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President's Column
Contents
Publishing and printing assistance by
This Source (Pvt.) Ltd etc.,236/14-2,Vijaya Kumaranathunga Mawatha,Kirulapone, Colombo 05,Sri LankaTele: [email protected]
It is with a profound sense of satisfaction and perhaps even a notion of relief that I write this message for the July Newsletter. The main activity in July was the 126th Anni-versary Scientific Medical Congress.
The general proceedings started with the Pre-Congress Workshop on the 4th of July 2013 at the National Institute of Health Sciences, Kalutara. The “SLMA Health Run & Walk” on the 7th of July 2013 succeeded as a prelude to the 126th Anniversary Scientific Medical Congress. It was attended by the Hon. Minister of Health, Secretary to the Ministry of Health, Director General of Health Services and approximately 2000 participants including doctors, al-lied healthcare workers, general public and children.
The 126th Anniversary Scientific Medical Congress was held at Waters Edge, Battaramulla. There were nine Pre-Congress Workshops attended by a total of around 1069 participants. The Inauguration Ceremony of the main congress was held on 10th July 2013 with Professor Sir Sabaratnam Arulkumaran, President, British Medical As-sociation as the Chief Guest and Dr. Firdosi Rustom Meh-ta, Resident Representative of the World Health Organ-isation as the Guest of Honour. This event was attended by 475 participants.
During the entire congress there were three Breakfast Sessions attended by a total of 194 participants. Around 295 participants registered for the Main Congress. The proceedings included a Keynote Address, two Principal Symposia, three Luncheon Events including a Debate, 14 Parallel Symposia, 6 Parallel Guest Lectures, 8 Free Pa-per Sessions. The proceedings concluded with the Ban-quet on the 13th July 2013 attended by 168 participants.
I am ever so grateful to all those who helped and par-ticularly to the Steering Committee for facilitating all the arrangements. It is hoped that we managed to serve up a reasonable collection of academic fare for each and ev-ery one of the participants. However, it is acknowledged that those who took part in the proceedings would be the judges and the jury. The ultimate privilege of making the final assessment would rest entirely in their hands.
With the very best of wishes.
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July 2013 Volume 06 Issue 07
SLMANEWSTHE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION
Citation Read out for Professor
Sir Sabaratnam Arulkumaran 02
SLMA sessions 2013 – awards
for free papers 03 Professor Sir Sabaratnam Arulkumaran’s
speech 04
SLMA Health Run and Walk 2013 14
Inauguration of the 126th Anniversary
Scientific Medical Congress 16
Winners of the prizes and awards 17
Snowden’s Leak 24
Dr B J C PereraPresident,Sri Lanka Medical Association,No.06, Wijerama Mawatha,Colombo 07, Sri Lanka
Official Newsletter of The Sri Lanka Medical Association.Tele : 0094 - 112 -693324 E mail - [email protected]
July, 2013 SLMANEWS
2
Our Guest of Honour, Dr. Fir-dosi Rustom Mehta, Chair-person and Members of the
Board of Trustees of the Sri Lanka Medical Association, Past Presidents, Members of the Council and Mem-bers of the Sri Lanka Medical Asso-ciation, Distinguished invitees,
It gives me great pleasure to pres-ent to you, albeit rather concisely, an amazing academic and a percep-tive clinician in the form of Profes-sor Sir Sabaratnam Arulkumaran MBBS (Cey) Hons., DCH (Cey), LRCP-MRCS (UK), FRCOG, FRCS Edin., FAMS (Sing), MD, PhD, Hon. FSOGC, FACOG, FSCOG, FCPS, FSACOG, FSLCOG, FICOG and FDGG.
He is currently the President of the British Medical Association and is un-doubtedly one of the most celebrated Sri Lankans. He is known the world over as a remarkable scholar, who has made a lasting impact on medi-cine in general and women’s health in particular.
It would be a daunting proposi-tion to even outline his marvellous achievements and his contribution to the health of women in the world. However, I am duty-bound to attempt the impossible. Just to illustrate the virtual impossibility of this onerous task, it is noteworthy that his name without the prefixed titles of honour has just 21 letters, with those titles, it goes up to 33, but just the academic degrees after his name run up to another extra 94 letters.
