THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION
September 2012 Volume 05 Issue 09
Workshop for Medical Journal Editors on the use of Sri Lanka Journals Online
Symposium on Healthcare Identification Number
SLMA Snake Bite Committee
SLMA Expert Committee on Tobacco and Alcohol
SLMA’s Entry into Cyberspace
Past Presidents of SLMA Prof. Colvin Goonaratna Dr Lucian Jayasuriya Deshamanya Vidyajyothi Dr J B Peiris Prof. Wilfred S E Perera
SLMA/Mobitel: DocCall Medial advice at your fingertip
Dear SLMA Members, colleagues, friends This issue is a special issue dedicated to presenting to you details of the electronic transformation that SLMA has been undergoing this year. As you know the SLMA embraced electronic and social media in 2012 resulting in a massive change in the perception of SLMA on the minds of the medical profession as well as the general public. Today SLMA, the national medical professional association in Sri Lanka, has become a household name. More and more people are turning to SLMA resulting in massive increase in participation at SLMA events, and many coming forward volunteering their services to SLMA committees. We are happy that through this process of electronic transformation, the SLMA has become a part of your daily life. Let us join hands to uplift the medical profession and health services in Sri Lanka.
Thank you. On behalf of the Council of the SLMA,
16 - 17
Patient Safety Programme at the Lady Ridgeway Hospital for Children
SLMA at the Commonwealth Medical Association International Conference
SLMA Ethics Committee
Our Advertisers Prof. Vajira H.W. Dissanayake President, Sri Lanka Medical Assosiation, No.06, Wijerama Mawatha, Colombo 07, Sri Lanka
Publisher and Printer
This Source (Pvt.) Ltd.,
236/14-2, Vijaya Kumaranathunga Mawatha, Kirillapone, Colombo 05, Sri Lanka Tele: +94-112-854954 firstname.lastname@example.org
Glaxo Wellcome (Ceylon) Ltd. Atlantis Developments (Pvt.) Ltd. (110 Parliament Road) Durdans Hospital Overseas Reality PLC (Havelock City) DFCC Vardhana Bank Seylan Bank PLC Citihealth Imports (Pvt.) Ltd. Hyundai Lanka (Pvt.) Ltd. TOYOTA Lanka (Pvt.) Ltd. Senok Trade Combine (Pvt.) Ltd. Fairway Holdings Guardian Acuity Asset Management Ltd. Hemas Hospitals (Pvt.) Ltd. United Motors Lanka PLC A. Baurs & Co. (Pvt.) Ltd. Emerchemie NB (Ceylon) Ltd. Asiri Surgical Hospital Astron Ltd. SmithKline Beecham (Pvt.) Ltd.
Notice Board UPCOMING EVENTS Annual Scientific Sessions of the Anuradhapura Clinical Society in Collaboration with the SLMA 17 and 18 October 2012 at Anuradhapura
SLMA Foundation Sessions 9 to 11 November 2012 at the SLMA
E M Wijerama Endowment Lecture 2012 “Research and Beyond...” by
Prof. Sanath P Lamabadusuriya MBE, MBBS(Cey), PhD(Lond), DSc(Ruhuna), FRCP(Lond), FRCP(Edin), FRCP(Glasg), FRCPCH (Eng), FCCP(SL), FSLCP (SL), FSLGP (SL), DCH (Eng) on Friday, 9 November 2012 at the SLMA Auditorium from 6.00 pm onwards
Sir Marcus Fernando Oration 2012 “Controlling Iodine Deficiency Disorders in Sri Lanka” by Dr Renuka Jayatissa MBBS, MSc, MD Consultant Medical Nutritionist and Head, Department of Nutrition, Medical Research Institute, Colombo at the Foundation Sessions of the SLMA on Saturday, 10 November 2012 at the SLMA Auditorium from 6.00 pm onwards
Medical Dance 2012 8 December 2012 at Cinnamon Grand
FERCAP 2012 12th Asia Western Pacific IRB/IEC conference “Ethnicity, Culture, Religion and Ethical Research for Health” 18 – 22 November 2012 Colombo, Sri Lanka Organized by the Forum for Ethics Review Committees in Asia and the Western Pacific and the Sri Lanka Medical Association http://www.slma2012.com/FERCAP
Workshop for Medical Journal Editors on the use of Sri Lanka Journals Online
LMA in collaboration with International Network for Availability of Scientific Publications (INASP) held a special workshop for training of Editors of Sri Lankan medical journals on on-line publishing. The workshop was held in conjunction with the SLMA 125th Anniversary International Medical Congress on July 5 and 6, 2012. It was conducted by INASP Programme Officer, Sioux Cumming. 20 participants representing various colleges and associations participated in the workshop. The objective of the workshop was to introduce Sri Lanka Journals Online (SLJOL) to as
many medical journal editors as possible and to show them how the system can be used not only to increase their visibility but also to help them manage the editorial process of their journals. If you are interested in finding out more about SLJOL please visit http:// www.sljol.info Already 15 Sri Lankan medical journals are online. They can be accessed at http://www.sljol.info/ index.php/index/search/ category/661 The workshop was accompanied by a symposium on publishing research addressed by eminent resource persons.
Resource persons at the symposium – The Ceylon Medical Journal, Joint Editor, Prof. Janaka De Silva, Sri Lanka Journal of Child Health, Joint Editor, Dr B.J.C. Perera, and Sioux Cummings with the chairpersons – Ceylon Medical Journal, Joint Editor, Dr Anuruddha Abeygunasekera and Ceylon Medical Journal Editorial Board Member, Dr Shalini Sri Ranganathan.
