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SLMANEWS

THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION

July 2013 Volume 06 Issue 07

President's Column It is with a profound sense of satisfaction and perhaps even a notion of relief that I write this message for the July Newsletter. The main activity in July was the 126th Anniversary Scientific Medical Congress. The general proceedings started with the Pre-Congress Workshop on the 4th of July 2013 at the National Institute of Health Sciences, Kalutara. The “SLMA Health Run & Walk” on the 7th of July 2013 succeeded as a prelude to the 126th Anniversary Scientific Medical Congress. It was attended by the Hon. Minister of Health, Secretary to the Ministry of Health, Director General of Health Services and approximately 2000 participants including doctors, allied healthcare workers, general public and children. The 126th Anniversary Scientific Medical Congress was held at Waters Edge, Battaramulla. There were nine PreCongress Workshops attended by a total of around 1069 participants. The Inauguration Ceremony of the main congress was held on 10th July 2013 with Professor Sir Sabaratnam Arulkumaran, President, British Medical Association as the Chief Guest and Dr. Firdosi Rustom Mehta, Resident Representative of the World Health Organisation as the Guest of Honour. This event was attended by 475 participants. During the entire congress there were three Breakfast Sessions attended by a total of 194 participants. Around 295 participants registered for the Main Congress. The proceedings included a Keynote Address, two Principal Symposia, three Luncheon Events including a Debate, 14 Parallel Symposia, 6 Parallel Guest Lectures, 8 Free Paper Sessions. The proceedings concluded with the Banquet on the 13th July 2013 attended by 168 participants. I am ever so grateful to all those who helped and particularly to the Steering Committee for facilitating all the arrangements. It is hoped that we managed to serve up a reasonable collection of academic fare for each and every one of the participants. However, it is acknowledged that those who took part in the proceedings would be the judges and the jury. The ultimate privilege of making the final assessment would rest entirely in their hands. With the very best of wishes.

Contents Page No.  Citation Read out for Professor Sir Sabaratnam Arulkumaran

02

 SLMA sessions 2013 – awards for free papers

03

 Professor Sir Sabaratnam Arulkumaran’s speech  SLMA Health Run and Walk 2013

04 14

 Inauguration of the 126th Anniversary Scientific Medical Congress

16

 Winners of the prizes and awards

17

 Snowden’s Leak  

24

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SLMANEWS

July, 2013

Citation read out for Professor Sir Sabaratnam Arulkumaran

O

ur Guest of Honour, Dr. Firdosi Rustom Mehta, Chairperson and Members of the Board of Trustees of the Sri Lanka Medical Association, Past Presidents, Members of the Council and Members of the Sri Lanka Medical Association, Distinguished invitees,

he was more interested in sports. He represented the University in soccer, basketball, hockey and athletics, won University Colours in Hockey and Basketball, Captained the University Basketball team and the Faculty Soccer Team. He qualified with MBBS 2nd Class Honours 1972.

It gives me great pleasure to present to you, albeit rather concisely, an amazing academic and a perceptive clinician in the form of Professor Sir Sabaratnam Arulkumaran MBBS (Cey) Hons., DCH (Cey), LRCP-MRCS (UK), FRCOG, FRCS Edin., FAMS (Sing), MD, PhD, Hon. FSOGC, FACOG, FSCOG, FCPS, FSACOG, FSLCOG, FICOG and FDGG.

From then onwards, it was a spectacular rise, in a career adorned with rare achievements. It started with the FRCS (England) LRCP & MRCS in 1979 and the MRCOG in 1980. Then a sojourn in Singapore, and ending up in the United Kingdom. He is the first Sri Lankan born Professional, to be elected as President of the Royal College of Obstericians & Gynaecologists in the UK and the President of FIGO, the highest world bodies in Obstetrics and Gynaecology.

He is currently the President of the British Medical Association and is undoubtedly one of the most celebrated Sri Lankans. He is known the world over as a remarkable scholar, who has made a lasting impact on medicine in general and women’s health in particular. It would be a daunting proposition to even outline his marvellous achievements and his contribution to the health of women in the world. However, I am duty-bound to attempt the impossible. Just to illustrate the virtual impossibility of this onerous task, it is noteworthy that his name without the prefixed titles of honour has just 21 letters, with those titles, it goes up to 33, but just the academic degrees after his name run up to another extra 94 letters. Young Arulkumaran had his early education at St. Michael's College, Batticaloa, then at Jaffna Central College till 1965 and finally at Mahajana College, Tellipallai. From there, he entered the Faculty of Medicine, University of Colombo in 1967. He was an all round student in the faculty but not someone who shone like a model prodigy of a great career in the years to come. In those days,