Young Arulkumaran had his early education at St. Michael's College, Batticaloa, then at Jaffna Central College till 1965 and finally at Maha-jana College, Tellipallai. From there, he entered the Faculty of Medicine, University of Colombo in 1967.
He was an all round student in the faculty but not someone who shone like a model prodigy of a great career in the years to come. In those days,
he was more interested in sports. He represented the University in soccer, basketball, hockey and athletics, won University Colours in Hockey and Basketball, Captained the University Basketball team and the Faculty Soc-cer Team. He qualified with MBBS 2nd Class Honours 1972.
From then onwards, it was a spec-tacular rise, in a career adorned with rare achievements. It started with the FRCS (England) LRCP & MRCS in 1979 and the MRCOG in 1980. Then a sojourn in Singapore, and ending up in the United Kingdom. He is the first Sri Lankan born Professional, to be elected as President of the Royal College of Obstericians & Gynaeco-logists in the UK and the President of FIGO, the highest world bodies in Obstetrics and Gynaecology.
He has over 250 publications in in-ternationally indexed journals, 74 in-vited articles and over 150 Congress Abstracts. He has edited or authored over 30 books and delivered over 500 lectures right round the globe. He is a Reviewer or a Referee, an Edito-rial Member or the Editor of over 15 Scientific Medical Journals.
In 2009, he was conferred the title, Knight Bachelor of the Most Excellent Order of the British Empire from Her Majesty, Queen Elizabeth the 2nd, for Services to Medicine. The London gazette on that day described him as “The most forward thinking Medical Leader in the United Kingdom”. We are all so proud of you Sir Sabarat-nam as the last conferment of the title Knight Bachelor of the British Empire for a Sri Lankan doctor was, on Sir Nicholas Attygalle, way back in 1953.
Originally hailing from a little village known as Kantharmadam, in Jaffna, Professor Sir Sabaratnam Arulkuma-ran has risen to one of the highest positions in the world, in his chosen field of Obstetrics & Gynaecology. Throughout a life, lived to the fullest, he has made several areas of the world his own patch, to produce and
leave behind, a legacy of outstand-ing contributions to the health of the Homo sapiens.
It has been said that the crest jewel in the crown of a man’s success in life, is his family.
Prof Arulkumaran is married to Gayathri, the daughter of one of the most eminent Obstetricians of Sri Lanka, the late Dr.A.G. Mututhamby and Mrs. Muthuthamby. Arul and his charming wife are blessed with a daughter who is an Obstetrician & Gynaecologist, and two sons, a Phy-sician and an IT specialist, all working in the UK.
During his medical student days, he stayed in the Bloemfontein Men’s Hostel. That is where I first met him. He was a friend to everybody around and was a delightful person in all his dealings. Then he and I were in ad-joining residential rooms at The Lady Ridgeway Hospital for Children.
He has been a much respected and admired friend of mine, for just over four decades. His gentle nature and kindness are indeed very well known. William Wordsworth, the great English romantic poet once said “The best portion of a good man's life: his little, nameless, unremembered, acts of kindness and love”. Arul is living testimony to those immortal words.
Citation read out for Professor Sir Sabaratnam Arulkumaran
Professor Sir Sabaratnam Arulkumaran
Contd. on page 03
SLMANEWS July, 2013
3
Though there are many qualities in his life which we admire, the most outstanding one of them all is his simplicity. That trait is quite evident by the fact, that he still wants all of us to call him, not Professor Sir Sabarat-nam Arulkumaran but just simply as “Arul”.
Professor Sir Sabaratnam Arul-kumaran.., by virtue of the powers
vested in me as The President of the Sri Lanka Medical Association, and based on a resolution ratified by the Council and the General Membership of the Sri Lanka Medical Association, I am now delighted to present to you this Scroll of Honour conferring on you Honorary Life Membership of the Sri Lanka Medical Association, the highest honour that this great
institution is authorized to bestow by its statute, and the equivalent of a lifetime achievement award.