Home page of the online version of the Ceylon Medical Journal
Symposium on Healthcare Identification Number SLMA Auditorium - 28th August 2012
Symposium on the “Healthcare Identification Number (HIN) to the eHealth System” was held at the auditorium of the SLMA on the 28th of August 2012. The audience included heads or representatives of the academics, colleges and association of the relevant fields in Sri Lanka. Presentations on Lanka Interoperability Framework and the facts to be considered when deciding
on a HIN were presented here. These presentations were followed by a one hour discussion among the medical professionals and Information Technology professionals. The discussion was focused on facts such as the need of a Healthcare Identification Number, continuation of medical ethics towards digital era, Protecting the patient privacy and confidentiality and whether to have a separate Healthcare Identification Number
or to use the Existing Citizen Identification Number. Following consensuses were drawn at the symposium. 1. Fundamentals of medical ethics on protecting the confidentiality of care recipients shall be applicable in any future electronic information system in the healthcare sector. Patients shall continue to have the facility to get healthcare without proving their biological identity hence any electronic health information system shall facilitate anonymity and pseudonymity. 2. There is a need to have a separate Healthcare Identification Number due to numerous reasons. (Hence the
existing or any future citizen identification number is not appropriate for healthcare purposes) 3. The number shall not contain any demographic details of the healthcare recipient. 4. Once the number is issued it can be used lifelong. 5. When in cases where the healthcare recipient wants to withhold information from his main health record he/ she could opt for a new number and a fresh medical record would be started. 6. There must be enough publicity given to promote healthcare recipients to use the same number and to educate them on the possible benefits in doing so.
SLMA Snake Bite Committee
he SLMA Expert Committee on Snake Bite is one of the oldest Expert Committees in the SLMA. It was established on the 3rd of July 1983 under the Chairmanship of Dr Dennis Aloysius. The committee has been providing yeomen service to the Medical Profession as well as the patients at large by publishing guidelines and creating awareness about management of Snake Bites, which mainly affect the poor rural farming community of our country. Dr Kolitha Sellahewa, the Chairman of the committee for many years, resigned from the post in 2011 to take up an overseas assignment. The new Chairman is Prof. S. A. M. Kularatne, from the Medical Faculty of the University of Peradeniya. Dr Malik
Fernando has been the Secretary of the Committee for many years. The most important undertaking of the committee at the moment is the revision of the Snakebite Management Guidelines, last updated in 2007. The new version 3.0 of 2012 takes into account research papers published in recent years â€“ most notably advice on pre-medication prior to administration of AVS to reduce reactions. There is also an expanded section on the treatment of reactions. More information and photographs are included about the hump-nosed pit vipers in Sri Lanka and a new article deals with treatment of sawscaled viper bites. The references supporting the new recommendations are given below. It is noteworthy that a number of Snakebite Committee
members are among the authors of the articles mentioned: Prof. SAM Kularatne, Dr. Kalana Maduwage, Dr Indika Gawarammana and Dr S. Sivansuthan. The service providers for the Snakebite Management Hotline have been revised. Please see the notice on SLMANews August issue. Recent scientific papers of interest
1. The study by the Kelaniya Clinical Trials Group regarding prophylactic interventions in reducing the incidence of reactions to AVS (Lowdose adrenaline in snakebite) has been published at: http://www.plosmedicine.org/article/ info%3Adoi%2F10.1371%2Fjournal.pmed.1000435 2. A taxonomic revision of the South Asian hump-nosed pit vipers. Maduwage et al. Zootaxa 2232: 1-28 (2009). 3. Epidemiology, clinical profile and management issues of cobra (Naja naja) bites in Sri Lanka: first authenticated case series. Kularatne et al. Transactions of the Royal Society of Tropical Medicine and Hygiene (2009). 4. The in vitro toxicity of venoms from South Asian Hump-nosed pit vipers (Viperidae: Hypnale). Maduwage et al. Journal of venom research, 2011, Vol 2 , 17-23. 5. Coagulopathy, acute kidney injury and death following Hypnale zara envenoming â€“ The first case report from Sri Lanka. Maduwage et al. Toxicon 58 (2011) 641643. 6. Revisiting saw-scaled viper (Echis carinatus) bites in the Jaffna Peninsula of Sri Lanka: distribution, epidemiology and clinical manifestations. Kularatne, Sivansuthan et al. Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (2011) 591597. 7. Chronic kidney disease in snake envenomed patients with acute kidney injury in Sri Lanka: a descriptive study. Herath et al. PGMJ Online First, published on January 25, 2012 as 10.1136/postgradmedj-2011-130225. 8. Thrombotic microangiopathy and acute kidney injury in hump-nosed viper (Hypnale species) envenoming: A descriptive study in Sri Lanka. Herath et al. Toxicon 60 (2012) 61-65.
SLMA Expert Committee on Tobacco and Alcohol SLMA Expert Committee on Tobacco and Alcohol had been actively involved in addressing harm from tobacco and alcohol in Sri Lanka, working with policy makers, health professionals and other relevant sectors. Following is a summary of its historical role in initiating national level action and the activities it has undertaken during the last two years. Role in advocacy for and development of national policy and legislation Both tobacco and alcohol cause significant morbidity and mortality, and is associated with widespread social and economic costs. The Expert Committee on Tobacco and Alcohol has been actively working on addressing the harm from these substances for a considerable period of time. In the mid 1990s the Committee was able to initiate the process of developing a national policy and legislation aimed at minimizing the harm from these substances by directly lobbying the then Head of State. Fittingly, several Members of the Committee
were appointed officially to the Presidential Task Force that developed what became the National Authority on Tobacco and Alcohol Act. Following its formulation, the Committee was in the forefront of national level advocacy, for approval and implementation of this act, until it was approved by Parliament in 2006. This is perhaps the only such piece of legislation anywhere in the world that addresses harms of both tobacco and alcohol in a comprehensive manner. Measures such as a comprehensive ban on promotion of both tobacco and alcohol products through advertising, sponsorship and other means are included in this act. Contd. on page 08
Contd.from page 06
SLMA Expert Committee...
