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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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Playing politics with science!

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It is obvious that the only way out of this disastrous pandemic is through science––the use of vaccines that have been introduced in double quick time due to scientific ingenuity. It is the duty of politicians to refrain from playing politics with science.

 

By Dr Upul Wijayawardhana

If you thought it was only our politicians who played politics with science, you thought wrong. Admittedly, ours are pretty bad as evident from the Dhammika peniya episode. We had our Health Minister freely advertising the concoction by ingesting it in her office and wasting the valuable time of academics by instructing them to test it for efficacy. Getting a pretty bad attack of Covid-19 demonstrated the idiocy of her action but she continues unashamedly to be our Minister of Health!

A Professor of Pharmacology turned politician did likewise. Forgetting what he taught his students, he supported the untested therapies, the explanation given by one of his colleagues being that he behaved as a politician, not a scientist! By implication, even scientists can forget science when they become politicians! Funnily, he was rewarded by being appointed the Acting Minister of Health the day the Health Minister was discharged from hospital, which was rather bizarre considering that during the Minister’s prolonged period of hospital-stay there was no acting appointment! Perhaps, fearing that he might take the bread out of her mouth, the Minister returned to office within a few days of discharge.

Although the first wave of the Covid-19 epidemic was very effectively controlled, the loss of efficiency as regards the second wave was due no doubt to allowing non-scientific ideas to creep in. The refusal of permission for the burial of Covid-19 victims in spite of a group of top scientists recommending it, made us look foolish and turned international opinion against the country.

The clamour for vaccination is a welcome sign, more so because the UK is continually producing evidence for the extreme efficacy of vaccination.

The UK was the first country in the world to start vaccination and has already vaccinated more than 21 million of its 66 million population. It started with the Pfizer vaccine, closely followed by the Oxford AstraZeneca vaccine. EU, which was a late starter, was critical of the Oxford AZ vaccine. The French President Emmanuel Macron is obviously guilty of playing politics with science as he was one of the vaccine’s most vociferous critics, calling it “quasi-ineffective” for the elderly. As a result of political comments of this nature, more than half of EU countries limited the Oxford AZ vaccine to those under 65 years, in spite of the European Medicines Agency approving it for all age groups.

Another political appointee, Ursula von der Leyen, European Commission President, had a public spat with AstraZeneca over gaining more of its vaccine doses and introduced a border between Ireland and Northern Ireland; she was forced to reverse her decision, quickly. She then suggested the UK had compromised on “safety and efficacy” by approving the jab so early, despite the EMA reaching the same conclusions as the UK’s internationally-respected MHRA, which approved the Oxford AZ vaccine for all ages. Millions of doses of Oxford AZ vaccine, which they obtained in spite of criticism, remain unused in France and Germany. Why did they not have the generosity to give these to struggling countries like Sri Lanka?

Data released by Public Health England (PHE) shows that both the Pfizer and Oxford-AstraZeneca vaccines are highly effective in reducing COVID-19 infections among those 70 years and over. Since January, protection against symptomatic Covid-19, four weeks after the first dose, ranged between 57 and 61% for Pfizer and between 60 and 73% for the Oxford AZ vaccine.

In the over 80s, data suggest that a single dose of either vaccine is more than 80% effective in preventing hospitalisation, around 3 to 4 weeks after the jab. There is also evidence for 83% reduction in deaths from Covid-19 with the Pfizer vaccine and data for Oxford AZ vaccine is awaited.

European aversion to Oxford AZ vaccine is, no doubt, due to Brexit than to science. Very soon, all EU countries would be forced by science to allow all age groups to have the Oxford AZ vaccine which, by the way, is the cheapest vaccine that is easier to transport and store. Politicians who criticised Oxford AZ vaccine have had to eat humble pie but they will no doubt come out with some claim to justify their idiocy!

A Belgian minister, Budget State Secretary Eva De Bleeker, has angered vaccine manufacturers by revealing sensitive and confidential commercial information – the price that the EU has agreed to pay for the leading Covid-19 vaccines. Though her twitter message was deleted quickly, screenshots taken show that the EU agreed prices for the three vaccines used at present are as follows: Oxford/AstraZeneca: €$ 1.78, Pfizer/BioNTech : €$ 12 and Moderna: $18.

