SLMAnews-2013-01 by Sri Lanka Medical Association

SLMANEWS

Contents

THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION

January 2013 Volume 06 Issue 01

President's Note A message from the new President SLMA Just after taking over the reins of the SLMA as the new President for the year 2013, I am writing to you with a great sense of commitment to apprise you of our plans for the coming year. At the very outset, let me first congratulate the out-going President, Professor Vajira H.W. Dissanayake, the out-going Secretary Dr. Lasantha Malavige and the out-going Council for providing us with the privilege of a superlative and a unique performance for the 125th Anniversary Year which we have just completed. They have taken the SLMA to an entirely different level with many a novel and innovative enterprise. The things that have taken place are well chronicled and I do not need to enumerate the countless achievements of the year except to say that in retrospect and from a personal point of view, it was a great dispensation to have been associated, as the President- Elect, with such a wonderful year. From now onwards, we are planning to ride on this huge wave that has been created. It would no doubt be a daunting task but I can assure you that my Council and I will certainly try our very best. Some of our plans and a tentative programme for 2013 are listed in the web site. Our theme for this year is “Towards continuing enhancement of quality and safety in healthcare” Our vision for the future is to take the SLMA from strength to strength. Towards that end we need to increase our membership. If each one of you who is a member could be so kind as to persuade just one extra doctor to join the SLMA, our numbers will be doubled. As Individuals, each one of us is just a drop but put together we would form an ocean. We could do wonders together. Please try your very best to help us in such a venture. The affairs of the SLMA should be a two-way process. We would like you also to tell us what your own thoughts and aspirations are as far as what the SLMA could do for you. We would certainly love to hear from you. Please feel free to write to me directly at the SLMA or through my e-mail bjcp@ymail.com. I hasten to assure you of our highest consideration for your suggestions. I wish to conclude this short communication with the very best wishes for prosperity and good health to every single one of you in 2013 and forever more. With the warmest of personal regards. Dr. B.J.C.Perera MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, FCGP(SL)

Page No.  Induction Of The President Of SLMA – 2013  The SLMA Council 2013

4 6

 A Holistic Approach To Improve Quality And Safety In Hospitals

 SLMA Research Grant 2013 And SLMA Glaxo Wellcome Research Award -2013

 A Dire Need Fulfilled - A “Chair Lift” For The SLMA Premises

 Burden of Road Traffic Crashes

 Health Care Quality And Safety Inetiatives Of The Department Of Health Services, Southern Province

16,17

 Sri Lanka Medical Association Call For Orations  Awards And Research Grants Slma 2013  Author Guidelines For On-Line Submission Of Abstracts For Annual Scientific Sessions Of The 126thSri Lanka Medical Association - 2013  The Living Will

18 18

President, SLMA

Dr B J C Perera President, Sri Lanka Medical Association, No.06, Wijerama Mawatha, Colombo 07, Sri Lanka

Official Newsletter of The Sri Lanka Medical Association. Publishing and printing assistance by

This Source (Pvt.) Ltd etc., 236/14-2, Vijaya Kumaranathunga Mawatha, Kirillapone, Colombo 05, Sri Lanka Tele: +94-112-854954 marketing@thissource.com

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Our Advertisers Atlantis Developments (Pvt.) Ltd. (110 Parliament Road) Mercantile Investments & Finance PLC DFCC Vardhana Bank Alliance Finance Co. PLC Guardian Acuity Asset Management Ltd. Tokyo Cement Group Astron Ltd. Delmege Forsyth & Co. Ltd. - Healthcare A. Baurs & Co. (Pvt.) Ltd. Citihealth Imports (Pvt.) Ltd. Asiri Surgical Hospital Edlocate (pvt) Ltd. GlaxoSmithKline Pharmaceuticals Emerchemie NB (Ceylon) Ltd.

SLMANEWS

January, 2013

Notice Board

FAIRMED Foundation - SLMA Research Grants in Neglected Tropical Diseases 2013 (Readvertisement) Three grants are offered to researchers in Sri Lanka in the area of Neglected Tropical Diseases (total value of the Grant SLR 1,000,000). Following submission of completed proposals by the deadline below, three projects will be selected by a SLMA expert panel. The selection criteria for funding, in addition to the technical soundness of the proposal, would be:

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   

Relevance of the research project to Sri Lanka Relevance to control programmes operating in Sri Lanka Clarity in the identification of the problem Appropriateness of the methodology to be adopted Academic credentials of the applicant Ability to complete the project within a reasonable time period Multi center collaboration within Sri Lanka

Preference will be given to projects on Leprosy and Leishmaniasis. Application Deadline: 15th March 2013 Applications can be obtained from http://www.slmaonline.info/images/pdf/applicationa.pdf

Short Message Service (SMS) alerts from SLMA Now you can receive SLMA Alerts from your Dialog, Mobitel or Etisalat mobile phones. Type <slmaonline> and send to 40404 The initial SMS will cost 25 cents, after that the service is free. This is a special service routed through Twitter and Facebook but you do not have to join either to receive alerts. As it is through Twitter, you may receive occasional other unsolicited SMSs through the service provider. You can just delete them. You can unsubscribe to the service at any time by typing <off> and sending to 40404. After unsubscribing, you can rejoin at any time with <slmaonline> to 40404 but it will cost 25 cents each time you rejoin.

SRI LANKA MEDICAL ASSOCIATION DOCTORS' CONCERT 2013 by doctors and their families

11th JULY 2013 at 7.00 PM at the Water’s Edge

Fresh Talent is always welcome If you like to participate please contact the Social Secretaries and the SLMA Office by 31st May. Dr. Suriyakanthie Amarasekara Gamini Walagampaya SLMA Office -

suri.amarasekera@gmail.comDr. nbwalgampaya@ymail.com office@slma.lk / slma@eureka.lk

Monthly Clinical Meeting - 19th February 2013 by the College of Surgeons of Sri Lanka Prof Neville Perera, Dr Satis Goonesinghe, Dr Ajith Malalasekera

SLMANEWS

January, 2013

INDUCTION OF THE SLMA PRESIDENT – 2013 Dr. B.J.C.Perera.