The National Authority on Tobacco and Alcohol (NATA) was set up through this act, as the government agency that was responsible for designing and implementing measures to reduce harm from tobacco and alcohol. As NATA was set up relatively recently, its technical capacity to carry out its objectives is limited. Therefore, the Committee has been involved in collaborating technically with NATA in activities
conducted in many parts of the country during the last two years.
Capacity Building of Health Workers District level multidisciplinary Tobacco Control Cells were established by NATA. These Cells consist of district level health, education, social development and enforcement agencies and nongovernment agencies. Through provision of training and technical assistance to these
cells, the Committee expanded its geographic reach to all parts of the country including the Northern Province, and has developed links with district level health staff and initiated work in many provinces. One example was conducting training of trainers programmes for district level health staff on addressing harm from both tobacco and alcohol. These core groups of trainers numbered 30 to 50 in each province,
consisting medical and nursing officers, Public Health Inspectors (PHIs) and Public Health Midwives (PHMs). Such groups were trained in ten districts. Earlier this year, as an independent activity, the Committee conducted a training workshop on community level tobacco and alcohol demand reduction for all the PHIs in the district of Colombo, who work for the Provincial Ministry of Health. Contd. on page 24
District level multidisciplinary Tobacco Control Cells were established by NATA (The National Authority on Tobacco and Alcohol). These Cells consist of district leve health, education, social development and enforcement agencies and nongovernment agencies.
SLMA’s Entry into Cyberspace
Revolutionizing dissemination of professional information to doctors in Sri Lanka
ne of the innovations of 2012 has been to rely on online technologies to broaden the reach of SLMA’s services. In this article we would like to show a glimpse of how the online medium works and how it has impacted the SLMA, the apex medical association in Sri Lanka.
Websites Another unique feature of 2012 is the maintenance of not one but two websites. www.slma.lk houses all the general information of the SLMA. It is also (we believe) Sri Lanka’s 1st mobile website designed by a professional medical association.
great success with 347 abstracts successfully received exclusively online, saving valuable time for the busy medical community.
Figure 3: slma2012.com News was read more than 100 times per page. All newsfeeds and many web pages were developed inhouse by the SLMA council and staff.
Social Media: Facebook & YouTube www.facebook.com/SLMAonline: As part of our outreach programme the SLMA initiated a social media page with the intention to reach the younger medical audience and the public.This page, launched in early February, which has now reached 10,000 followers, is by all counts the largest page of a Sri Lankan Medical Association and ranks high in the top 10 of all official medical association
Figure 1: A typical email One of the big differences created this year has been the introduction of a formalized mailing list. Starting from a list of around 3000 of mostly SLMA doctors, the list has now expanded to include not only doctors but also medical professionals, which also require such updates. The list is currently 8,200 strong and expanding rapidly. The email list has all the typical features of subscription and unsubscription and users can opt-in and out as they please. The use of email alerts has resulted in improving participation at SLMA events, and other colleges and associations who advertise their events through the list has reported similar
Figure 2: SLMA Mobile! www.slma2012.com played a key role this year as it hosted all the news and events of 2012. This included not only workshops, symposia, regional conferences and the international medical congress but also included for the first time a completely online abstract registration and conference payment system. This system was a
Figure 4: Facebook Page pages worldwide on Facebook. This page is updated at least daily with news and events in the format of pictures, videos and links. All content is moderated and evaluated for effectiveness via Facebook’s ‘Insight’ analytic system. Contd. on page 10
Contd.from page 09
SLMA’s entry... Results*: Of the 10,000 fans 92.7 per cent were from Sri Lanka. (51.7per cent from Colombo, 6.4per cent from Kandy, 3.6 per cent from Galle and 2.4per cent from Jaffna). The page was gender biased with 69 per cent males and only 31 per cent females as followers. On a typical day this page was viewed by 69.8 per cent desktop users and 30.2 per cent mobile phone or tablet device users. 87 per cent of users were below 35 years of age. On average the whole page reaches ~ 1,000,000 viewers. On average each post is viewed by 5,000-10,000 people.
speakers are selected and videos are uploaded once a month. In addition video news feeds and in-house documentaries are being created for upload. Results*: A total of 13 videos have been uploaded so far. The videos have been viewed more than 4500 time. 74.9 per cent of the views were from Sri Lanka, 5 per cent from the UK and <4.6 per cent from Australia. Views were also gender biased with 72.6 per cent males and 27.4 per cent females. 92.3 per cent of viewers are above the age of 35. The videos were accessed 74.2 per cent of the time from desktop PCs and 14.6 per cent of the time from mobile devices and tablets.
E-SLMA Book Store: news (issuu. com/slmanews)
Figure 5: Format vs. reach Photos were very popular and accounted for 80 per cent of the reach via ‘Like’s, shares and comments by Facebook users (See Figure 5). The page was interactive with followers regularly sharing posts, asking research questions, medical inquiries, membership inquiries and even creating SLMA page spokespersons!
Figure 6: YouTube Channel www.youtube.com/SLMAonline: Another innovation has been to showcase key presentations to the public and professionals alike via the public video channel YouTube. Key
times on average. The most interest was within the first two weeks after publication, there were on average, 162.8 reads per day for 2 weeks from the date of publishing. The SLMA’s venture into the online world has been by all counts a resounding success and indeed a wake-up call to all medical associations wanting to educate and reach a modern, digital medical community. The spread of age groups among all media indicates a spread of digital natives and immigrants. The SLMA plans to expand these ventures through online CPD, video conferencing for its valuable membership in the near future. The SLMA online team includes Prof. Vajira Dissanayake, Dr Deepal Wijesooriya (Webmaster, slma.lk), Dr Rikaz Sheriff (Social Media Manager, Webmaster, slma2012.com), Dr Prasad Ranatunga (issuu.com/SLMAnews Manager) supported by Secretary Dr Lasantha Malavige, Luckshi Gamarachchi, Dr Amjad Kariyappa and SLMA staff.
