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Much-needed Family Health Care Centre for Jaffna

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A public health worker in the North

BY Consultant Family Physician, Dr. S. Kumaran, and Viduni Basnayake

This article describes the experiences of a novel, evidence-based approach that involves patients, and their family members, in delivering health care, providing medical education, and conducting research, at a primary care institution, called a Family Health Care Centre.

The Northern Province, in Sri Lanka, is a war-ravaged region that lags behind the rest of the country, in economic development.

After the COVID-19 pandemic had already squeezed the health services of its limited resources, the current financial crisis has pushed the sector to the brink of collapse. This crisis puts patients at further risk due to power outages, a lack of medicine, and equipment shortages. Another major issue, caused by the economic collapse, is the shortage of human resources. In addition, frequent protests, brought on by political unrest, disrupt the provision of health services.

Primary care is the provision of integrated, accessible healthcare services, by physicians and their support teams, to patients, while developing a sustained relationship with patients, within the family and community. The care is person-centered, team-based, communit-aligned, and designed to achieve better health, and better care, at lower costs. Family Medicine is the focal point of primary care and, unlike other specialties that focus on a specific organ or disease, Family Medicine is a field in which physicians treat most ailments and provide comprehensive healthcare to people of all ages – from newborns to seniors.

In Sri Lanka, the delivery of primary care is no easy task. Inadequate human resources, limited infrastructure (buildings, furniture, labs and equipment), lack of a multidisciplinary approach in team work, inadequate government policies and fund allocation, and the lack of awareness of primary care services, among the general population, are the main obstacles. The delivery of health services is made more challenging by patients who have multiple health issues, complicated psychosocial problems, transportation issues from their homes to healthcare facilities, and a lack of awareness of their medical conditions. The preventive sector is often overlooked in times of crisis, which makes the situation worse.

Research studies play a major role in primary care as the findings can be used for the betterment of public health-related issues. But, such studies have become challenging due to inadequate public participation that affects the data collection, and insufficient funding to carry out research. When the healthcare system is in crisis, clinical medicine will receive more attention than research. Further, most doctors also shift their attention away from research.

Despite the challenges outlined above, Sri Lanka’s one of effective Family Health Care Centre was established in the newly built maternity block of the District Hospital, Kondavil, with the full support of the hospital’s District Medical Officer (DMO) and the Regional Director of Health Services (RDHS), Jaffna. The authors created the basic structural drawings and the final plan was agreed, after several discussions with the authorities of both Provincial Ministries of Health and academics of the Faculty of Medicine, University of Jaffna, in 2012. The centre is an extended arm of the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna.

The centre welcomed young, unemployed family members, who had ceased their formal education after the secondary level. Job titles were created, based on their identified areas of interest. The job training provided, helped in capacity building, as well as social recognition. These trained community members play a variety of roles in the delivery of FHC services as noted below.

Community health assistant in home-based geriatric care:

Home-based geriatric care is one of the services provided by the Family Health Centre, Kondavil, for patients who are unable to visit the hospital for various reasons, such as elderly or bedridden conditions. Young women, introduced by patient forums, were trained to register the chosen elders for home care, locate the homes, schedule monthly visits, indicate drug delivery dates, and maintain the home-visit bag and equipment in a calibrated manner.

Health assistant for community-based geriatric care:

The community-based geriatric care is conducted by a group of trained members. During the programme, screening for NCD/Non communicable diseases and many activities, related to improve the mental health, are carried out.

Health assistants for non-communicable disease clinics:

As a part of the community members’ involvement in routine clinical activities, young women were trained to be health assistants for non-communicable disease clinics.

Peer educators:

These personnel received training to conduct patient education both during FHC clinical operations and during community outreach activities. They teach patients diabetic foot care, basic level breathing exercises, basic level physiotherapy for stroke patients and required home modifications, proper way of using spacer, etc.

Play therapy assistants:

Children, who fall under the Autistic spectrum, display a variety of social, behavioral and developmental challenges throughout their childhood. The therapy assistants were trained for a period of six months, by experts, to deal with such children. These young women were trained to engage in child-centered play activities that help them develop gross motor, fine motor, creative, life and pre-learning skills. It began with six young women, in 2018, and there are 10 women in the group now.

Healthy diet promotion programme:

A few empowered mothers are involved in increasing the availability, accessibility and affordability of nutritious food, in Kondavil village. They prepare food, in a hygienic manner, and pack it in biodegradable paper bags, or tissues. They also provide food delivery services.

Helpline and telemedicine services:

The helpline service was created to serve populations that are not covered by the FHC, Kondavil. The helpline deals with clinical and non-clinical questions for a population of 10,000 in the Northern Province, in collaboration with NICST, an NGO that provides financial and technical support. It helps to conduct follow-ups on a regular basis. People who want to see the consultant or a doctor can schedule an appointment on Wednesdays, between 10am to 12pm and join through telemedicine for the medical inquiries.

