Health watch

Tobacco Smoking :

Risk, not only for users

Dr. Shantha HETTIARACHCHI

The World Health Organization (WHO) estimates that more than one billion smokers of the world have polluted our environment. Today, nearly 50 percent of the children in the world breathe air polluted by tobacco smoke.

The use of tobacco has become a major public health problem, globally. The first cultivation of the tobacco plant was carried out in America in 6000 BC. The spread of tobacco into different regions of the world commenced in the year 1492, by Columbus during his historical voyage. He has taken this plant to Europe as well.

This strange plant spread rapidly throughout the world. It has invaded Europe and Middle East in 1500, Asia in 1530 and Africa in 1560. The re-introduction to America has been occurred in 1500. The unhealthy tobacco smoke entered the human body in the form of cigar in the 19th century followed by cigarettes in the 20th century.

People in the world were ignorant on health hazards, caused by tobacco, yet the first link between smoking and lung cancer was reported in 1939 in America. Eventually cancer of the lips in pipe smokers has been reported in Germany in 1795.

Currently every country impose a tax on tobacco in varying amount. The first tobacco tax was introduced by the Government of United State of America with the aim of financing the civil war during President Abraham Lincoln’s time in 1862.

The amount of tobacco tax has being rapidly increasing to date. Some countries allocate a fair percentage of this taxation for health promotion of the people but this total taxation is used to reduce the budget deficit by other countries

The global consumption of cigarettes has been rising from the introduction of cigarettes at the beginning of the 20th century. China, USA, Japan, Russia and Indonesia are high in the list of countries, in which more cigarettes are burned by people.

As the tobacco is packed with harmful and additive substances, it leads to development of many diseases involving all systems of the body. The tobacco contains more than 3000 chemicals and over 19 known carcinogens including polynuclear aromatic hydrocarbon and nitrosamine. Clinical manifestations of tobacco smoking affects the head to feet comprising unpleasant smell, staining of hair and pain in the legs and feet due to peripheral vascular disease.

Health hazards in tobacco smoking includes, cataract and visual impairment of the eyes, less sensation of smell from the nose, wrinkles and premature aging of the skin, discoloration, staining and loosening of the teeth, reduced sense of taste to the tongue, bad smell of the mouth, cancers of the lips, mouth, throat, larynx, lungs, oesophagus, stomach, pancreas, colon, liver, kidneys, bladder, pneumonia, asthma and emphysema of the lungs and leukemia of the blood. Infertility, impotence and impairment of immunity are other probable results of this bad habit.

The smokers harm other people by exposing them to passive smoking while destroying themselves with this addiction. The first conclusive evidence on the danger of passive smoking was reported from Japan in 1981.

It was found in a study that the prevalence of lung cancers were high in non-smoking Japanese women married to men who smoked. Respiratory illnesses such as bronchitis, pneumonia and asthma represent higher positions in the list of diseases due to passive smoking with cardiac problems including heart attack and angina.

It was stated that if the current trends are continuing, there will be up to one billion deaths in the 21st century.

Globally 5.4 million people have to see the end of their life annually as a consequence of this bad habit. Out of which, 1.2 million deaths are occurring in South East Asian region. It was estimated that one smoker is dying in every six seconds in the world.

Majority of tobacco smokers have started this unhealthy habit at a younger age. The younger a person begins to smoke, the greater the risk of contracting the resultant diseases of smoking. The nicotine, a stimulant that is contained in tobacco will lead to physical and psychological dependence. It is the main factor of addiction leading to continue tobacco smoking.

The smoker needs help and encouragement medically and socially to quit smoking. If someone feels that it is difficult to quit smoking due to the psychological effects of nicotine, it may be beneficial to start nicotine replacement therapy.

Tobacco smoke contains deadly chemicals. It includes Acetone found in paint stripper, Ammonia found in floor cleaner, Arsenic found in ant poison, Butane found in lighter fuel, Cadmium found in car batteries, Carbon monoxide found in car exhaust fumes, DDT found in insecticide, Hydrogen cyanide found in gas chambers, Methanol found in rocket fuel, Naphthalene found in moth balls, Toluene found in industrial solvent and Vinyl chloride found in plastics.