One of the big differences created this year has been the introduction of a formalized mailing list. Starting from a list of Figure 7: SLMAnews Page SLMA newsletter and other publications, which were created in-house or produced for the SLMA were uploaded to an interactive online eBook site called www.issuu.com. Results*: A total of 12 online publications have been accessed more than 25,500 times since February 2012. The SLMAnews was the most popular publication accessed. Each edition of SLMAnews has been read 2280
around 3000 of mostly SLMA doctors, the list has now expanded to include over 8000 not only doctors but also others in medical and related fields, who also require such updates. The list is currently 8200 strong and expanding rapidly.
Past Presidents of SLMA 1996
Professor Colvin Goonaratna MBBS, FRCP, FRCPE, PhD, Hon. DSc, FNASL, Hon. FCSSL, Hon. FCGPSL Emeritus Professor of Physiology, Faculty of Medicine, University of Colombo Editor Emeritus, Ceylon Medical Journal President, Sri Lanka Association for the Advancement of Science, 2003
The following activities were undertaken during 1996. • Clinical Meetings were held every month from January through December, each followed by MCQ sessions. • Joint Clinical Meetings were held with the Galle Medical Association, Chilaw Clinical Society, Avissawella Clinical Society, Kalutara Clinical Society, Kandy Society of Medicine, and Ruhuna Clinical Society. • Four special Guest Lectures were arranged, on Haemolytic Disease of the New-born; Hypermedia and Multimedia; Surgery for Bile Duct Injuries; and the Speciality of Haematology. • Multidisciplinary seminar were held on: Management of Torture Survivors: Conflict Resolution
of Industrial Disputes in the Health Sector; All change: Changing the Change of Life; Perioperative Care in Cardiac Surgery; National Medical Drug Policy; and Medical Writing. • The 109th Anniversary Scientific Sessions (20-24 March) were very successful, with the participation of Dr Richard Smith (Editor, BMJ) as Chief Guest, Professor K Saunders, Professor Oliver Wrong, Dr D P Cameron, Dr Atul Mehta, Dr P A Sobotka, Dr D E Euler, Professor B K Gupta, Professor S Das Gupta, Professor Channa Wijesinghe, Dr G L Griffiths, Dr Ravi Pillai, Dr Michael Sinclair and Dr C Sivathasan as distinguished foreign invitees. The theme for the Sessions was: “Health is for People”. A full-day hands-on Workshop on “Medical Writing” and a Satellite Clinical Meeting at the Faculty of
Medicine at Galle, with Dr Richard Smith as Chief Guest, were special highlights of the sessions. • Public lectures in Sinhala were delivered in the SLMA Auditorium by Drs Jean Perera (on Forensic Medicine) and Nalani Vitharana (Dengue Haemmorlagic Fever) in October 1996. • Two SLMA Publications, (i) Ethical Criteria for Promotion of Medicinal Drugs and Devices in Sri Lanka, and (ii) SLMA Declaration on Health were officially launched at the SLFI by the Chief Guest Sarath Silva PC, Hon Attorney General of Sri Lanka on 23 September 1996. Ten thousand copies of each have been published and distributed, sponsored by the SPC. • The former publication was a consensus documents prepared at a meeting of SLMA, SLDA, SL Veterinary Surgeons’ Association, S.L. Pharmaceutical Traders’ Association and S.L. Pharmaceutical Manufacturer’s Association – a unique event. • The SLMA Expert Committee on Tobacco and Alcohol has met with Her Excellency the President, the Deputy Minister of Finance, and several MPs to initiate the development of legislation, in consultation with ADIC. Dr Tara De Mel served as Honorary Secretary in 1996.
Dr Lucian Jayasuriya MBBS (Cey), DTPH (Lond)
Honorary Senior Fellow of the Postgraduate Institute of Medicine, University of Colombo Fellow of the College of Medical Administrators of Sri Lanka Fellow of the Sri Lanka College of Venereologists Honorary Fellow of the College of General Practitioners of Sri Lanka Medical Director GlaxoSmithKline Director, General Hospital Colombo (1982-1984) Director General, Teaching Hospitals (1984-1989) Additional Secretary, Ministry of Health (1995-1997) Founder President, Sri Lanka College of Venereologists (1996-1997) President, College of Medical Administrators of Sri Lanka (1997) Chair, Board of Management of the Postgraduate Institute of Medicine (2001-2004, 2011-to date) Dr Jayasuriya’s main area of interest is health services management. His Presidential Address was on ‘The health services of Sri Lanka – present and future’. The theme of the Annual Scientific Sessions 1995 was ‘Health services management’. The Chief Guest at the Annual Sci-
entific Sessions was WHO SouthEast Asia Region, Regional Director Dr Uton Muchtar Refai. He spoke on ‘Health development in SouthEast Asia and challenges to professional associations’. The Guest of Honour at the Sessions was the International Hospital Federation
Director General Dr Errol Pickering. Dr Jayasuriya founded the Health Management Committee of the SLMA and chaired it for nearly two decades. Discussions at this committee were the catalyst for regular meetings of the SLMA with the Ministry of Health.
This committee has also organised annual career guidance seminars from 1996, which has been held unbroken every year ever since then. He is a member of the SLMA Drugs Committee and the Com-
municable Diseases Committee for many years. The latter has published four editions of the SLMA Guidelines on Vaccines 2001, 2004, 2008, and 2011. He has been the co-ordinator and a joint editor of these publications.