The new President was introduced to the audience by Professor Dissanayake and this was followed by the Presidential Address presented by Dr. B.J.C.Perera. The title of the address was “The Sri Lanka Medical Association : From there, to here., to eternity”. 4

he new President of SLMA was inducted at a simple but elegant ceremony at the HNB Towers in Darley Road on the 12th of January 2013. The event was attended by over 325 invitees. The ceremony commenced with the Ceremonial Procession, a rendition of the National Anthem and the traditional lighting of the lamp of learning. Following these formalities, the outgoing President, Professor Vajira H.W. Dissanayake cordially wel-

comed the guests and presented a very brief account of the work carried out in his tenure of office in 2012. The laudable efforts made by him and his council were acknowledged and deeply appreciated by the audience with a prolonged round of applause. The formal Induction of the President was then carried out with the President’s Medal being presented to the new President, Dr. B.J.C.Perera

Contd. on page 5

SLMANEWS

January, 2013

Contd. from page 4

Induction of... The new President was introduced to the audience by Professor Dissanayake and this was followed by the Presidential Address presented by Dr. B.J.C.Perera. The title of the address was “The Sri Lanka Medical Association : From there, to here., to eternity”. He traced the beginnings of this august association and how it had developed up to the current state. The tremendous gains of the last 125 years were graphically chronicled and the contributions made by members of the SLMA in achieving ground-breaking progress in the then prevalent health problems and very specially those related to major infectious diseases were presented in a most succinct manner. He made special mention of the way the association has progressed in leaps and bounds in the last year and was singularly complimentary on the work undertaken. At this stage he presented the Past President’s Medal to Professor Dissanayake and said that it was a very small gesture on the part of the SLMA for the tremendous contribution made to the association by the dynamic immediate Past President. Dr. Perera reiterated that we need

to ride on the huge wave that has been created in the last year and outlined the ‘way to go’ in the future. The classical problems that are likely to be faced by all concerned in the future, particularly those related to an aging population and the scourge of Non-Communicable Diseases, was brought to the limelight in no uncertain manner. The President outlined the proposed programme for the year based on the theme “Towards con-

tinuing enhancement of quality and safety in healthcare”. The main events for the year were then outlined. The Annual Scientific Congress would be in Colombo from the 10th to the 13th of July 2013 and the Foundations Sessions would be in Anuradhapura from the 23rd to the 25th of October 2013. The Chief Guest for the Anniual Scientific Congress would be President of the British Medical Association who is a Knight Bachelor of the British Empire. The President concluded by inviting Mr. Chanaka De Silva, Attorneyat-Law, a member of the committee which undertook the task, to launch and present the first copy of the book “A synopsis of Guidelines on sharing significant information in healthcare settings” to Professor Vajira Dissanayake. The catalyst for this endeavour was Mr. Chanaka De Silva who made a request for such a venture at the SLMA event to commemorate World Down Syndrome Day in 2012. Dr. Samanmali Sumanasena presented the vote of thanks and the event concluded with a reception.

SLMANEWS

January, 2013

THE SLMA COUNCIL

President

Vice President

Honorary Secretary

Dr. B.J.C.Perera. MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, FCGP(SL) Consultant Paediatrician

Prof Rohan Jayasekara. M.B.B.S., Ph.D. (N’CLE. U.K.), C.Biol.,MSB(Lond) Dean, Faculty of Medicine Founder, Director and Medical Geneticist, Human Genetics Unit

Dr. Kalyani Guruge. MBBS Ceylon), MD (Paediatrics)

Dr Samanmali Sumanasena. MBBS, DCH, MD, MRCPCH Senior Lecturer in Paediatrics, Department of Paediatrics, Faculty of Medicine, University of Colombo

Honorary Treasurer

Immediate Past President

President Elect

Immediate Past Secretary

Public Relation Officer

Dr. Ruvaiz Haniffa. MBBS, MSc Lecturer in Family Medicine Family Medicine Unit, Faculty of Medicine, University of Colombo.

Prof. Vajira H. W. Dissanayake. MBBS, PhD, Professor in Anatomy, Medical Geneticist, University of Colombo.

Dr Palitha Abeykoon. MD, MMed,Chairman, AIDS Foundation of Lanka Advisor, World Health Organisation, South East Asia Regional Officer (SEARO), Senior Advisor, Ministry of Health.

Dr. Lasantha Malavige. MBBS, DIPM, PhD Specialist in Sexual Medicine.

Dr. Deepal Wijesooriya. MBBs, MBA, Diploma in Phsychology Founder and Chairman of the Family Care Hospital (Pvt) Ltd.

Hony. Assistant Secretary

Dr B Kumarendran. MBBS, MSc Lecturer, Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama.

Dr D Sanjeewa Gunasekera. MBBS MD Senior Registrar Paediatric Oncology National Cancer Institute, Sri Lanka.

Dr Shyamalee Samaranayaka. MBBS, DCH, DFM, MD (Fam Med), MRCGP(Int) Lecturer in Family Medicine, Faculty of Medical Sciences, University of Sri Jajewardenepura.

Dr. Navoda Atapattu. MBBS, DCH, MD, MRCPCH Senior Registrar in Endocrinology.

Honorary Assistant Treasurer

Dr. Leenika Wijeratne. MBBS, MD(Psych) Lecturer in Psychiatry Secretary Curriculum Committee, Faculty of Medicine, University of Kelaniya, Ragama.

Past President’s Representative

Social Secretary

Co-Editor (Ceylon Medical Journal)

Dr Suriyakanthie Amarasekera. MBBS (Cey), DA (Lond), FRCA (Eng) Consultant Anaesthetist.

Dr Gamini Walgampaya. MBBS,FCGP Family Physician.

Dr. Anuruddha M Abeygunasekera. MRCS Urological Surgeon, Colombo South Teaching Hospital Kalubowila.

Prof. Janaka de Silva. MBBS, MD, DPhil(Oxford), FRCP(London), FRCP(Edin.), FCCP, FRACP(Hon), MRCP(UK), FNAS(SL)Senior Professor of Medicine, Faculty of Medicine, University of Kelaniya, Ragama.

Dr. Malik Fernando. MB, ChB (Bristol) Retired Medical Practitioners.

Contd. on page 7

SLMANEWS

January, 2013

Contd. from page 6

The SLMA...

Dr S Sridharan. MD (USSR), M.Sc. (Med. Admn.), MD (Col.) Director / Healthcare Quality & Safety Ministry of Health Castle Street Hospital for Women Premises, Colombo.

Prof. MSA Perera. MBBS,.DFM, MD in Family Medicine, FCGP Senior Professor and Chair Dept. of Family Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura.

Dr. Ajith De Silva Nagahawatte. MBBS, Dip.Med.Micro, MD Senior Lecturer in Microbiology, Department of Microbiology, Faculty of Medicine, University of Ruhuna, Karapitiya, Galle.

Deshamanya Vidyajyothi Dr J B Peiris. MD Consultant Neurologist Nawaloka Hospital, Colombo.

Prof. Samath D. Dharmaratne. MBBS, MSc, MD Consultant Community Physician; Associate Professor and Head, Department of Community Medicine, Faculty of Medicine, University of Peradeniya.