Satellite centre clinics:

Consultants from the Teaching Hospital, Jaffna, who wish to conduct village-level medical campaigns, have teamed up with the FHC to organize annual satellite centere clinics, in rural villages, in the Northern Province, along with the Faculty of Medicine, University of Jaffna. The satellite centre clinics are going to function in Divisional Hospitals in Tharmapuram (Killinocchi District) and Palai (Jaffna District).

The patients’ relative are trained in such a way to act as simulated patients. This trained simulated patients are mainly to help to teach medical student on communication, counselling and consultation skill. Sharing experience with medical students, the trained therapy assistants share their experience of caring for autistic children and their parents with medical students.The helpline operators share their experience with the medical students. Involving in enhancing medical student and staff wellbeing. Few trained patients’ relatives conduct regular programmes with medical students and staff to improve their wellbeing. The programme include laughter yoga, forum theater drama and many relaxation techniques. Further, patients and their relative’s involvement in writing books and supporting research could also can seen.



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US’ drastic aid cut to UN poses moral challenge to world

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An UN humanitarian mission in the Gaza. [File: Ashraf Amra/Anadolu Agency]

‘Adapt, shrink or die’ – thus runs the warning issued by the Trump administration to UN humanitarian agencies with brute insensitivity in the wake of its recent decision to drastically reduce to $2bn its humanitarian aid to the UN system. This is a substantial climb down from the $17bn the US usually provided to the UN for its humanitarian operations.

Considering that the US has hitherto been the UN’s biggest aid provider, it need hardly be said that the US decision would pose a daunting challenge to the UN’s humanitarian operations around the world. This would indeed mean that, among other things, people living in poverty and stifling material hardships, in particularly the Southern hemisphere, could dramatically increase. Coming on top of the US decision to bring to an end USAID operations, the poor of the world could be said to have been left to their devices as a consequence of these morally insensitive policy rethinks of the Trump administration.

Earlier, the UN had warned that it would be compelled to reduce its aid programs in the face of ‘the deepest funding cuts ever.’ In fact the UN is on record as requesting the world for $23bn for its 2026 aid operations.

If this UN appeal happens to go unheeded, the possibilities are that the UN would not be in a position to uphold the status it has hitherto held as the world’s foremost humanitarian aid provider. It would not be incorrect to state that a substantial part of the rationale for the UN’s existence could come in for questioning if its humanitarian identity is thus eroded.

Inherent in these developments is a challenge for those sections of the international community that wish to stand up and be counted as humanists and the ‘Conscience of the World.’ A responsibility is cast on them to not only keep the UN system going but to also ensure its increased efficiency as a humanitarian aid provider to particularly the poorest of the poor.

It is unfortunate that the US is increasingly opting for a position of international isolation. Such a policy position was adopted by it in the decades leading to World War Two and the consequences for the world as a result for this policy posture were most disquieting. For instance, it opened the door to the flourishing of dictatorial regimes in the West, such as that led by Adolph Hitler in Germany, which nearly paved the way for the subjugation of a good part of Europe by the Nazis.

If the US had not intervened militarily in the war on the side of the Allies, the West would have faced the distressing prospect of coming under the sway of the Nazis and as a result earned indefinite political and military repression. By entering World War Two the US helped to ward off these bleak outcomes and indeed helped the major democracies of Western Europe to hold their own and thrive against fascism and dictatorial rule.

Republican administrations in the US in particular have not proved the greatest defenders of democratic rule the world over, but by helping to keep the international power balance in favour of democracy and fundamental human rights they could keep under a tight leash fascism and linked anti-democratic forces even in contemporary times. Russia’s invasion and continued occupation of parts of Ukraine reminds us starkly that the democracy versus fascism battle is far from over.

Right now, the US needs to remain on the side of the rest of the West very firmly, lest fascism enjoys another unfettered lease of life through the absence of countervailing and substantial military and political power.

However, by reducing its financial support for the UN and backing away from sustaining its humanitarian programs the world over the US could be laying the ground work for an aggravation of poverty in the South in particular and its accompaniments, such as, political repression, runaway social discontent and anarchy.

What should not go unnoticed by the US is the fact that peace and social stability in the South and the flourishing of the same conditions in the global North are symbiotically linked, although not so apparent at first blush. For instance, if illegal migration from the South to the US is a major problem for the US today, it is because poor countries are not receiving development assistance from the UN system to the required degree. Such deprivation on the part of the South leads to aggravating social discontent in the latter and consequences such as illegal migratory movements from South to North.

Accordingly, it will be in the North’s best interests to ensure that the South is not deprived of sustained development assistance since the latter is an essential condition for social contentment and stable governance, which factors in turn would guard against the emergence of phenomena such as illegal migration.

Meanwhile, democratic sections of the rest of the world in particular need to consider it a matter of conscience to ensure the sustenance and flourishing of the UN system. To be sure, the UN system is considerably flawed but at present it could be called the most equitable and fair among international development organizations and the most far-flung one. Without it world poverty would have proved unmanageable along with the ills that come along with it.

Dehumanizing poverty is an indictment on humanity. It stands to reason that the world community should rally round the UN and ensure its survival lest the abomination which is poverty flourishes. In this undertaking the world needs to stand united. Ambiguities on this score could be self-defeating for the world community.

