as the lead. The rest of the Addams Family, even with limited screen time, lack the eccentricities their characters should have. Hopeless romantics Morticia and Gomez seem incompatible in this version and Uncle Fester is far less crazy than he ought to be. The only member worth mentioning is the Thing—a severed hand— who brought more character and spirit to the series acting alongside Ortega. With barely any room to develop a majority of the characters are prosaic and tedious, even though they remain vital to the plot.

Apart from Ortega, Gwendoline Christie and Emma Myers deserve honorable mentions for their roles as Nevermore’s head teacher, Larissa Weems and the peppy Enid Sinclair respectively. Enid quickly became a fan favorite as the character was the polar opposite to Wednesday. Her character is vital to Wednesday’s character development and their journey to find common ground as mismatched individuals is amusing.

Christina Ricci who played Wednesday in the 90s returns as ‘normie’ teacher, Miss Thornhill and unfortunately barely stands out and this in large part due to the messy storyline. The series is bogged down with numerous subplots and overlapping tropes and the characters with potential for growth are completely overlooked. With love triangles, bullies and killer monsters on the loose, the series self-destructs and the climax sinks into disappointment.

At the end of the day, Wednesday plays to the beat of the new generation and touches on new themes, which is welcoming seeing as the character should grow up at some point. While not everyone may relate to Wednesday’s teenage perils, it is interesting to witness her growth and her journey as an ‘outcast’ or ‘weirdo’. And while Wednesday doesn’t exactly offer a distinctly unique story, it gives audiences a small taste of what Jenna Ortega’s Wednesday is capable of. Creating a story around a well-established franchise is a difficult task, and in this case the creators fail to add value to their visions. If the series continues, the creators will have the opportunity to think further outside the box and push the limits to Wednesday’s character and give audiences a bone-chilling experience. Wednesday is currently streaming on Netflix.

 

 

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Stage set for… AWESOME FRIDAY

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The past few weeks have been a very busy period for the new-look Mirage outfit…preparing themselves for their big night – Friday, December 2nd – when they would perform, on stage, for the very first time, as Donald Pieries (leader/vocals/drums), Benjy (bass), Niro Wattaladeniya (guitar), Viraj Cooray (guitar/vocals), Asangi Wickramasinghe (keyboard/vocals), along with their two frontline female vocalist, Sharon (Lulu) and Christine.

They have thoroughly immersed themselves in their practice sessions as they are very keen to surprise their fans, music lovers, and well-wishers, on opening night…at the Peacock, Berjaya Hotel, in Mount Lavinia.

Action starts at 8.00 pm and, thereafter, it will be five hours of great music, along with EFFEX DJs Widhara and Damien, interspersed with fun and excitement…for the whole family!

Yes, opening night is for the whole family, so you don’t need to keep some of your family members at home – kids, especially.

Working on their repertoire for Friday, bassist Benjy says “what we will dish out will be extra special, with lots of action on stage.”

It would be interesting to see Sharon (Lulu) doing her thing with Mirage, after her early days with the Gypsies, and, I’m told, a dynamic performance from Sharon is what is in store for all those who make it to the Peacock this Friday

Edward (Eddy) Joseph (centre) with Donald and Benjy

While the band was at one of their practice sessions, last week, they had a surprise visitor – Edward (Eddy) Joseph, a former member of the group Steelers, who is now based in Germany.

Eddy is here on a short visit and is scheduled to return to Germany, tomorrow (30).

He spent an hour with Mirage, at their practice session, and says he is disappointed that he would not be around for the group’s opening night.

However, there is a possibility of several well-known personalities, in the showbiz scene, turning up, on Friday night, to experience the sounds of the new-look Mirage, including Sohan Weerasinghe and Joey Lewis (from London).

Rajiv Sebastian, too, says he is keen to be a part of the fun-filled evening.

You could contact Benjy, on 0777356356, if you need to double check…their plans for AWESOME FRIDAY!

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