Dr Sunil Seneviratne Epa . MD Consultant Physician Matara Nursing Home Matara.

Dr. Rikaz Sheriff. MBBS PGCert Med Ed, MSc Medical Officer in Health Informatics, Provincial Director of Health Services, Western Province.

Dr. Indika Karunathilake. MBBS, DMedEd, MMEdEd Senior Lecturer in Medical Education and Director, Medical Education Development & Research Centre (MEDARC) Faculty of Medicine, University of Colombo.

Prof. Ranjanie Gamage. MBBS (Col), MD (Col), FRCCP, MRCP (UK) Consultant Neurologist National Hospital of Sri Lanka.

Dr. Pramilla Senanayake. MBBS, PhD, FRCOG, FACOG, FSLCOG Medical Consultant Reproductive Health.

Dr Shihan Azeez. MBBS

Dr. Lucian Jayasuriya. MBBS (Cey.), DTPH (Lond.), Hony. Senior Fellow of the PGIM (Col.) Medical Director, GlaxoSmithKline.

Prof Asita de Silva. MBBS, MD, DPhil Professor of Pharmacology Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama.

Dr W M Arjuna Wijekoon. MBBS, MSc Medical Officer in Health Informatics , Health Information and Research Unit,Provincial Department of Health Services (North Western Province), Kurunegala.

Dr. Niroshan C. Lokunarangoda. MBBS, MD Senior Registrar in Cardiology, National Hospital of Sri Lanka and Lecturer in Medicine, Rajarata University of Sri Lanka, Anuradhapura.

Dr Uditha Bulugahapitiya. MBBS (SL), MD (Col), MRCP (UK) Consultant Endocrinologist Colombo South Teaching Hospital.

Deshamanya Dr Vijith. Gunasekera MBBS, MSc (Med Admin) Deputy Director, Laboratory Services., Cosmetics, Drugs and Devices Regulatory Authority, Ministry of Health.

Dr. Kapila Jayaratne. MBBS, DCH, MSc, MD Consultant Community Physician; National Programme Manager - Maternal & Child Morbidity & Mortality Surveillance, Ministry of Health.

Dr W M A U Jayatilleke. MBBS(Peradeniya), MBA(Peradeniya), MHSc(Tokyo), PhD(Tokyo) Senior Lecturer, Post Graduate Institute of Medicine, Colombo.

Prof. S.P. Lambadusuriya. MBBS, PhD, DSc, MBE Emeritus Professor in Paediatrics University of Colombo.

Dr Dennis J Aloysius. MBBS, FCGP, FSLCPaed, Hon. FCCP Family Physician.

Prof. Saroj Jayasinghe. MBBS, MD, FRCP, FCCP, MD (Bristol) Consultant Physician, Professor, Department of Clinical Medicine, Faculty of Medicine, University of Colombo.

Dr W M A Rathnayake MBBS (SL), District Medical Officer, District Hospital, Uraniya, Mahiyangana (Uva PDHS & RDHS Badulla).

Dr Amitha Fernando. Consultant Respiratory Physician, National Hospital of Sri Lanka, Colombo/Central Chest Clinic, Colombo.

SLMANEWS

January, 2013

A HOLISTIC APPROACH TO IMPROVE QUALITY AND SAFETY IN HOSPITALS Dr S Sridharan MD (USSR), M.Sc (Med. Admn.), MD (Col.), Director / Healthcare Quality & Safety, Ministry of Health, Sri Lanka

ri Lanka is a country known to the world as a role model for providing cost effective healthcare free of direct cost to the patient. The Sri Lankan maternal mortality ratio, neonatal mortality rate, life expectancy at birth and many more health indices are comparable with those of the developed world. Although these Sri Lankan indicators are the best in the region much has to be done to ensure Quality and Safety in the delivery of Healthcare, especially in hospitals. Many attempts were made in the past to achieve this, but had little success due to a variety of reasons. In the year 2000, Castle Street Hospital for Women initiated the Continuous Quality Improvement (CQI) Programme, using Japanese management practices. The principle followed was ‘Quality Healthcare through Productivity’. This is based on the principle ‘Quality Fails when Systems Fail’. As a starting point of the programme, Japanese ‘5S’ concept was used to organize the hospital. The “5S Concept”, implemented as “Seiri” (Sorting & Cleaning), “Seiton” (Organizing Orderliness), “Seiso”

(Cleaning & Beautification), “Seiketsu” (Standardization), “Seitsuke” (Training and staff discipline) was applied appropriately for this hospital setting. This popular Japanese management technique was employed as an initial step to improve productivity, quality, cost reduction, delivery on time, safety for the employees and patients and to improve the morale of the staff. Following this, the efficiency and effectiveness of the Hospital was improved using productivity concepts such as reducing waste, Suggestions Schemes (SS), Just-in-Time (JIT), Total Productive Maintenance (TPM), Work Improvement Teams (WIT), Mistake Proofing (Poka-Yoke) etc,. In addition, improvement of Quality of Work Life (QWL) and Quality of Work Environment (QWE) of the employees were also addressed. This is to boost the job satisfaction level of the employees and then attract external customers (patients) through internal customers (employees). At present Quality concepts are applied to achieve Total Quality Management (TQM). During this programme, a situation analysis was done by a committee appointed by the Director. This committee comprised all categories of staff. This was to ensure that the programme is everyone’s

programme and gave “ownership” to all categories of staff. The committee was supported by external resource people who had wide experience in hospital management. The committee identified ten key areas to bring about change with the implementation of ‘5S’. Following the implementation of thie programme

the hospital won several awards related to Japanese Management Practices, Productivity and Quality, in competition with the private sector. These improvements paved the pathway for the decrease in the maternal, neonatal and perinatal death rates and still-birth rates. Contd. on page 10

SLMANEWS

January, 2013 Contd. from page 10

A Holistic... Further, there is a reduction in the post Caesarean Section (LSCS) and post surgical infection rates. The preventable maternal death is zero for the past few years. Preventable still births are also on a decreasing trend. Due to these achievements, in July 2003, this hospital was declared as the Focal Point for National Quality Assurance Programme by the Ministry of Health of Sri Lanka. Since then senior and middle level managers of other hospitals are trained at Castle Street Hospital for Women. Many other hospitals in Sri Lanka too followed the pathway of Castle Street Hospital for Women, to improve quality and safety in their hospitals. Other government institutions and private companies also visit this hospital to study the application of Japanese Management Practices. Apart from these many foreign health personnel visit Castle Street Hospital for Women to learn hospital management. After Castle Street Hospital was identified as the focal point for the National Quality Assurance Programme of the Ministry of Health, measures had been taken to expand this programme to other hospitals too. As a result hospitals such as Ampara DGH, Peradeniya TH and Kurunegala PGH initiated its quality improvement programme and

won few National awards. It was said that quality improvement programme can be implemented only in the line ministry institutions because of the availability of resources. Quality improvement programme at Mahiyangana BH in 2004-2005 paved the pathway for hospitals which comes under provincial councils and other smaller hospitals to join this initiative. With this experience, a pilot study was carried out in five different levels of hospitals in North Western Province with the assistance of JICA. This gave the insight on carting out the quality improvement programme for the Ministry of Health. In 2007-2009, with this experience, the programme was expanded to eight hospitals in Southern and Uva provinces. With these pilot studies it was identified that establishment of District Quality Assurance Unit and