For example, all groupings of countries that could demonstrate economic muscle need to figure prominently in this initiative. One such grouping is BRICS. Inasmuch as the US and the West should shrug aside Realpolitik considerations in this enterprise, the same goes for organizations such as BRICS.

The arrival at the above international consensus would be greatly facilitated by stepped up dialogue among states on the continued importance of the UN system. Fresh efforts to speed-up UN reform would prove major catalysts in bringing about these positive changes as well. Also requiring to be shunned is the blind pursuit of narrow national interests.

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Egg white scene …

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Hi! Great to be back after my Christmas break.

Thought of starting this week with egg white.

Yes, eggs are brimming with nutrients beneficial for your overall health and wellness, but did you know that eggs, especially the whites, are excellent for your complexion?

OK, if you have no idea about how to use egg whites for your face, read on.

Egg White, Lemon, Honey:

Separate the yolk from the egg white and add about a teaspoon of freshly squeezed lemon juice and about one and a half teaspoons of organic honey. Whisk all the ingredients together until they are mixed well.

Apply this mixture to your face and allow it to rest for about 15 minutes before cleansing your face with a gentle face wash.

Don’t forget to apply your favourite moisturiser, after using this face mask, to help seal in all the goodness.

Egg White, Avocado:

In a clean mixing bowl, start by mashing the avocado, until it turns into a soft, lump-free paste, and then add the whites of one egg, a teaspoon of yoghurt and mix everything together until it looks like a creamy paste.

Apply this mixture all over your face and neck area, and leave it on for about 20 to 30 minutes before washing it off with cold water and a gentle face wash.

Egg White, Cucumber, Yoghurt:

In a bowl, add one egg white, one teaspoon each of yoghurt, fresh cucumber juice and organic honey. Mix all the ingredients together until it forms a thick paste.

Apply this paste all over your face and neck area and leave it on for at least 20 minutes and then gently rinse off this face mask with lukewarm water and immediately follow it up with a gentle and nourishing moisturiser.

Egg White, Aloe Vera, Castor Oil:

To the egg white, add about a teaspoon each of aloe vera gel and castor oil and then mix all the ingredients together and apply it all over your face and neck area in a thin, even layer.

Leave it on for about 20 minutes and wash it off with a gentle face wash and some cold water. Follow it up with your favourite moisturiser.

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Confusion cropping up with Ne-Yo in the spotlight

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Ne-Yo: His management should clarify the last-minute cancellation

Superlatives galore were used, especially on social media, to highlight R&B singer Ne-Yo’s trip to Sri Lanka: Global superstar Ne-Yo to perform live in Colombo this December; Ne-Yo concert puts Sri Lanka back on the global entertainment map; A global music sensation is coming to Sri Lanka … and there were lots more!

At an official press conference, held at a five-star venue, in Colombo, it was indicated that the gathering marked a defining moment for Sri Lanka’s entertainment industry as international R&B powerhouse and three-time Grammy Award winner Ne-Yo prepares to take the stage in Colombo this December.

What’s more, the occasion was graced by the presence of Sunil Kumara Gamage, Minister of Sports & Youth Affairs of Sri Lanka, and Professor Ruwan Ranasinghe, Deputy Minister of Tourism, alongside distinguished dignitaries, sponsors, and members of the media.

Shah Rukh Khan: Disappointed his fans in Sri Lanka

According to reports, the concert had received the official endorsement of the Sri Lanka Tourism Promotion Bureau, recognising it as a flagship initiative in developing the country’s concert economy by attracting fans, and media, from all over South Asia.

Nick Carter: His concert, too, was cancelled due to “Unforeseen circumstances

However, I had that strange feeling that this concert would not become a reality, keeping in mind what happened to Nick Carter’s Colombo concert – cancelled at the very last moment.

Carter issued a video message announcing he had to return to the USA due to “unforeseen circumstances” and a “family emergency”.

Though “unforeseen circumstances” was the official reason provided by Carter and the local organisers, there was speculation that low ticket sales may also have been a factor in the cancellation.

Well, “Unforeseen Circumstances” has cropped up again!

In a brief statement, via social media, the organisers of the Ne-Yo concert said the decision was taken due to “unforeseen circumstances and factors beyond their control.”

Ne-Yo, too, subsequently made an announcement, citing “Unforeseen circumstances.”

The public has a right to know what these “unforeseen circumstances” are, and who is to be blamed – the organisers or Ne-Yo!

Ne-Yo’s management certainly need to come out with the truth.

However, those who are aware of some of the happenings in the setup here put it down to poor ticket sales, mentioning that the tickets for the concert, and a meet-and-greet event, were exorbitantly high, considering that Ne-Yo is not a current mega star.

We also had a cancellation coming our way from Shah Rukh Khan, who was scheduled to visit Sri Lanka for the City of Dreams resort launch, and then this was received: “Unfortunately due to unforeseen personal reasons beyond his control, Mr. Khan is no longer able to attend.”

Referring to this kind of mess up, a leading showbiz personality said that it will only make people reluctant to buy their tickets, online.

“Tickets will go mostly at the gate and it will be very bad for the industry,” he added.

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