Deshamanya Vidyajyothi Dr J B Peiris MD, FRCP, FRCPE, Hon. FRACP Senior Consultant Neurologist Patron, Association of Sri Lankan Neurologists Patron, National Stroke Association of Sri Lanka Director, Postgraduate Institute of Medicine 1995-2001 President, Ceylon College of Physicians 1987-1988 The SLMA, nearly 20 years ago, was different to the present SLMA, though the infrastructure including the main buildings and staffing were the same. The Presidency and Council positions were much sought after but usually not contested, which unfortunately gave the SLMA the aura of being an exclusive club with poor participation by younger members. Highlights of the year 1994, included: • The Induction of the President at the BMICH in the presence of Madam Sirimavo Bandaranaike,
Prime Minister of Sri Lanka and the Presidential address on ‘New Vistas of the Nervous system’. • The Anniversary session was held at the SLMA House and auditorium to minimise expenditure and dependence on donors. There were food stalls of reputed hotels in the garden perimeter. The Registration fee was minimal around Rs250/• The visiting faculty was from the Royal College of Physicians, Edinburgh and the Chief Guest was Dr Anthony Toft, President RCP Edinburgh. There were foreign guests from USA, UK, India, Singapore and Australia. All the visitors attended the popular medical concert. • The visitors and members were taken in a luxury coach to Galle for a satellite session in Neurology
He delivered the EM Wijerama Memorial Lecture in 2003 where he spoke on ‘Towards a better managed health service’. Dr Devaka Fernando served as Honorary Secretary in 1995.
and Endocrinology. • Joint clinical meetings were held in Galle, Kandy, Kurunegala, Kalmunai and Ampara. • The highlight of the outstation meetings was the one in Kalmunai and Ampara during the ‘ceasefire’ in the internal conflict. The President, Her Excellency Chandrika Bandaranaike Kumaratunga, provided an Antonov aircraft for our transport to and from Colombo and a helicopter to hold a Health camp, which was attended by the general public, army personnel as well as members of the LTTE. The helicopter ride skimming the coconut trees with gunners standing in the open doorway was memorable. • The regular monthly clinical evenings were well attended. • Medical Dance was a tremendous success. • The South Asian Medical Associations met in Nepal and inaugurated the SAMA (South Asia Medical Association), which unfortunately has not forged ahead. Prof. Ravindra Fernando served as Honorary Secretary in 1994.
Prof Wilfred S E Perera MJF, MBBS, FRCS(Ed), FRCS (Eng) FRCOG, FSLCOG, FAOFOG, FSLCS, honFCGP (SL) Consultant Obstetrician and Gynaecologist Foundation Professor of Obstetrics and Gynaecology, North Colombo Medical College Ragama 1985-1995 President, Sri Lanka College of Obstetricians and Gynaecologists 1992 – 1993 Vice President, Asia Oceania Federation of Obstetrics and Gynaecology 1995 – 1998 President, Sri Lanka Medical Library for the past 12 years President, St. Luke’s Guild of Doctors 1995 – 1998 He took over the presidency of the SLMA immediately after the JVP insurrection was suppressed in Sri Lanka. His presidential address was “Changing Trends in Maternity Care in Sri Lanka”. He had Prof. Shan Ratnam from Singapore as the Chief Guest at the annual sessions.
He had the rare privilege of holding the presidency of the SLMA at the same time as the Presidency of Sri Lanka College of Obstetricians and Gynaecologists in 1993 President R Premadasa was very helpful in arranging an aircraft to take a team from the SLMA from
Ratmalana airport to Batticaloa and Ampara where the SLMA conducted a very successful health camp at the height of the war. For the first time in the history of the SLMA he had a very energetic lady Honorary Secretary in Dr Sita Nanayakkara.
Medical advice at your inquiring and receiving information on medical conditions over the phone is not a new thing. However, it was limited to doctors and their close circle of relatives, friends and a few selected patients. The real revolution begins when the two communicating parties, although strangers, trust one another to discuss sensitive details of a medical condition. Their trust is built on the prestige of the institutions they are associated with. 16
lone soldier stationed in a camp in Delft Island off Jaffna is worried about the poor weight gain of his 18-month old baby girl living with mother in Madulla, a remote village in Badulla district and decides to get advice from a doctor at around 11pm simply because that was the only free time left for him to do so. A doctor living in Colombo explains the reasons for poor weight gain and suggests a few feeding options and directs the baby to the General Hospital Badulla for clinical evaluation and investigation. A few days later, the grateful father calls back to the same doctor to inform that the investigations had shown that the baby had urinary tract infection and is being treated at the Badulla General Hospital. Sounds familiar? Yes, to a certain extent, inquiring and receiving information on medical conditions over the phone is not a new thing. However, it was limited to doctors and their close circle of relatives, friends and a few selected patients. The real revolution begins when the two communicating parties, although strangers, trust one another to discuss sensitive details of a medical condition. Their
trust is built on the prestige of the institutions they are associated with. The doctor providing medical advice is a member of the Sri Lanka Medical Association and the client, seeking services, knows that he is speaking to a qualified doctor and the doctor knows the call he receives is genuine, not a hoax, because that call is directed to him through the DocCall platform of Sri Lanka Telecom Mobitel.
The Dawn of a new chapter in telemedicine in Sri Lanka thus becomes a reality with the DocCall tele phone advice service, a pio neer collaboration between SLMA and SLT Mobitel. Mobitel, as the National Mobile Service Provider, stands out with a distinct reputation for innovation, value and superior service. DocCall is a result of one such endeavor where the service is accessible for all active Mobitel subscribers
via the easy to remember short code 247 (standing for 24 hours a day 7 days per week) regardless of their connection type (i.e. Prepaid / Postpaid ). DocCall connects people from all walks of life from all corners of the country with a qualified doctor 24 hours a day 7 days a week in their preferred language for initial medical advice and guidance. Telemedicine is the use of Information Communica-
tion Technology to provide health care at a distance. It can enhance communication between a patient and a health care provider without the physical presence of both of them at one place. The most important aspect of telemedicine is that it is not intended to replace the traditional doctorâ€“patient relationship but to enhance existing mode of communication thus providing more opportunities for effective interaction between doctors and clients. Moreover, telemedicine can provide lifesaving information and guidance in an emergency. A survey of a group of customers who have already used the service has showed that 95 per cent of them were highly satisfied with the service provided. Furthermore, it was noted that the service is accessed by a diverse segment of customers all around the country ranging from teenagers to senior citizens, students to PhD holders and housewives to professionals. Analysis of calls received from clients since the commencement of the service revealed the stark reality of the unmet needs of traditional health care provision.