Quality Management Units are important to facilitate and monitor the quality improvement programme. This later resulted in other institutions such as Gampaha DGH, Ettampitiya PU, Dambana RH winning national productivity awards. Then also, it was recommended to establish an apex body to facilitate the quality improvement programme throughout the country. Therefore under World Bank â&#x20AC;&#x201C; HSDP funds a building was constructed for the National Quality Assurance Programme. A consultative committee was appointed to decide on the scope and functions of the Directorate / Healthcare Quality and Safety. It was commissioned in August 2012. Since then measures have been taken to carry out the quality improvement programme of the Ministry of Health in a planned manner. The Directorate is situated at the Castle Street Hospital for Women prem-

ises and comes under the purview of DDG (MS â&#x20AC;&#x201C; 1). Currently this Directorate works under the concept of â&#x20AC;&#x2DC;Centrally Driven, Locally Led, Clinically Oriented, Patient Centered Continuous Quality Improvement Programme. Currently JICA has recognized this low cost approach to quality improvement in health sector. Therefore Sri Lanka was selected for the third country training programme and so far nearly 24 countries were trained in Sri Lanka to understand this 5S-CQITQM approach to quality improvement programme for hospitals. Finally, it must be emphasized that none of these achievements would have been possible without the dedication of the stakeholders including the Ministry of Health. It is indeed a feather in the collective cap of all those who were involved in this venture which secured such marvelous results.

SLMANEWS

January, 2013

SLMA RESEARCH GRANT 2013 and SLMA/Glaxo Wellcome Research Award -2013

he research promotion committee of the SLMA is glad to inform that applications are invited from SLMA members for the fifth round of SLMA research grant and for the SLMA / Glaxo Wellcome Research Award - 2013. The grants are targeted for young researchers in their early carrier. Preference

will be given for detailed proposals on applied research that could be initiated or completed with the available grant. The proposal should include a detailed methodology. The award of grant for this year would be withheld if none of the proposals meets the minimum acceptable standard.

The maximum financial assistance for a SLMA Research Grant is LKR 100,000 and for GSK / Glaxo Wellcome Research Grant is LKR 50, 000. The guidelines for the award of the grants and the application forms are available from the SLMA official website http://www. slmaonline.info/images/ pdf/applicationa.pdf.

The deadline for the applications is 15th of March 2013. Applications will be reviewed by an expert panel and the grant will be awarded on scientific merit of the proposal. Dr. B. Kumarendran Secretary, Research Promotion Committee

A DIRE NEED FULFILLED - A “CHAIR LIFT” FOR THE SLMA PREMISES

t was a long felt need for the SLMA premises to acquire a device to transport the differentlyabled persons from the ground floor to the first floor. This essential requirement was fulfilled by the installation of an electric “Chair Lift”. This venture was implemented by the very kind donation of the equipment by the family of late Dr. Stella De Silva, who was a distinguished Past President of the SLMA. This was the “Chair Lift” that was used by Dr. Stella De Silva during the latter part of her life and the installation costs were borne by her family.

The necessary extension of the railings to suit its new environment was funded through a personal donation by Professor Ranjani Gam-

age. The SLMA wishes to convey its gratitude to all persons involved in this magnanimous gesture.

SLMANEWS

January, 2013

Burden of Road Traffic Crashes Dr. Samath D. Dharmaratne, Dr. Geethika Amarasinghe, Dr. Achala Upendra Jayatillake Global Situation

A Road Traffic Crash is an event that produces death, injury and/or property damage, involves one or more moving vehicles and occurs on a road or while the vehicle is still in motion after running off the public highway. Globally, Road Traffic Injuries (RTIs), a major consequence of Road Traffic Crashes (RTCs), are considered an important public health problem that needs urgent attention. RTIs account for nearly 1.2 million deaths annually, especially in low-income and middle income countries. A RTI is defined as an incident due to a RTC that reduces the functional health state of an individual due to energy exchange that have relatively sudden discernible effects. RTIs affect all age groups, but their impact is most striking among young people. RTIs are one of the leading causes of death for people aged 5 to 44 years. Almost half of those who die in RTCs are pedestrians, pedal cyclists and motorcyclists. This proportion is higher in the low-income countries. Apart from the high

mortality, RTI is associated with high morbidity which requires hospital admission. It is estimated that 20 to 50 million people are injured or disabled from RTCs each year. The global burden of disease due to RTIs is expected to move from the ninth position in 1990 to the third position by 2020. It is also estimated that if low-and middle-income countries do not act immediately, up to 1% of a countryâ&#x20AC;&#x2122;s gross domestic product will be neutralized by RTIs. Although the incidence of road traffic fatalities (RTFs) were reduced significantly in high-income countries over the past four to five decades, there has been no reduction in low-income countries; particularly in countries of the South-East Asia Region. Disability adjusted life years (DALY) are a summary measure of population health that aims to quantify the proportion of years of life that are lost in a population as a result of early death or disability. Several recent stud-

ies have highlighted the usefulness of DALY for quantifying the impact of road traffic crashes. Globally, road traffic crashes are estimated to be the 8th cause of DALY, accounting for 2.6% of the total at an estimated annual cost of $518 billion in 2004. Situation of Road Traffic Crashes in Sri Lanka Sri Lanka is facing a growing burden of RTCs due to the exponential growth in motorization. In Sri Lanka from 1995 to 2007 the leading cause of hospital admissions has been traumatic injuries. In 2007, 16.1% of total admissions and 4% of deaths in government health institutions in Sri Lanka were due

to traumatic injuries. The report on Global Burden of Injuries, 2011, has revealed that in 2003, all injuries resulted in 13,591 deaths or 11.8% of all deaths in Sri Lanka. Out of all injury deaths, there were nearly 2,000 deaths due to RTIs representing an annual death rate (ADR) due to RTI of 12.1 deaths per 100,000 people, which makes RTIs the third leading cause of injury deaths in Sri Lanka. Over 80% of all deaths from RTCs were among men and over 80% of these men were adults older than 20 years. Death rates among men were five times than among women. Most road traffic fatalities (RTFs) in Sri Lanka occur among pedestrians (36%), vehicle occupants (33%) and motorcyclists (13%). A study conducted in Sri Lanka to describe the RTFs from 1980 to 2000, highlighted that the fatality rate per 100,000 population increased by 55% during the study period and reached 11.6 per 100,000 population in the year 2000. Contd. on page 25