Moderna, a Bio-tech company, which has not been profitable so-far, is heading for wind-fall profits and the drug-giant Pfizer will get richer. No one seems to have followed the noble gesture of AstraZeneca, which agreed with the Oxford group to provide the vaccine on no-profit basis.

It is obvious that the only way out of this disastrous pandemic is through science––the use of vaccines that have been introduced in double quick time due to scientific ingenuity. It is the duty of politicians to refrain from playing politics with science.

As Dolly Parton sang with a rewrite of her famous song ‘Jolene’ whilst having her jab:

“Vaccine, vaccine, vaccine, vaccine, I’m begging of you, please don’t hesitate. Vaccine, vaccine, vaccine, vaccine, because once you’re dead, then that’s a bit too late.”

 

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Who wants to live forever?

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The haunting lyrics of The Queen song and the almost plaintive tone in Freddie Mercury’s oh so unique voice, when he sang this song (particularly in his live performance at Wembley), echo through my mind these days. There are two main reasons why longevity is foremost these days.

The first, of course, being the pandemic that is among us. It may be the first time that the civilian population of the entire world is facing the possibility of sudden death, not from incoming fire or even suicide bombers but from an insidious, unseen, minute germ!

The second reason why the length of our lives and prolonging it for as long as we possibly can have been entering my thoughts, is when I see the scramble to get the anti-virus vaccine that I observe in the Pearl. Now, most of us are Buddhists and somewhere in those teachings is a belief that we come into this world with a certain amount of AYUSHA or length of life, and that when that is over the end happens and there is no choice. At least, that is the basic interpretation of undoubtedly very complex teaching.

If that is the case, why this scramble for the vaccine? Why are we using privileged positions (connections to rulers and politicians), connections to doctors, and even the Mayors of certain cities to short-circuit the waiting lists? Older people are complaining that they are being denied the vaccine, why? Those people have probably achieved all their objectives in life, completed successful lives, seen grandchildren or even great-grandchildren, why do they want to deny some young man or woman starting out on life with all those milestones to reach, the vaccine, particularly if they are devoted to the teachings of the Buddha.

Is it selfishness, greed, and avarice, things we should avoid according to these self-same teachings, or is it simply one-up-man-ship and the need to be able to boast that they got the vaccine when the “ordinary” man is still standing in queues and probably infecting each other due to the total chaos and non-observance of Covid protocols in these places of administering the vaccine? Think about it dear readers, especially those of you who have completed productive and useful lives, brought up “successful” children, and as is the way in our society provided them with houses, lands, dowries, and other ways of sustenance. Do we really need to join this scramble for the vaccine? Or, use our position of privilege to probably deny some younger person, with a life to live, the chance of getting it. Is it even our ego (something else we should control and make less significant in our lives and decisions) that allows us to justify our long existence in this world? They need my superior intellect, does this world and this society, therefore I must live as long as possible! Or, is it simply the basic animal instinct to live as long as possible, something that we as humans with our superior brains should be able to think around?

Here in Aotearoa, we have re-entered a level 3 lockdown in our most heavily populated city and a level 2 lockdown for the rest of our country. This has been due to certain non-observance of Covid protocols by people of a clearly identified community, living in a certain part of the city of sails, as Auckland is also known. This is the second time that the community, living in that part of the city has brought about an escalation of the pandemic and stricter lockdowns. It has brought more economic misery and spelled the end of the road to more businesses and enterprises. Now, in the Pearl, we may have resorted to attacking those communities and even rioting. All that seems to have happened here are of course the usual vitriolic racist attacks on the internet and a government decision to vaccinate those areas of the city first, in an attempt to control the pandemic. Wow! in the pearl either all these people would have been rounded up and locked up in a camp in the Vanni or locked down under strict curfew with the threat of being shot if violated. The jury with regard to if the Pearl alternative or the Aotearoa alternative of these should have been used is still out …

Maybe some readers are interested in the outcome of the threat that is looming over us from the upcoming United Nations action in Geneva? I have been trying to get some feedback from “intellectuals” currently living in the Pearl, but they seem distracted, and a feeling of helplessness seems to prevail. The incumbent Foreign Minister seems to think that a humble Indian Ocean Island with what strictly speaking, can be considered a failed or at least failing economy, can dictate terms to the UN, behaving like the proverbial bull in a china shop. Maybe our “new best friend” China, probably aided and abetted by Russia has lent strength to his arm.