Ladies and Gentlemen, I present to you, Professor Sir Sabaratnam Arulkumaran, Honorary Life Member of The Sri Lanka Medical Association and most cordially invite him to ad-dress the audience.
Citation Read...Contd. from page 2
A large number of abstracts on diverse topics were received for free paper presentations
at the 2013 sessions, signifying the enhanced interest in research among the medical and health professions community. Upon scientific review 42 abstracts were selected for oral presentations and 82 abstracts were selected for poster presentations. All papers excluding 6 posters were presented at the sessions. The eminent panel of judges commented that most papers were of high quality. The follow-ing winners of the free paper awards were announced at the SLMA Banquet.
E M Wijerama prize
Randomised clinical trial comparing prednisolone and ACTH in reversal of hypsarrhythmia in untreated epileptic spasms
J Wanigasinghe, C Arambepola, GM At-tanapola, LSD Liyanage, CB Liyanage, PSK Silva, PKSJ Kankanamge, S Sumanasena, S S Ranganathan, B Dissanayake, M E C Muhandiram
S E Seneviratna Prize
Defining obesity in children using a biological end point
VP Wickramasinghe, C Arambepola, P Ban-dara, M Abeysekera, S Kuruppu, P Dilshan, BS Dissanayake
H K T Fernando Prize
Intramuscular haloperidol vs. olan-zapine for rapid tranquillization: a double blind randomised controlled trial
WMH Wijesundara, R Hanwella, J Mendis, VA de Silva
Sir Nicholas Attygalle Prize
Geographical Information Systems (GIS) for monitoring of Millennium De-velopment Goal 5 (MDG): a Study from Badulla district
PVDS Dharmagunawardene, HMJR Her-ath, NSR Hewageegana
Wilson Peiris Prize
A new people-friendly epidemiologi-cal approach to confirm the elimination of lymphatic filariasis in Sri Lanka
TC Yahathugoda1, MVWeerasooriya, F Nagaoka, H Takagi, E Kimura, WA Samara-wickrema, M Itoh1
SLMA Price for Best Poster
Knowledge, attitudes and practices regarding type 2 diabetes mellitus, nu-trition and lifestyle in urban Sri Lankan women
I Waidyatilaka, PHIU Waidyatilaka, A de Silva, S Atukorala, N Somasundaram, P Lanerolle, R Wickremasinghe
Sir Frank Gunasekera Prize for the best paper in Commu-nity Medicine & Tuberculo-sis
Community incidence of snakebite in the Anuradhapura district
A Kasturiratne, NK Gunawardena, BA Wijayawickrama, SF Jayamanne, A Pathmeswaran, G Isbister, A Dawson, HJ
de Silva
Kumaradasa Rajasuriya Prize for the best paper in Tropical Medicine
Meeting challenges of microscopic diagnosis in malaria surveillance under field conditions in Sri Lanka
SD Fernando, RL Ihalamulla, J Tilleker-atne, R Wickremasinghe, P Wijeyaratne, NL de Silva, R Premarathna
Special prize in Cardiol-ogy
Audit on timelines for administration of acute reperfusion therapy in acute ST elevation myocardial infraction at the National Hospital of Sri Lanka
AK Pathirana, WS Santharaj, RAI Ekanay-ake, JB Jayawardena, V Senaratne, MP Seneviratne, KKAO Walawwatta, KGV Saranga
S Ramachandran Prize for the best paper in Nephrology
Differences in estimation of glomeru-lar filtration rate using three standard formulae in selected type 2 Diabetic patients
NN Wijayatunga, PPR Perera, K Wanigas-uriya, H Peiris
Daphne Attygalle Prize for the best paper in Cancer – Not awarded
The SLMA wishes to thank all partici-pants, reviewers of the abstracts, and judges of the free papers.