Why patients DocCall? Why patientscall call DocCall? Clarification on medical conditions
Sexually Transmitted Diseases
Questions on sub fertility
Interpretation of test results
Guidance on selection of a specialist
Feeding problems of children
7% 7% 5% 6% 5%
Who uses DocCall - Males or Females?
Contd. on page 18
Contd.from page 17
SLMA/Mobitel... Majority of calls received from male clients were on sexual problems ranging from erectile dysfunction, premature ejaculation and sexually transmitted diseases. Most of the callers had never talked to their doctors about the condition they suffered mainly due to ignorance, perceived â€˜stigmaâ€™ and embarrassment associated with having one-to-one discussions on sexuality. Hence they resort to receiving advice and obtaining care from quacks. One young client with premature ejaculation living in Tangalle had travelled several times to Colombo to see a so-called traditional healer bypassing many government hospitals and specialists merely because he was unaware of services and facilities available at local hospitals and was too shy to ask about it from anybody.
DocCall connects people from all walks of life from all corners of the country with a qualified doctor 24 hours a day 7 days a week in their preferred language for initial medical advice and guidance. 18
A considerable number of women with problems called into tell their problems to a doctor with the hope of finding a solution or to get guidance on finding the correct doctor for a consultation. The main problem in one such woman, who wept throughout the ten minute consultation, was that there was no one at home to listen to her problem, the doctor was successful in consoling her and directing her to seek appropriate medical care at the end of the conversation. People with so-called socially unacceptable illnesses and unable to find proper solutions to their problems due to stigma or ignorance become desperate and turn to quacks for help and end up losing health as well as wealth. With the help of the DocCall service people have the choice of receiving qualified medical advice without ever revealing their identity thus improving the chances of getting proper medical attention. Senior citizens, mostly with chronic illnesses are concerned about their diseases and the treatment received by them use of the DocCall service to ask many questions from a doctor to clarify their doubts, a need, they claim was not adequately fulfilled in their consultation with the doctor. The SLMA/Mobitel DocCall service has brought medical advice to the fingertips of patients.
Who uses DocCall - Age Group
Who uses DocCall Where do calls come from?
Patient Safety Programme at the Lady Ridgeway Hospital for Children
n August 2012 Lady Ridgeway Hospital for Children, Colombo 8 (LRH) started a training programme on Patient safety in collaboration with Government Medical Officers Association (GMOA) under the direction of Lady Ridgeway Hospital for Children, Certified Consultant in Medical Administration and Director, Dr Rathnasiri A. Hewage. So far 80 medical officers were trained using workshop materials called LEARNING FROM ERROR developed by WHO Patient Safety wing. Dr Santhushitha Senarathna, Dr Athula Wijesiriwardana and Dr P P Pathirage (Secretary GMOA LRH branch) facilitated the programme. Participation was very good. A Continuous Medical Education (CME) certificate and a copy of British National Formulary (BNF) were provided to all successful participants. Patient safety is one of the most important issues in healthcare. According to WHO, every year, tens of millions of patients worldwide suffer disabling
injuries or death due to unsafe medical care. In some instances healthcare has become as dangerous as the disease itself. According to World Health Organization (2008) nearly one in ten patients is harmed while receiving healthcare. It has become a global issue. In October 2004 WHO launched a patient safety programme in response to a World Health Assembly Resolution (2002) urging WHO member countries to pay the closest possible attention to the problem of patient safety. This underlined the importance of
patient safety as a global healthcare issue. There were efforts made in the past to introduce patient safety initiatives to Sri Lanka. At the intercountry meeting on Hospital Accreditation held at Bangkok, Thailand, from 7 to 11 December 1998, it was agreed by Sri Lankan representatives to draw up a national programme of hospital accreditation by March 1999, establish monitoring bodies for government and private sector by March 1999 and develop norms, standards/ indicators by June 1999. Then, the first regional
workshop on Patient Safety was held in New Delhi, India on 12-14 July 2006. Ministry of Health of Sri Lanka agreed to implement a system based on 2007 National Patient Safety Goals (NPSG) created by the Joint Commission International (JCI). But, So far no tangible patient safety initiatives have taken off the ground. Therefore, LRH Patient Safety programme has become important initiative. Also LRH is working with WHO and the Joint Commission International (JCI), which is WHO focal point for Patient Safety.
SLMA at the Commonwealth Medical Association International conference
ri Lanka Medical Association, Council Member; Kandy, Teaching Hospital, Medical Officer (Health Informatics); and Technical Committee of the National eHealth Steering Committee Member, Dr Saminda Dharmarathne, represented the Sri Lanka Medical Association at the Commonwealth Medical Association International Conference on Non-Communicable Diseases and the role of Information and Communication Technology (eHealth and mHealth) from September 14-16, 2012 in Chennai, India. The conference was attended by delegates from member countries from around the globe. Dr Dharmarathne made a presentation of eHealth and mHealth developments in Sri Lanka, which was well received. He was invited to chair the working group appointed by the delegates to come up with the final recommendations of the conference. The working group considered following in making their recommendations: Commonwealth National Priorities, Need for linking ICT and NCD, Governmentâ€™s role, Role
of National Medical Associations and Partnerships and Affordability Risk. The conference concluded with some key recommendations, which would be made public in due course. The SLMA understands that these recommendations would include the following: 1. Governments should formulate and implement policies and strategies favorable to the development of ehealth and mhealth. 2. Member countries need to adopt ehealth and mhealth policies that are tailored to their particular circumstances. 3. Governments should create appropriate legal, ethical and regulatory frameworks for eHealth and mHealth. 4. Adequate funding should be set aside by Governments and other stakeholders in order to implement ehealth and mhealth in their countries. 5. Governments should involve National Medical Associations, healthcare providers and all relevant stakeholders in the initiation and implementation of ehealth and mhealth policies in member countries 6. National Medical
Dr Saminda Dharmarathne addressing the conference
Associations should take the lead in advocacy, collaboration and research towards promoting ehealth and mhealth in their respective countries. 7. The concept of ehealth and mhealth should be incorporated into the curricula of medical and paramedical education and training. 8. In recognition of the importance of ICTs in strengthening health care systems, affordable and
accessible ICT technology should be developed with user friendly and compatible software 9. Public and private healthcare providers should work together to promote ehealth and mhealth. The SLMA wishes to congratulate Dr Saminda Dharmarathne for representing the SLMA and Sri Lanka with distinction at this conference.