Tobacco smoking is considered as the single most preventable cause of death in the world today. WHO framework convention on tobacco control was introduced at world health assembly in May 2003. It came into force in February 2005.

The 168 member states are signatories to this framework convention and 154 States are party to it. Ten out of eleven member countries of the South East Asian Region are parties to the convention with five member countries namely, Sri Lanka, India, Bangladesh, Thailand and Myanmar have comprehensive tobacco control legislation.

The ability and courage to exit from this unhealthy habit of tobacco smoking lies with the people who were used to that in someway in the past. It was revealed in certain researches that three out of four smokers are willing to quit smoking. Therefore, it is necessary to help and guide these people and to build up courageous environment for the expecting change. Law enforcement, improving awareness and developing skills are equally important in this context.

Healthy behaviours

Nadira GUNATILLEKE

Have you ever used a surgical mask? I don’t think so. Even when the A (H1N1) hit Sri Lanka nobody wanted to wear surgical masks. I thought, as soon as the health authorities issued the warning for AH1N1 in Sri Lanka, all surgical masks will be disappeared from pharmacies as hot hoppers but it was not so. Surgical masks were available at all pharmacies at a very low price. But not wearing surgical masks when required cause various problems to you and others around you. It can kill a person warded in a modern hospital with a certain type of sickness!

Wearing surgical masks to prevent infections is another problem existing in hospitals. The care available for the patients who need to be protected from infections (the patients who need to wear surgical masks) is very poor in all hospitals. Some nurses who suffer from illnesses have no idea that they have a big responsibility to protect patients from infections. They just visit them without masks and even sneeze in front of them freely while treating them. Cleaners with various sicknesses come and clean the rooms of patients who should be protected from infections.

Why are these local health staffs and managements so irresponsible? One fact is obvious. Majority of them do not have a proper training and some get `on the job training’! So, they have no idea about the risk of certain diseases or their responsibility towards patients. They cannot be blamed because it is a hospital and managements use them for a low salary sometimes even without a basic training. But private hospitals should be operated in a more responsible manner. One can say that they are just mushrooming all over the country but there is no standard or quality in them at all.

The reality is you can find a private hospital or `nursing home’ just round the corner of your village. But this so called `nursing homes’ have only one or two rooms, one or two doctors and a ‘nurse’! Not even an ambulance to transfer a serious patient to another hospital.

Sometimes hospital security makes healthy people sick! This is what some of my family members experienced when they visited the Panadura Base Hospital to see a patient. It seems the security of the Panadura Hospital treat all visitors in a very rude manner and use filth to say that `vising hours are now over’.

This is all right when it comes to thugs, criminals and rapists who visit the hospital to see patients. But how about sensitive family members of the patients who are already mentally suffering and in tension and stress? The security can cause major heart attacks or high blood pressure in some of them adding more problems to their suffering! Why can’t the security staff of state hospitals use decent words to speak to the public? Why can’t action be taken against them when they ill-treat the public?

The poor visitors do not have time to go and complain against them. They are more worried about their loved ones who are sick and in hospital. It is same when it comes to some members of some hospital staffs. Especially who the ones who join the private sectors after retiring from the State sector. The majority of health staff members who retire from the State sector and join private sectors immediately convert themselves from lions /lioness to cats/kittens! But few try to act like lions forgetting that one complain can cost their job.

Scolding/shouting at mothers in labour pain is a common practice in many Sri Lankan State hospitals. It has become an ‘accepted tradition’ in our State hospitals. No matter how old she is or who she is, she should be ready to get scolded (sometimes in filth) if she moans or screams unable to bear the labour pain. There is no need to mention the filthy words and sentences used by some health staffers to scold mothers in labour pain.

Rarely mothers or their guardians take action against culprits because they are more worried about their new born babies and health of mothers. The other problem is they have to visit the same place for the second or third child birth and get the services of same staffers because they are not rich enough to visit a private hospital. Therefore, we cannot expect many complaints from the public other than relating their bitter experience to others.

The situation is entirely different when a daughter/sister or a close relative of one of those health staffer visit a state hospital for a child birth or for any other illness. They get a warm welcome and sweet words from all. More care and attention. The Health Ministry needs to take action to change this sick behaviours or some members of health staffs. No one has given them powers to be rude to the patients. Sri Lankan culture respect mothers and call them Gedara Budun. A mother is treated as holy and worshipped. So how come health sector employees become powerful to use filth to speak to them?