SLMA

January, 2013

HEALTH CARE QUALITY AN

THE DEPARTMENT OF HEALTH SE

epartment of Health Services, Southern Province, with the vision to be the best Provincial Health Department in Sri Lanka by contributing towards the advancement of health enriching Southern Province and giving its pride of place for a glorious and prosperous South, successfully held “Dakshina Suwa Viruwo”, the second annual awards ceremony to appreciate and reward the health care institutions on their performance on quality, productivity and patient safety, on the 22nd of December 2012. The panel of guests included the Governor of Southern Province, Hon. Kumari Balasooriya, The Chief Minister of the Southern Province, Hon.

Shan Wijayalal De Silva, the Director General of Department of Health Services, Dr. Palitha Maheepala, the Director of Health Safety, Dr. Sridharan and WHO Consultant Dr. S M Samarage. It not only promoted the quality of the health services, but also provided a platform to stage the talents of the department employees in singing, dancing, drama and martial arts. The event was glimmered by the maximum use of ICT technology and a web cast of the whole event was streamed lively over the internet. The event also appreciated the exceptional performance of some employee like Mr. Ariyarathna, a nursing officer from DH Narawelpita,

who invented a Nebulizer powered by a bicycle pump to be used in power failures , Dr. D S Lokuarachchi, a black belt holder in Karate who is training employees on physical fitness and self defence, Dr. Anada Kodikara and Dr. Sarath Vitharana, the two Dental Surgeons who achieved national level awards and Mr. Baldula Gunawardhana, a PHI from the Southern Provincial Health Training Institute, who is highly praised by Sinhala song critics as one of the finest lyricist. The son of Dr. Kelum Kodithuwakkau, the MOIC of Arachchkanda Hospital, Master Kisara Sadaluka Kodithuwakku, who had the best results in the last year five scholarship examination

was also honoured in the event. In the National Productivity Awards 2012, the Office of the Provincial Director selected as a Grade A award winner. Only six more Grade A winners were there from the whole country. Out of the seventy one Health institutions who were awarded as Grade B, C, D1 and D2 category winners, twenty two institutions are under the Department of Health, Southern Province and this highlighted the commitment of the Southern Provincial Health Department to deliver quality service. The Department also rewarded with the first place from the in Taiki Akimoto Award 2011, which is the leading 5S competition of the country organized by JASTECA, and judged by a world renowned panel including Prof. Seiichi Fujitha. The department is now in verge of achieving the ISO 9001/2008 certification in its journey to achieve the highest standards of health care delivery focusing on quality, productivity and patient safety. Department of Health Services successfully held “Dakshina Suwa Viruwo”, the second annual awards ceremony on the 22nd of December 2012. This effort was to appreci-

ANEWS

January, 2013

ND SAFETY INITIATIVES -

ERVICES, SOUTHERN PROVINCE

ate and reward the health care institutions on their performance on quality, productivity and patient safety. Guests included the Governor of Southern Province, Hon. Kumari Balasooriya, The Chief Minister of the Southern Province, Hon. Shan Wijayalal De Silva, the Director General of Department of Health Services, Dr. Palitha Maheepala, the Director of Health Safety, Dr. S. Sridharan and WHO Consultant Dr. S M Samarage. It not only promoted the quality of the health services, but also provided a platform to stage the talents of the department employees in singing, dancing, drama and martial arts. The event recognised the

exceptional performance of some employees like Mr. Ariyarathna, a nursing officer from DH Narawelpita, who invented a Nebulizer powered by a bicycle pump, designed to be used during power failures , Dr. D S Lokuarachchi, a black belt holder in Karate who is training employees on physical fitness and self defence, Dr. Anada Kodikara and Dr. Sarath Vitharana, two Dental Surgeons who achieved national level awards and Mr. Baldula Gunawardhana, a PHI from the Southern Provincial Health Training Institute, who was acclaimed as a talented lyricist. The son of Dr. Kelum Kodithuwakkau, MO/IC of Arachchkanda Hospital,

Master Kisara Sadaluka Kodithuwakku, who had the best results in the last year five scholarship examination was also honoured in the event. In the National Productivity Awards 2012, the Office of the Provincial Director was selected as a Grade A award winner. The Department was also rewarded with the first place from the Taiki Akimoto Award 2011, which is the leading 5S competition of the country organized by JASTECA. and judged by a world renowned panel. The department is now on the verge of achieving the ISO 9001/2008 certification in its journey to achieve the highest standards of health care delivery.

SLMANEWS

January, 2013

SRI LANKA MEDICAL ASSOCIATION CALL FOR ORATIONS Applications are called for the following orations to be delivered in 2013

SLMA Oration - July 2013, Waters Edge The SLMA Oration is the most prestigious oration of the Association. Instituted in 1979,it recognises outstanding achievement in research. It is delivered at the Inaugural Ceremony of the Annual Scientific Congress of the SLMA.

S C Paul Oration - July 2013, Waters Edge The S.C. Paul Oration is the oldest Oration of the Association. Instituted in 1966 it is delivered in the memory of Dr. S. C Paul, an outstanding surgeon. It is delivered on the second day of the Annual Scientific Congress of the SLMA.

Murugesar Sinnetamby Oration Instituted in 1968, this Oration is delivered in the memory of Murugesar Sinnetamby, an outstanding obstetrician and gynaecologist.

Sir Nicholas Attygalle Oration Instituted in 1975 this Oration is delivered in the memory of Sir Nicholas Attygalle, an outstanding Obstetrician and Gynaecologist, the first Ceylonese Vice Chancellor of the University of Ceylon, and President of the Senate. It is delivered on the Second day of the Foundation Sessions of the Association. Sir Marcus Fernando Oration Institute in 1969, this oration is delivered in the memory of Sri Marcus Fernando, outstanding Physician and the first Sinhalese member of the

Legislative Council. Applicants should submit the full script of the oration. The covering letter, addressed to the Honorary Secretary, SLMA should explain why the applicant believes that the work is of sufficient merit to deserve an oration, and list the original papers and conference presentations (both oral and poster) of the applicant cited in the oration. Applications should reach the Honorary Secretary, SLMA, 6 Wijerama Mawatha, Colombo 7 on or before 15th March 2013. www.slma.lk, office@slma.lk, +94112693324 To unsubscribe from the SLMA E-mail List send a blank email to info-unsubscribe@slma.lk

AWARDS AND RESEARCH GRANTS SLMA 2013

t is hereby called for applications for the following awards and grants for year 2013.