Even a “victory’ for Lanka at the UNHCR to this resolution should not be cheered too vociferously, as the countries ranged against us will have long term plans. Every step of this government will be monitored closely. The loss of our garment exporting privileges to the first world could result along with other economic sanctions that would make the cost of living in the Pearl even higher.

One rather interesting possibility seems to be travel bans on certain individuals and freezing of their assets held abroad. Now that could be stimulating, especially if the numbers involved are made public! However, if that was the case, I believe the attempt to rectify the situation would have been given to a more competent person than “the bull in the china shop”!

I cannot resist putting this out dear readers and I apologise profusely in advance. What if someone like Ranil W, was in charge of foreign affairs? Do you think we would have had a more professional approach and had a better chance in dealing with the complicated nuances of handling UN diplomacy, in the long term? At least we may have not insulted and possibly humiliated the visiting PM of one of our allies, Imran Khan of Pakistan! On the other hand, Mr. Khan, you may rest assured that even if you had addressed our parliament, no member would have understood anything you said or even been able to decipher your immaculate Oxbridge accent. It is only those of us who have shut ourselves out mentally from the shenanigans or gone into voluntary exile who watch with dismay, who would have savoured your words and briefly wondered …what if … ?

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Thanks for quick vaccination; harmful dabblers in the occult should be severely dealt with

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There has been much in the daily press on vaccination against Covid-19 in this fair isle of ours, or rather in Colombo and its suburbs

Let’s put aside complaints and say praise be!

Most of what was media-written was on the ensuing chaos of not knowing where to go for the jab; how to get a token; which age group will be given it (apart of course from VIPs and politicians who were close behind frontline health workers). Mercifully, the authorities righted the initial wrong of deciding on prioritizing the 30-65 age group and neglecting the over 65s, who were placed second in the priority list in more enlightened countries following WHO strictures. And so lots have got the jab and we anticipate a drastic drop in infection and Covid death rates. Cass contributed her fair share of criticism in this column but not stridently nor unreasonably. She had not seen the privileged list that passed off as Municipal workers on Tuesday 24 February at the Public Library, Colombo 7, arriving in Mercedes Benzes and SUVs. If she had, her ire would have emerged in pure vitriol! One friend said she enquired from several sophisticates in the queue how they got there, but received mumbled replies. So, a Rose by any other name, even Do-Gooder, smells as bad when it goes unjust! Things got much better and the service worked smoothly once the MOHs came into their own.

What Cass notes in summarizing the issue today is thanks and gratitude to the government and the Health Services particularly, for vaccinating so very many so quickly. People who wrote about this issue, Cass included, were all praise for the actual data takers and vaccine givers. In certain centres, the old and disabled were queued in a different line and vaccinated within an hour.

The gratitude Cass renders is because only part of the total amount of vaccine was gifted by India and the WHO. Our government booked early and paid for the rest, and of the Oxford kind. This vaccine is admittedly relatively cheaper, but it had to be paid for, which cost the government bore. We have to appreciate the massive organization entailed and excuse inevitable hiccups. This fact struck Cass as a feeling of much needed security and elimination of fear was felt, and all for free. Also when a friend in Melbourne wrote they were as yet awaiting vaccination.