Dr. Shantha Hettiarachchi

Q: I underwent a surgery last November 23 for “Fistula”. For the wound that has been left by the operation, I use the Betadine ointment and another cream. The wound is not healed 100 percent, I like to know how long does it usually take for the wound to heal?

A: The condition mentioned may be an anal fistula. The majority of fistulae arise from infected anal glands. It is a track or pathway between the anal margin exteriorly and anal canal interiorly. The treatment involves laying open the track to ensure adequate drainage. It will be healed with the formation of granulation tissue gradually. The healing process is slow compared to a sutured clean surgical incisions, made in other surgeries. It is important to keep the area clean and dry as the healing get delayed with local infection. Follow up visits to the clinic is needed to accesses the condition.

Q: My nails are very brittle and they are breaking very easily. Is there a remedy?

A: The fungal infections due to dermatophytes are the commonest cause for brittle nails. The toe nails are involved more than finger nails in these circumstances. The nail plate becomes thick and crumbles easily. Systemic antifungal treatment is necessary to control and cure the disease. Brittle and hyperkeratotic or thickened nails may be a manifestation in few other skin diseases such as psoriasis and lichen planus.

It is advisable to consult a dermatologist as the treatments are easily available for these conditions.

Q: I like to know why I am losing hair at a fast rate? The hairdresser I go to says there is no solution for the hair fall and the only way to stop is if I cut my hair short, the hair will grow to be thick but not long. And also they told me not to use any oil or any other conditioner. Is it the shampoo or is there anything else wrong?

A: All are loosing hair day to day. There are three stages in the hair cycle namely anagen, catagen and telogen phases. Each hair grows at the rate of about 1cm in a month and this is known as the anagen phase. This is followed by the catagen phase, in which the end of the hair strand forms a club and is shed. The telogen phase is a resting stage during which there is no activity. The number of hairs shed each day varies from about 50 to 300. The life of a hair ranges up to about 3 years. Around 1 percent of hairs are in the shedding stage of the catagen phase at any time, while the rest are completing their three year cycle.

When there is a systemic illness or a physiological state such as pregnancy, many of older hairs may pass into the shedding catagen phase temporally. The hair recovers completely within few months in these circumstances. A shampoo with a conditioner could be used but it is better to avoid using soap.

Q: At the age of 23, I started becoming bald and at the age of 28, I started having gray hair. Is there a particular reason for this happening or is it the genes taking their course?

A: There are various causes for loss of hair, called alopecia. The most common cause for baldness is physiological sexual maturation in which there is a shortening of the growing anagen phase and increase the proportion of hairs in shedding telogen phase. It is androgen dependent in this period of maturation. There is also an immunologically mediated condition, called alopecia areata, in which there may be a spontaneous recovery with re-growth of gray hair for a time. A family history of baldness is fairly common and it is likely that the genetic factors are involved.

New export product

Health Watch Associated Medical Project:

Edward ARAMBEWALA

Early this month the Health Watch Associated Sri Lanka Association for Welfare of Centenarians (SLAWC) headed by Prof. Colvin Goonaratna signed an agreement with Ramya Horticulture Walpita for the production of the Vanda 100 Centenaria specially cultured orchid plant for SLAWC by the Royal Botanical Gardens Peradeniya in honour of Centenarians (those who reach 100 years in human life) the world over.

Under this agreement Vanda 100 Centenaria orchid plant, which becomes an exclusive orchid plant only produced in Sri Lanka for the SLAWC, will become available as an exclusive Human Life Honouring Product from Sri Lanka to the world.

SLAWC in a statement on this states:

Ramya Horticulture Limited of Walpita has undertaken to reproduce by tissue culture technology the orchid Vanda 100 centenaria.

This unique orchid was developed at the Royal Botanical Gardens, Peradeniya, by Dr. Shalomi Krishnarajah, under the guidance of the Director General of Royal Botanical Gardens Dr. Wijesundara.

Dr. Wijesundara recently handed over this orchid plant to Professor Colvin Goonaratna, current President of the Sri Lanka Association for the Welfare of Centenarians (SLAWC) at the Faculty of Medicine, Colombo.