CNAPT Award: Applications are invited from doctors and others for the best research publication (article, book chapter or book) in medicine or in an allied field, published in the year 2012, for the Richard and Sheila Peiris Memorial Award. All material should be in triplicate. Closing date: 15th March 2013.

GR Handy Award:

Applications are invited from Sri Lankans, for the best publications in cardiovascular diseases published in the year 2012 for the G R Handy Memorial award. All mate-

rial should be in triplicate. Closing date: 15th March 2013.

Glaxo Wellcome :

Applications are invited from members for research proposals on topics related Research Award:to medicine. Five copies of the research proposal should be submitted. Closing date: 15th March 2013

For further details please contact: The Honorary Secretary, SLMA â&#x20AC;&#x153;Wijerama Houseâ&#x20AC;?, 6, Wijerama Mawatha, Colombo 7 Telephone: 2693324 Fax: 2698802 E-mail: slma@eureka.lk

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January, 2013

AUTHOR GUIDELINES FOR ON-LINE

SUBMISSION OF ABSTRACTS FOR ANNUAL SCIENTIFIC SESSIONS OF THE 126th SRI LANKA MEDICAL ASSOCIATION - 2013

Abstracts for the Annual Scientific Sessions of the SLMA should conform to the following requirements. All submissions should be made electronically. Hard copy submissions directly to the SLMA office will not be accepted. All authors of abstracts should be members of the SLMA. The presenting author is required to register for the sessions at the time of submission of the abstract. Underline the name of the speaker. Names of all authors should be stated. Indicate preference of presentation under item 5 of annex 1. The language of the submission Microsoft word should be set to English (UK). Those sent in English (USA) will be rejected. 1.

The abstract should be loaded as a Title Page in the first page of the submission site. A maximum of five (5) authors could be accom modated in the title page. If there are more than five authors extra space is provided. Please see the instructions in the web site for submissions. THE ABSTRACT PROPER, WITH THE TITLE OF THE ABSTRACT BUT WITHOUT ANY NAMES OF AUTHORS, SHOULD BE INSERTED INTO THE SECOND PAGE OF THE SUBMISSION SITE. The abstracts will be reviewed anonymously by referees. The corresponding author will be in formed of the decision by e mail in April/ May 2013.

Please note that NO amendments to the submitted abstract (including the number of authors) would be entertained thereafter. 4.

All abstracts should reach the Honorary Sec retary SLMA, before 12.00 hours on Friday the 15th of March 2013. Late entries will not be accepted.

The title of the abstract should be brief but ad equately descriptive. Lower case letters should be used unless indicated. The SLMA reserves the right to modify the title where necessary.

Author’s surname should be preceded by the initial(s) but not by prefixes such as Mr, Dr or Professor. The names of all authors and the places of work (one place of affiliation per per son only) should be mentioned in the Title Page.

7. The text of the abstract in the second page of the submission site should be double spaced and not exceed 250 words. It should be struc tured as follows: (ⅰ) Introduction and Objectives (ⅱ) Methods ResultsConclusions Prospective authors are requested to refer to the abstracts of papers in a recent issue of the CMJ for guidance on writing abstracts. Any abstract with over 250 words would be rejected. Contd. on page 21

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Contd. from page 20

Auther Guidelines... This 250 word limit includes sub-headings following the title. 8. The author/s should take full public responsibility for the research work and the contents reported in the abstract. 9. If the work has been previously presented or pub lished, in whole or in part, this should be stated clearly in the abstract. This does not disqualify a paper but must be stated when submitting the paper.

14. All research studies should be supported by a scanned image of a letter granting approval from an acceptable Ethical Review Committee (ERC). All Clinical Trials should be registered with a Clini cal Trials Registry and the registration number should be provided with the submission. 15. No conflict of interest statement / declaration should be signed by all authors prior to the ses sions

10. The SLMA reserves the right to make alterations and to edit the text to improve presentation. 11. Abstracts not conforming to the above instruc tions will be rejected. Accepted abstracts will be published in the book of abstracts. Those abstracts that are accepted but not physically presented (oral or poster) at the sessions will not be included in the CMJ Supplement containing the abstracts. Not making a presentation (oral or poster) of an ac cepted abstract at the SLMA sessions will be con sid ered an episode of academic/ scientific miscon duct and make the authors liable for punitive action. 12. Oral Presentations: Each paper will be allowed only 8 minutes for presentation with 2 minutes for discussion. Parallel sessions may be conducted depending on the number of papers selected. Multimedia facilities will be made available.

13 2. The size of the poster should be approximately 1m (width) X 1.5m (height). Screens (portrait) will be provided to put up posters. Posters should be made on material which can be mounted easily.

16. The following prizes will be awarded for Free Papers and Posters:

1. E M Wijerama 2. S E Seneviratna 3. H K T Fernando 4. Sir Nicholas Attygalle 5. Wilson Peiris 6. Daphne Attygalle (Cancer) 7. Sir Frank Gunasekera (Community Medicine and Tuberculosis) 8. Kumaradasa Rajasuriya (Research Tropical Medicine) 9. Special prize in cardiology 10. SLMA prize for the best poster 11. S Ramachandran (Nephrology)

For further details please contact: The Honorary Secretary Sri Lanka Medical Association â&#x20AC;&#x153;Wijerama Houseâ&#x20AC;? 6, Wijerama Mawatha Colombo 7

Telephone No: 2693324 Fax No: 2698802 E - mail: slma@eureka.lk Web site: http://www.slma.lk

SLMANEWS

January, 2013

THE LIVING WILL Many people, including some lawyers and doctors, are unaware of a Living will. Through advances in medical technology, some patients who formerly would have died can now be kept alive by artificial means. Sometimes a patient may desire such treatment because it is a temporary measure potentially leading to the restoration of health. At other times, such treatment may be undesirable because it may only prolong the process of dying rather than restore the patient to an acceptable quality of life. In any case, each person is seen, under the law, as having the personal right to decide whether to institute, continue or terminate such treatment. As long as a patient is mentally competent, he or she can be consulted about desired treatment. When a patient has lost the capacity to communicate (as in coma or some strokes) the situation is different, unless an advanced directive or living will is in place. The legal profession in association with the medical profession would need to think of enacting the necessary legislation in Sri Lanka for the purpose . Dr J B Peiris, Neurologist and Dr Natasha Peiris, Physician

INTRODUCTION A last will becomes effective only when a person dies. A living will is effective while one is alive and comes into play when one is seriously ill or cannot communicate for any reason. It is thus an advance

directive to doctors and relatives of what one wants done if one cannot express oneâ&#x20AC;&#x2122;s wishes or requirements.