Contd.from page 08
SLMA Expert Committee... Community level interventions The Committee is currently involved as the main technical partner in a government – nongovernment initiative to implement effective community level action in underserved settlements in Colombo. This programme is now active in around 140 such settlements. The agencies involved are NATA, Colombo Municipality (CMC), National Dangerous Drugs Control Board (NDDCB) the Urban Settlement Development Authority (USDA), Samurdhi Authority, Alcohol and Drug Information Centre and Sri Lanka Sumithrayo. The Committee was involved in the development of the overall implementation strategy and provided training for around 120 field workers of USDA, CMC, NDDCB and Samdurdi Authority for this purpose. Technical guidance on monitoring and evaluation is provided for this programme by the committee through a technical steering committee.
Education Sector activities This year, the Ministry of Education initiated a formal process of institutionalizing drug and alcohol demand reduction in the education system on the request of this Committee. A meeting was convened with other agencies involved in drug and
alcohol related work such as NATA, NDDCB, Departments of Excise and Police, and Alcohol and Drug Information Centre for this purpose. The Minister of Education and the Secretary, Ministry of Education also participated at this meeting. The Committee outlined the technical requirements of an effective and sustainable programme for reducing demand for drugs and alcohol in school children. It was decided that a manual for teachers to be developed and a programme to be implemented in selected schools, as a first step. The committee supported the development of the outline of this manual. This process is on-going. The Committee, in collaboration with the National Drug Policy Operations Unit, Government of Sri Lanka, conducted technical trainings on drugs and alcohol demand reduction in school environments for student teachers of 11 of the 18 National Colleges of Education, in both English and Sinhala mediums during 2012. During this process over 1,000 student teachers were trained to carry out technically sound and sustained drugs and alcohol demand reduction activities in schools. Steps are being taken to make this an annual training to ensure each batch leaving the Colleges is trained. This was in addition to a prior activity of the
Committee, which provided training for over 100 teachers and principals in the Kurunegala district. This was carried out in parallel to conducting discussions on the determinants of tobacco and alcohol use and how these can be addressed, with students of three schools in Colombo.
Media Advocacy During the past two years, the Members of the Committee have participated in several live television broadcasts discussion issues related to tobacco alcohol. In addition, the Committee was also invited to be a part of the technical resource group at the press briefing conducted by NATA on the optimum taxation of tobacco products in Sri Lanka, which received wide coverage in both the print and electronic media. The Committee was also the technical resource at the media briefing, which introduced the guidelines on portrayal of the use of tobacco and alcohol in media, conducted by the Ministry of Media and NATA. Members also participated as speakers in the World No Tobacco Day Workshop for journalists conducted by the Health Education Bureau last year.
SLMA and other one-off activities The Committee conducted a symposium on Tobacco and Alcohol use
during the SLMA Foundation Sessions held in Batticoloa. A presentation on issues related to smokeless tobacco was made at the SLMA Regional Summit on NCDs in Galle. A Clinical Lecture Demonstration on oral tobacco use was conducted in January 2012. Members of this Committee were also involved in the processes of identifying research priorities on alcohol, for implementation by the United Nations International Children’s Fund (UNICEF) for 2012 -2013. Members of the Expert Committee on Tobacco and Alcohol are Prof. Narada Warnasuriya (Chairman), Dr Hemantha Amarasinghe, Dr Nadeeka Chandraratne, Dr Manoj Fernando (Secretary), Dr Ravindra Fernando, Dr Sameera Hewage, Dr Sajeeva Ranaweera, Dr Mahesh Rajasuriya and Dr Nayani Suriyarachchi
The Committee is currently involved as the main technical partner in a government – nongovernment initiative to implement effective community level action in underserved settlements in Colombo.
SLMA Ethics Committee This article is continued from the SLMANews August issue.
Case No 5 - Serious professional misconduct: A complaint by a female patient An article written by a patient about the indecent behaviour of an urologist during a consultation was posted on the social networking website Facebook. This was followed by emails. Later the patient met the medical director and a verbal complaint was made. The incident was referred to the ethics committee for investigation and report.
Question: Was there serious professional misconduct in the behaviour of the doctor?
The SLMC Instructions on Serious Professional Misconduct explains that the trust placed upon a doctor is breached if he/ she enters into an emotional or sexual relationship with a patient (or with a member of the patient’s family), which may disrupt the patient’s family life or otherwise damages or causes distress to the patient or his or her family. The Hippocratic Oath (470-460 B.C.) also mentions this thus: “Into whatever houses I enter, I will go into them for the benefit of the sick and abstain from every voluntary act of mischief and corruption, and, further, from
the seduction of females or males, of freemen and slaves”. The ethics committee obtained a written complaint from the patient “A”, a written explanation from the doctor “U” about the incident and examined the patient’s OPD clinic file. The Complaint: Patient “A” consulted Doctor “U”, an urologist, with her husband for “an infection that was constantly irritating my bladder”. During the consultation the doctor “checked my genitals for possible infections; spent
an unusual (long) time in doing so; discussed irrelevant facts in doing so; observed private parts of my body; discussed topics such as sex with me and sat around looking confused; and moved his fingers across my body (in a manner), which made me feel was not normal.” After the consultation “when I walked out of the hospital I mentioned to my husband, an expatriate, how uneasy I felt during the consultation and he mentioned that he too felt the same way.”