SLMA sessions 2013 – awards for free papers
July, 2013 SLMANEWS
4
SLMANEWS
It is a great pleasure and privilege to be the chief guest for the 126th annual scientific sessions of SLMA
in 2013 for several reasons. The first reason is that I am a Sri Lankan having regular ties with the Sri Lankan College of Obstetrics and Gynaecology for several years and it makes me happy that I will be able to do that with the SLMA too.
The second reason is the ties that the SLMA has with the British Medical Association (BMA) in which I am the in-cumbent President. The SLMA started as the Ceylon branch of the BMA on 17th December 1887 with 65 members and Dr PD Anthoniz as the first Presi-dent. The idea of forming this branch was mooted by Sir Kynsey in February 1887. It became the Ceylon Medical Association in 1951 and with the birth of the Republic of Sri Lanka it became the Sri Lanka Medical Association in 1972. Probably as the first Sri Lankan President of the BMA, I am happy to be here and bring greetings to you from the chief officers and members of the BMA.
The third reason is that Dr BJC Per-era, current President of SLMA and I shared adjacent rooms with a common bathroom at Lady Ridgeway Hospital for Children many years ago as junior doctors – we called ourselves the ‘bathroom mates’. He was senior and I was a house officer to Prof Priyani E Soysa. We had a strong friendship and I had great admiration for his profes-sional wisdom.
The fourth reason – The SLMA is the most influential medical profes-sional organisation in Sri Lanka, true to the word as indicated in your vision statement; it humbles me to be invited by you. Your members look after the health of the Nation admirably. With-out your help there will be no health, wealth or happiness in mother Lanka.
You should be proud of the SLMA as it is held in high esteem nationally and globally.
Internationally, there has been a spate of adverse publicity about health care at clinical, managerial and organisational level. We need to rectify the shortcomings and stand up to the challenges as indicated in the theme of your conference ‘Safety and Quality’. Your President in his induction speech expressed this. Every one of us will face the health care provided by our country at some stage in our lives. If we want the best for us, then we have to do our best individually and collec-tively and as an organisation we should strive to further enhance the safety and quality of health care we provide. Mahathma Gandhi said ‘If you want a change you should be the change’.
To provide the best care to patients, our knowledge, skills and attitudes has to be the best and that is what the SLMA is doing day after day - en-gineering better CPD programmes, guidelines and ethical codes of practice for you to provide the best care. These are actions of the SLMA as witnessed by me from your web site and as stated in your mission statement. My best wishes for you to continue this march for the best care for your patients. The introduction of the Sri Lankan clinical trials registry by the visionaries of your organisation will take you further; re-search today is practice tomorrow and I wish you well in this endeavour.
The image of the SLMA as a great organisation within Sri Lanka and glob-ally should continue. This can be done by highlighting what you do at work, outside work and by advocacy. To maintain this respect, the SLMA should have continuous interactions with four groups of people - its members, the public, the politicians and sister organ-isations globally. Membership issues are the core functions of the SLMA, but the public civic-based activities gives you a better professional image, attract your members and gain the support from the public.
I would like to explore four avenues
that I proposed for the BMA for you to consider to help maintain your good reputation. These proposals should also help the population you serve nationally and in some activities you can work in partnership with your sister organisations.
The first activity is a simple survey for building your image and to promote voluntary activity for the betterment of your society. Hundreds of SLMA members spend days, weeks and months on voluntary activity nationally and globally in clinical and non-clinical activities. They do this on their own goodwill as individuals or through vari-ous charities. With a simple electronic questionnaire it will be good to cap-ture the number of days per year they spend on such activities and informa-tion on the specific activities. I hope this would come to thousands of days per year. If it is the case you should publicise that information for the public and the politicians to recognise the good things done by the members of the SLMA. They should talk about the good things your members do at the sacrifice of their own time, energy and money rather than talking negatively about the members of the SLMA. If the information obtained suggests that you as members of SLMA are not volun-teering part of your time for public good you should explore avenues as to how the SLMA can catalyse such activities.
The second and third activities, I would like you to consider is national and international advocacy and action for climate change and non-commu-nicable diseases (NCDs). The BMA would be happy to work with you on these issues.