DEFINTIONS An advance directive is a legal document in which you state how you want to be treated if you become very ill and there is no reasonable

hope for your recovery. Although laws vary from country to country or even from state to state in the U S, there are basically two kinds of advance directives. You may change or cancel your advance directive at any time, as long as you are considered of sound mind toÂ do so. Contd. on page 23

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Contd. from page 23

The living.. Being of sound mind means that you are still able to think rationally and communicate your wishes in a clear manner. You can change the document at any time. It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust. A living will is a legal document in which you state the kind of health care you want or don’t want under certain circumstances. It only comes into effect when you are terminally ill and this generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in certain situations. A living will does not let you select someone to make decisions for you. A living will does not allocate property rights or estate. These are covered in a standard will, often referred to as the last will and testament. A health care proxy (or durable health care power of attorney) is a legal document in which you name someone close to you to make decisions about your health care if you become incapacitated. You can have both, a health care proxy naming a person to make the decisions and a living will to help guide that person in making the decisions. Durable Power of Attorney for health care is a legal document that allows

you to name anyone, at least eighteen years old, to be your advocate and make health care decisions for you. You can pick a family member, friend or any other person you trust, but be sure the person you choose is willing to serve. A durable power can be used to accept or refuse any treatment. If you want your patient advocate to be able to refuse any treatment and let you die, you must say so specifically in the durable power document. A durable power goes into effect only when you are not able to make decisions for yourself.

A do not resuscitate order (DNR) is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Generally, unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. You can use an advance directive form or tell your doctor that you do wish to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states of the US. Most patients who die in a hospital have had a DNR order written for them. Patients who are not likely to benefit from CPR include people who have cancer

that has spread, people whose kidneys do not work well, people who need a lot of help with daily activities, or people who have severe infections such as pneumonia that require hospitalization. In order for your advance directive to be useful, it has to be available. After all, your advance directive will not do you any good if no one can find it. Ensure that your advance directive is available when you need it, wherever you are.

CASES It was something you would never ever want to go through again. Your father had a severe stroke. He lay in a hospital bed for six weeks unable to communicate. Then the doctors told you that he was developing a lifethreatening pneumonia. They took you into a small room and asked you what you want done. You could request antibiotics or allow nature to run its course. If your father recovered from the pneumonia, he would need institutionalized care for the rest of his days. This story is enacted daily throughout the world. Family members are not able to make decisions without feeling profound remorse and the medical profession struggles between the ability to save life and the need to reduce suffering. In Quebec, Canada, the Nancy B. case brought a great deal of public attention to the issue. She was a young lady, in her early

twenties. She was stricken by a paralysing disorder called Guillain-Barre Syndrome, from which many patients but not all recover. Usually this is a limited disease and clears up spontaneously. Nancy was not so fortunate. For months she was maintained on a respirator as she could not breathe for herself. Eventually she came to the conclusion that she could not go on. She asked her doctors to take her off the respirator. You can imagine the heart-ache this engendered for everyone around. As a result, a judge was called to her bedside to hear her submissions. In the end he granted her, her wish, and the respirator was turned off. She died quietly under mild sedation

THE NEED Individuals, are encouraged to discuss their living wills with their families, clergy, doctors, and lawyers. In addition, each subscriber may designate a “proxy” who can make decisions to ensure that the person’s wishes are observed. The living will should not direct doctors to engage in anything illegal (euthanasia or assisted suicide, which are illegal in most countries). A living will spares family members the anguish of having to make difficult decisions, and it helps them to discuss situations in advance and come to terms with the loved one’s wishes. Contd. on page 24

SLMANEWS

January, 2013 Contd. from page 23.

The living.. Doctors themselves are concerned about these ethical issues and living wills provide needed direction. Living wills can also assist the medical profession struggling between the ability to save life, and the need to reduce suffering.

met with resistance by other family members, friends and even unaffiliated parties with political agendas, including members of government. This was no better illustrated than in the Terri Schiavo case brought to the public’s attention in 2005.

No one really likes dealing with their own mortality, but a living will allows control over medical treatment in near-death situations, and it removes the stress and guilt associated with these decisions from family members and friends.

Terri Schiavo was a young woman in 1990 when her heart stopped from an episode believed to have been brought on by an eating disorder. Schiavo was resuscitated but suffered permanent brain damage that left her in a persistent vegetative state. She did not have a living will but was survived by a husband who, after several years, requested the cessation of life support efforts. Schiavo’s parents contested and a legal battle ensued for seven years. This unfortunate human drama culminated in 2005, exacerbated by political theocratic pandering. The emotional pain surrounding Terri Schiavo’s 15-year tragedy could have been avoided by a living will.

A living will is a document you draft that stipulates what kind of treatment you want or do not want in the event of an unrecoverable illness or injury that leaves you unable to speak for yourself. It gives you the power to refuse extraordinary measures that would keep your body alive when there is no hope of recovery and when you would choose, if able, to die a natural death. People have differing attitudes and beliefs about what constitutes life and quality of life. For some, their religious beliefs dictate that any form of life is sacred and should be preserved as long as is humanly possible. Others believe life ends when the brain ceases to function and that life-support in this state is a form of dehumanization and a burden on loved ones, emotionally and economically. A living will allows you to make your desires known on this issue. Without a living will or advance directive, it is incumbent on the hospital or healthcare facility to continue to provide life support, unless a spouse comes forward to relay your unwritten wishes and ask that life-support be suspended. If there is no spouse, the closest living relative can speak for you. However, requests to stop life-support without a living will or advance directive in place can be

A living will only comes into play when multiple conditions have been met. The will must be legal and in the possession of your doctor. Your doctor must further find that your condition precludes you from making a competent decision about the care you wish to receive. Lastly, a second doctor must concur and both physicians must also find you to be terminally ill or permanently unconscious. Though the task of making a living will may not be a joyous one, it is not only in your best interest but in the best interest of loved ones. An advance directive also allows you to stipulate what kind of medical care you wish to receive, or do not wish to receive, and can be as detailed and specific as you like. A durable power of attorney (DPA) will allow you to legally appoint a trusted partner, a family member or

friend to make medical decisions for you, should you become unable to do so by yourself. A DPA is especially wise for unmarried couples, single people or those whose partners are deceased. Laws regarding these documents vary between states and it is necessary to check with your local physician or healthcare facility to see what documents you can submit for your own protection and peace of mind. In short, a living will is a document that states how you wish to be treated if you become incapacitated by illness, injury or old age. The document states how we wish to be treated, if we become incapacitated by illness, injury, or old age. It could also include a values statement and an organ donation statement. What the living will is designed to do is provide explicit direction in neardeath situations, specifying whether the patient wants all possible medical intervention or certain limits be imposed on treatment. ln Sri Lanka, legislation has still to be enacted recognizing that we want more control over decisions involving our own care. This is done by making out a living will before incapacity occurs. However, even if a living will or advance directive has no legal binding, it gives definite guidance of the patient’s desire, at a time that he has been able to contemplate and decide, to both the attending physician and the family. The attending physician otherwise decides on the merits of treatment and type of treatment with the help of the relations which may be in conflict with the patient’s desire for his ‘last illness’. This article is reproduced with permission from the author and the Editor of CoMSAA NEWS. It was published in CoMSAA NEWS 2012;1(2):31-34