 

Black Magic and witchcraft in Sri Lanka

If you thought as Cass did that we would never ever resemble a dark Congo tribe resorting to occult cures or a re-enactment of shades of supernatural superstitious beliefs in witchcraft as in Salem, Massachusetts, USA, in 1692 (where some young girls caught prancing naked cooked up lies about good women in the village being witches), you and Cass were both mistaken. We’ve had these in different styles right here in supposedly majority Buddhist Free Sri Lanka with other religions holding people together, in the 21st century with some of our own doing brilliantly well in advanced scientific disciplines all over the developed world. Cass, as you now know, was born and bred in the hills of Kandy with its most sacred Dalada Maligawa and picturesquely situated quaint temples in peaceful green valleys with the sound of evening pooja bells, joined by Kovil tinkles and Sunday sonorous Church gantara and the cry of the Muzeen. We never had a bali or thovil ceremony. If an inauspicious time descended on the village or a household, it was pirith chanted by Bhikkhus. So to Cass what has been happening very recently is even stranger than to those who have village cousins who dabble in mantra and kodivina with kattadiyas in action.

I refer here to the stupidly preposterous belief in Dhammika’s peniya as both a prophylactic and cure for pernicious Covid-19. Where is that charlatan veda – oops sorry- Kaliamma devala kapurala now? Safe with his ill-gotten gains, we suppose.

The latest voodoo story, but with such a tragic ending, is that of the 9-year-old Delgoda girl who suffered an emotional (rather than mental) aberration and was subject to exorcism by caning her mercilessly. The exorcist could not be a woman; she must certainly be a sadistic aberration herself. Can you believe that she applied oil on the girl and used the cane on her till the kid went unconscious? Was the cane an ordinary one? At first I could not believe the story read in the papers – how cane a person to death, but it was a child receiving the torture and who knows what sort of ‘weapon’ was used. The mother definitely must be punished more severely. Maternal love, even in the animal kingdom, will never allow harming an offspring, so how on earth did the mother watch all that caning. One shot would have torn Cass to the defence of her child, or for that matter any child, with talons extended and blood now not turned to milk as the Sinhala saying goes, but to vitriolic fury. The woman exorcist with supernatural powers and the mother are in police custody. Why doesn’t she do a Houdini and astound handsome Police high-up Ajit Rohana?

People claiming superhuman clairvoyance and divine power crop up everywhere. Cass accompanied a friend to consult a girl in the suburbs of Kandy to find out where her hub had ‘donated’ a fairly large sum of money. This girl had given clear directions to find a lost Persian cat to a third friend; hence the visit. She was a pretty, soft girl of around 18. Once Cass and the other entered the room, the girl changed, was in a near trance and speaking in an entirely different voice, pronounced the reason for seeking her help and said “Look for a man always dressed in long sleeves and thinning hair parted in the middle.” The friend was baffled and defeated by this long shot, but finally she met a man of this description – the father of a girl in her husband’s office. She did not ask for the money!

Such ‘powers’ are temporary; maybe like poltergeist manifestations in a teenager’s home. But going for cures to them is unthinkable. Buddhist bhikkhus and maybe bhikkhuunis, so also certain Christian priests (the bulk of lecherous Father Mathew intrudes here) do have powers of exorcism. A medical doctor is the best bet, in any case, including even mental upsets.

 

Short Takes

Imran Khan’s all too brief visit was a successful veni, vidi, vici in spite of being snubbed ungraciously over the address to Parliamentarians (what a weak, threadbare excuse was offered – C-19 precaution!) and missing out two of our cricket greats: Michael Tissera and Anura Tennakoon from the list of cricket folk to say Hi to the great Cricketer at lunch at Shangri La. What was the success apart from charming everyone and showing off what a Statesman can look like and carry himself off? Why – the Muslims of Sri Lanka conquered. Burial was theirs or so it seemed. But hold it, is it gazetted or is this ‘yes’ like the Prime Minister’s definite ‘can bury’ pronounced in Parliament and then brushed aside and explained by the Gaman as “he was merely expressing his thoughts.”

Main headline in The Island of Wednesday 3 March:” PCol report on Easter Sunday carnage: AG won’t be given ‘sensitive’ volumes.” Why on earth? Is it X-rated and the AG underage?

Picture on page I of same issue of Dr Rajitha Senaratne arriving at the Colombo High Court to appear in a case involving two persons who accused then Defence Secretary Gotabaya Rajapaksa of various crimes. We have long forgotten even a single word of what they said. They will not get off free is Cass’ bet unlike Aluthgamage, who emerged very recently from a court house free as a bird, accused of corruption, Cass recalls.

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