The BMJ under the leadership of Dr Fiona Godlee provides science and messages for advocacy and action.
The same is true of the SLMA Newsletter and Ceylon Medical Journal and advocacy messages could be enhanced.
Professor Sir Sabaratnam Arulkumaran’s speech as the Chief Guest at the 126th Anniversary Scientific Medical Congress of SLMA - 2013
Contd. on page 06
5
July, 2013 SLMANEWS
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These activities on climate change and NCDs should help us to improve national and international health. Climate change by the greenhouse effect is a killer of the human race. The vast changes in the climate lead to the tsunami and thousands of deaths, in Indonesia, Thailand and Sri Lanka. The recent smoke and smog affect-ing Indonesia, Singapore and Malay-sia by the deforestation in Sumatra by the slash and burn technique to clear lands for agriculture has cre-ated havoc - affecting the health of all and the lives of the elderly in addition to a major indent in the economy in these countries. SLMA should work with sister associations and colleges to advocate steps to reduce global warming.
By not acting collectively with our sister international organisations, our generation is said to be stealing the environment from our future genera-tions. The editorial of BMJ last week states that asthma inhalers are re-sponsible for 2 million of the 20 million tons of CO2 equivalent greenhouse gases that the NHS emits annually. That is the equivalent of the CO2 emit-ted by Estonia. Dry powder inhalers can be substituted in nearly all cases. All that is needed is a change in doctors’ prescribing habits. The NHS Sustainable Development Unit, British Thoracic Society and Lung Foundation are working on this issue by building an alliance. The SLMA could lead the campaign to bring about a change in prescription habits to tackle this issue. We need to engage with major phar-maceutical companies and our sister international organisations to tackle this problem.
Health organisations are major con-sumers of energy and use fossil fuels as the main energy source. All health organisations in the world should work towards the goal of using 100% renewable energy. Solar energy is found in plenty in Sri Lanka and SLMA should moot activities with the govern-ment to achieve this.
The third issue is about non-commu-nicable diseases, especially obesity and awareness of its adverse conse-quences as mentioned by Dr BJC Per-era in his Presidential Message in the SLMA website. Tackling the seven S’s reduces NCDs but do not eliminate it. The seven S’s are sugar, salt, saturat-ed fatty acids, sedentary life, spirits in excess, smoking and starvation of nu-tritious food. Obesity is a ticking time bomb for health as it leads to diabetes, infertility, cardiovascular, liver and oth-er diseases. There is a contribution of Nature and Nurture to obesity. Barker proposed fetal origins of adult diseas-es two decades ago. A baby born with a smaller birth weight or born preterm is more prone to syndrome X of dia-betes, liver, cardiac and other system disorder and faces premature death. This is thought to be due to less an-giogenesis and tissue mass in all the organs. The process is exacerbated if the small for dates or preterm babies are overfed and become obese. Cur-rent studies indicate the importance of epigenetics at the time of conception and afterwards due to nutritional fac-tors as a major contributor to obesity and stress the importance of the first 1000 days from the day of concep-tion. Good birth weight, avoidance of prematurity, breast feeding, appropri-ate childhood and adolescent nutrition through to pregnancy is important to break this cycle; hence the need for good nutritional advice for the ado-lescent, for the mother and children in school. I believe a simple proposal like a ‘square plate concept’ with each quarter of the plate providing equal proportion of carbohydrate, proteins, vegetables and fruits may do the trick to promote a healthy diet (provided the plate is of standard size and there is no second serving!). This can be prac-tised in our own lives and passed on to our patients. Healthy eating reduces NCDs but also helps with the climate change agenda. One day a week vegetarian food consumption helps with climate change as the land area
needed for cultivation of vegetables to feed a certain number of individuals is hundred times less than the land needed to grow animals for red meat. The same goes with the promotion of walking, cycling and public transport that reduces NCDs and helps with the climate change agenda.