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Contd. from page 14

Burden of... The fatality rate for pedestrians remained relatively constant during the study period. However, pedestrian fatalities, as a proportion of the total fatalities, decreased from 51% in 1980 to 40% in the year 2000. Driver fatalities, as a proportion of the total fatalities, increased during the period. These changes highlight the transition Sri Lanka is undergoing, from a low to high-motorized nation. The report on Global Burden on Injuries, 2011, has revealed that in 2003, there were over 300,000 people who had non-fatal injuries due to RTCs. Road injury incidence is significantly higher among residents of urban areas than residents of rural areas. Similar to fatal injuries, men have significantly higher rates of non-fatal injury incidence

compared to women. Road injury incidence was higher among young adults (18-44 years) than adults over 65years in 2003. The report by the Trauma Secretariat, in the Ministry of Health has revealed that in 2003, buses were responsible for half of the RTCs and in the others dual purpose vehicles, Lorries, containers, threewheelers, motor cars/ jeeps were the responsible vehicle. Considering the cause of for the RTCs, half were due to factors attributable to the driver such as overtaking, speeding and turning without signals. Out of total RTCs, 70% occurred between noon and midnight; 40% of all the crashes and half of the fatal crashes occurred between 6.00 pm and midnight. Above report shows that in Sri Lanka, driving under

the influence of alcohol is one of the main factors that account for RTIs. From 1996 to 2000, the number of RTIs associated with drunk driving doubled while the number of total crashes increased only by 12%. All road traffic fatalities reported to the police in Sri Lanka during the period 1940 to 2000 were studied and time series analysis was used to predict them to the future. The road traffic fatality rate was calcu-

lated by dividing the police reported road fatalities by the population for each respective year and reported per 100,000 population. Overall, road traffic fatalities increased in Sri Lanka during this period from 2.8 per 100,000 population in 1940 to 11.6 per 100,000 population in the year 2000; a three-fold increase over the period. During the observational period (1940 â&#x20AC;&#x201C; 2000) the number of registered vehicles increased 54-fold and the population of Sri Lanka 2-fold to reach 1,706,074 registered vehicles and 18,467,000 people, respectively. There were 2,150 deaths from road fatalities in the year 2000 and based on the projected trend, this will increase to 2,688 deaths by 2020; a 25% increase. A total of 48,565 deaths from road fatalities could be expected during this 20-year period. According to the projected trends, the fatality rate will increase gradually to reach 14.5 fatalities per 100,000 population in 2020 from 11.6 per 100,000 population in 2000. Contd. on page 28

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SLMANEWS

January, 2013

Contd. from page 25

Burden of... A study has estimated that approximately 2,300 people died and 300,000 were injured in non-fatal crashes and 140,000 received care for their injuries at hospitals in 2005. While the RTF rate in Sri Lanka is low compared to other low-income countries, it has been steadily rising for several years. Although young adults are at high risk in non-fatal crashes, the elderly have the highest death rate. Pedestrians and pedal cyclists account for more than half of all RTFs and riders of motorized two-wheelers accounted for an additional 13%. In Sri Lanka, according to statistics compiled by the Police, in the year 2010 2,483 fatal crashes were reported killing 2,630 persons. In the same year 6,021 were grievously injured and 12,451 received minor injuries. On this basis an average 7 persons die due to RTCs every day, about 16 persons are seriously injured and 34 persons receive minor injuries. In 1999, there were 53 515 road crashes in Sri Lanka, of which 1 938

were fatal crashes, 14 244 were injury producing and 37 333 were damage-only crashes. The estimated cost of RTCs in Sri Lanka was Rs.3 909 430 500 ($US41 164 899) for fatal crashes, Rs.499 109 760 ($US5 255 447) for injury crashes and Rs.638 618 298 ($US6 724 421) for damage-only crashes, with the total loss to the country from road crashes amounting to Rs.5 047 158 558 ($US53 144 767). In 1999 the Gross Domestic Product (GDP) of Sri Lanka was Rs.1 111 000 million ($US11 698 million), and the cost of RTCs as a percentage of GDP was 0.5%. For a country with limited resources and an average monthly per capita income of only Rs.3 141 ($US33), this is a sizeable amount both in monetary terms and loss of foreign exchange used to import vehicle spare parts. Policy makers should acknowledge road safety as a public health problem in Sri Lanka and implement strategies and programs aimed at reducing the number and severity of road traffic

crashes. In conclusion, RTCs are a major public health problem in Sri Lanka causing death and injury at epidemic proportions at present. Majority killed and injured being young people needed for development programs of the country. Majority (between 40 to 50 per cent) injured and killed being pedestrians (poor people? â&#x20AC;&#x201C; and? the principal wage earner of the family) could be an important reason for the increase in poverty in Sri Lanka. Therefore, RTCs are also an important social problem affecting our society today. If no urgent action is taken, in the next 20 years, 50,000 will die, 400,000 will be injured and more than Rs. 20 x 5,047,158,558 will be lost from RTCs. They are an important disease which has assumed epidemic proportions but is given stepmotherly treatment by the authorities and the policy makers and therefore prevention and control programs for RTCs are not being initiated properly at present in the country even though at least one RTC is reported every day in the media.

Dengue, Malaria and TB kills far less but they have programs and campaigns for their prevention and control and even one death attracts huge media attention. RTCs and associated injuries and deaths can be prevented, but copying strategies directly from developed countries might not work because the scenario is different and therefore we need to identify local risk factors and solutions for which local research is needed and to conduct research money is needed and to get money, people with money have to recognize that RTCs and associated injuries and deaths are a significant problem in Sri Lanka. Prof. Samath D. Dharmaratne, is an Associate Professor and Geethika Amarasinghe is a Postgraduate Trainee at the Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya. Dr. Achala Upendra Jayatilleke is a Senior Lecturer at the Postgraduate Institute of Medicine, University of Colombo, Colombo.

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