She made another visit one week later, this time accompanied by her brother. On that day “U” had wanted her brother to leave the consultation room, which she stated, was done with the intention of “isolating her”. No physical examination was done but “an inappropriate conversation took place.” After that she decided to write about these incidents in Facebook and two weeks later complained to the hospital. Contd. on page 28
September, 2012 Contd.from page 26
SLMA Ethics... The Inquiry “U” denied all charges and maintained that “A” had consulted him for dyspareunia (painful sexual intercourse). The urologist “U” had entered the presenting complaint in the OPD clinic file as “recurrent episodes of dysuria ever since her marriage. Symptoms come on with sexual intercourse. Plenty of discharge from the private area. Dyspareunia.” On the same day as the initial consultation “A” had consulted a gynaecologist who had documented the presenting complaint as “Dyspareu-
nia” and had observed a fibrous ring causing a tight introitus and had recommended “Fanton’s operation” to loosen the vagina. This consultation was not mentioned by the patient in her complaint. The committee in its report stated that they were not inclined to believe “ A’s” complaint for the following reasons: • Her presenting complaint was not dysuria but dyspareunia (confirmed by another consultant). • During the first consultation, during which most of the incidents complained of took place and when a physical examination took place, her husband had been present inside the
consultation room. If they had felt “uneasy” why didn’t they protest at that time or soon after to the management? Despite a traumatic first visit, “A” came for follow-up a week later, and this time without her husband! • Why did she conveniently forget to mention that she had met a gynaecologist too? If she felt abused at the initial consultation she had the option of not meeting “U” for the second time; and she should have followed the recommendations of the gynaecologist or met another consultant. • Without complaining to the hospital or some other authority why did she decide to describe her experiences in Facebook, even mentioning the consultant’s name? Was it with malicious intent? • Could such behaviour on the part of After a tea break, Dr Sarath Gamini de Silva and Dr Malik Fernando jointly chaired the final free discussion. There was a consensus expression that Clinical Ethics Committees are necessary, required and timely for all large hospitals. Subsequent discussion centred on the composition of such committees (administrative head of the institution a member
the patient be called unethical? Do the principles of ethics apply only to doctors? The ethics committee ruled that based on the results of the inquiry it did not find evidence to substantiate the accusations of the patient against “U”. However, despite the negative findings of the committee “U” was issued with a letter of reprimand by the management. The ethics committee, which had been working in a voluntary capacity for 5 years, resigned over this issue in February of 2009.
of the committee or not?) the types of issues it would engage in and how the process of establishing such committees should be pursued. It was generally felt that Clinical Ethics Committees should be established according to agreed guidelines and that these should be sanctioned and supported by the State. Dr Malik Fernando stated that the SLMA EC was willing to give leadership in establishing these guidelines. Dr H. R. U. Indrasiri from the Health Department said that a decision regarding this issue could only be taken after it was discussed at Ministry level and invited the SLMA EC to make a proposal. He agreed to work jointly with the SLMA EC to map the way forward. Contd. on page 30
Contd.from page 28
SLMA Ethics... This would be done at future meetings where the issues would be clarified and a proposal to the Ministry would be drafted setting out the aims and objectives of CECs, their composition, subject areas and associated matters. Important matters that were raised during discussion following the case presentations and the free discussion are as follows: 1. SLMC guidelines need to be expanded to comprehensively encompass anticipated ethical dilemmas thereby reducing, if not eliminating, the need to refer to GMC guidelines. 2. ‘Research Ethics Committees’ in hospitals were set up in an “ad hoc” manner by ministry circular without any guidelines, terms of reference or recommendations on required training. This should not be the case with CECs. 3. Opinion was divided on whether the same committee should carry out the functions of clinical ethics and re-
search ethics. Some felt that too many committees could mean poor participation by members. Others felt that clinical ethics consultations should be available 24/7, at least by phone, and therefore that CECs would have ample work and should be separate. It was pointed out that the expertise needed for each committee was different. 4. The view was expressed that research ethics review should be taken out of the hospital and established in nationally recognized centres such as the Faculties of Medicine, SLMA and MRI as such review is becoming increasingly specialized and the documentation and expertise required could not be provided by a multitude of committees. The CECs, however, will be hospital-based and provide clinical ethics services. Therefore discussion about setting up such committees should encompass both types (and possibly professional ethics committees) and a national model should be adopted, after wider consultation of all stakeholders, with leadership to be taken by the Ministry. SLMA Eth-
ics Committee and FERCSL (Forum of Ethics Research Committees of Sri Lanka) to contribute expertise. 5. CECs should be advisory to the administration and therefore the head of the institution should, ideally, not be a member. However, recommendations of the CEC will be implemented by the administration when necessary. Hospital administrations that appoint CECs should respect the decisions of such committees. There should be a mechanism for resolving differences of opinion between the two parties. 6. Routine clinical ethics consultation decisions do not have to be reported to the administration. 7. CECs should be set up as mandatory committees by a directive from the Ministry as a part of national policy. This will give them sufficient authority. 8. Clinical ethics consultations should be available to doctors, health care workers and patients and their families to provide advice on ethics issues. 9. The Ministry representative expressed caution that the line of demarcation
between ethics issues and administrative issues must be clearly drawn so that the CEC do not become patient grievance committees. They should be consulted in exceptional circumstances where major ethical issues are involved. 10. There was no consensus as to whether CECs should also deal with breaches of professional ethics. Some felt that this should be dealt with by the Colleges and by the administration. 11. As the committees would have no legal status a lawyer should be included to ensure the committee acts within the law. The SLMA would value your observations/comments on the matters discussed in this report. Please send your comments please email to email@example.com or write to Chairperson, Ethics Committee, Sri Lanka Medical Association, 6 Wijerama Mawatha, Colombo 7.
The official news paper of the Sri Lanka Medical Association