The fourth activity I would like you to explore is the rights based approach to health care by education. Provision of care based on the principles of human rights would enhance the care given to our patients. The knowledge should be imparted at the formation stages of a doctor when they are in the medical school. The international Federation of Gynaecolgy and Obstetrics (FIGO) have created a syllabus and curricu-lum and several case examples on rights based approach to women’s health. I have proposed the Student BMA to take over the educational aspects of this curriculum to continu-ously disseminate the information in their own medical schools. We hope to engage 2 to 3 motivated medical stu-dents and a teacher who are members of the BMA, from each medical school in the UK and have a workshop using the FIGO curriculum. We hope to facil-itate this internationally by partnering with donor community. The workshop would train the medical students and the teacher as trainers who would then disseminate the information to the rest of the medical students in their school. A monitoring and evaluation mecha-nism would be developed to identify its effectiveness. Such education would enhance the safety and quality of care given with self-respect and dignity. Delivery of rights based approach to care can be seen in the FIGO web site and that of a free educational platform, the global library of women’s medicine i.e. www.glowm.com.
I am grateful to you for providing me the enormous privilege of being the Chief Guest of this prestigious confer-ence.
Professor...Contd. from page 04
Thank you.
Contd. on page 12
10
12
July, 2013 SLMANEWS
SLMA HEALTH RUN AND WALK 2013
14
Contd. on page 18
An inclusive walk
A healthy bowl of Kolakenda
A happy moment for the President
Dr Sanjeewa Gunasekara the chief organiser of the walk and run explaining the facts to the Hon. Minister
The President with the distingueshed invitiees
An exctiting ending. the Sports Minsitry of-ficials lending a helping hand to orgniase the health run
The treasurer Dr. Hanifa flaging off the event
They contributed in many ways
The Hon. Minster and his team spent their Sunday morning promoting healthy walking
Other colleges joined hands
They all joined us
Yoga for all
First aid for the participants
Yoga session
Our partners
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July, 2013 SLMANEWS
Inauguration of the 126th Anniversary Scientific Medical Congress
Lighting of lamp of learning by the chief guest.
Professor Sir Sabarathnam Arulkumaran was hournored with the SLMA life membership
SLMA oration by Vidyajyothi Prof. Janaka de Silva
SLMA oration by Vidyajyothi Prof. Janaka de Silva Cultural show “ Thelme Dance” adding colour to the Inauguration
SLMANEWS
17
July, 2013
Winners of the research grants and award
July, 2013 SLMANEWS
18
SLMA Run...Contd. from page 18
Contribution by the College of Pulmonologists
team work pays back Full of smiles
They compered
Dr. Prabath Gunawardena, the star amongst stars
Prizes given away by the sponsors
the vice President awarding the giftsdistribution of prizes
President handing away the prizes Tokens of appreciation to our partners
Physiotherapy exercises by the Allied Health Sciences Unit, Faculty of Medicine Colombo
Lung function testing was a hit
Our sponsors
July, 2013 SLMANEWS
24
After the bombshell dropped through Wikileaks
Comes in its wake the story of another leak
Snowden of the CIA made the exposure
That upset more the allies’ composure
Angela and Hollande on this side of the Atlantic
Sent calls to Obama, urgent and frantic
The revelations by Snowden are clearly unacceptable
Is this the behaviour of a friend honourable?
Now that there is no more a cold war
Why are friendly countries being spied for
Don’t you consider us as your allies
Or are we reckoned as Soviet satellites? Admissions are made that it is a common practice
Bugging and spying continue-let diplomats be at ease!
Even among friendly nations how they dare
Is it that in love and war everything is fair!
To understand the world better we need his type of information
Says Obama, we will answer your spying allegations.
No trade talks, transactions or negotiations ever
European allies may decide whether friendship to sever
Snowden is hero or villain we are compelled to decide
The audience he received was necessarily worldwide
Should a government intrude into citizens’ privacy,
And citizens give in to a state’s piracy?
I wish Snowden is given asylum in a country free
Breaking only man made laws he need not flee
Don’t subject him to inquiry through a moralist’s scan
Can I say, go my friend, you are a free man!
Dr. Nanda Amarasekera Member, SLMA
SNOWDEN’S LEAK Winners of the awards for free papers
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