2

He has over 250 publications in internationally indexed journals, 74 invited articles and over 150 Congress Abstracts. He has edited or authored over 30 books and delivered over 500 lectures right round the globe. He is a Reviewer or a Referee, an Editorial Member or the Editor of over 15 Scientific Medical Journals. In 2009, he was conferred the title, Knight Bachelor of the Most Excellent Order of the British Empire from Her Majesty, Queen Elizabeth the 2nd, for Services to Medicine. The London gazette on that day described him as “The most forward thinking Medical Leader in the United Kingdom”. We are all so proud of you Sir Sabaratnam as the last conferment of the title Knight Bachelor of the British Empire for a Sri Lankan doctor was, on Sir Nicholas Attygalle, way back in 1953. Originally hailing from a little village known as Kantharmadam, in Jaffna, Professor Sir Sabaratnam Arulkumaran has risen to one of the highest positions in the world, in his chosen field of Obstetrics & Gynaecology. Throughout a life, lived to the fullest, he has made several areas of the world his own patch, to produce and

Professor Sir Sabaratnam Arulkumaran

leave behind, a legacy of outstanding contributions to the health of the Homo sapiens. It has been said that the crest jewel in the crown of a man’s success in life, is his family. Prof Arulkumaran is married to Gayathri, the daughter of one of the most eminent Obstetricians of Sri Lanka, the late Dr.A.G. Mututhamby and Mrs. Muthuthamby. Arul and his charming wife are blessed with a daughter who is an Obstetrician & Gynaecologist, and two sons, a Physician and an IT specialist, all working in the UK. During his medical student days, he stayed in the Bloemfontein Men’s Hostel. That is where I first met him. He was a friend to everybody around and was a delightful person in all his dealings. Then he and I were in adjoining residential rooms at The Lady Ridgeway Hospital for Children. He has been a much respected and admired friend of mine, for just over four decades. His gentle nature and kindness are indeed very well known. William Wordsworth, the great English romantic poet once said “The best portion of a good man's life: his little, nameless, unremembered, acts of kindness and love”. Arul is living testimony to those immortal words. Contd. on page 03


SLMANEWS

July, 2013

Contd. from page 2

Citation Read...

Though there are many qualities in his life which we admire, the most outstanding one of them all is his simplicity. That trait is quite evident by the fact, that he still wants all of us to call him, not Professor Sir Sabaratnam Arulkumaran but just simply as “Arul”. Professor Sir Sabaratnam Arulkumaran.., by virtue of the powers

vested in me as The President of the Sri Lanka Medical Association, and based on a resolution ratified by the Council and the General Membership of the Sri Lanka Medical Association, I am now delighted to present to you this Scroll of Honour conferring on you Honorary Life Membership of the Sri Lanka Medical Association, the highest honour that this great

institution is authorized to bestow by its statute, and the equivalent of a lifetime achievement award. Ladies and Gentlemen, I present to you, Professor Sir Sabaratnam Arulkumaran, Honorary Life Member of The Sri Lanka Medical Association and most cordially invite him to address the audience.

SLMA sessions 2013 – awards for free papers

A

large number of abstracts on diverse topics were received for free paper presentations at the 2013 sessions, signifying the enhanced interest in research among the medical and health professions community. Upon scientific review 42 abstracts were selected for oral presentations and 82 abstracts were selected for poster presentations. All papers excluding 6 posters were presented at the sessions. The eminent panel of judges commented that most papers were of high quality. The following winners of the free paper awards were announced at the SLMA Banquet.

E M Wijerama prize Randomised clinical trial comparing prednisolone and ACTH in reversal of hypsarrhythmia in untreated epileptic spasms J Wanigasinghe, C Arambepola, GM Attanapola, LSD Liyanage, CB Liyanage, PSK Silva, PKSJ Kankanamge, S Sumanasena, S S Ranganathan, B Dissanayake, M E C Muhandiram

S E Seneviratna Prize Defining obesity in children using a biological end point VP Wickramasinghe, C Arambepola, P Bandara, M Abeysekera, S Kuruppu, P Dilshan, BS Dissanayake

WMH Wijesundara, R Hanwella, J Mendis, VA de Silva

Sir Nicholas Attygalle Prize Geographical Information Systems (GIS) for monitoring of Millennium Development Goal 5 (MDG): a Study from Badulla district PVDS Dharmagunawardene, HMJR Herath, NSR Hewageegana

Wilson Peiris Prize A new people-friendly epidemiological approach to confirm the elimination of lymphatic filariasis in Sri Lanka TC Yahathugoda1, MVWeerasooriya, F Nagaoka, H Takagi, E Kimura, WA Samarawickrema, M Itoh1

SLMA Price for Best Poster Knowledge, attitudes and practices regarding type 2 diabetes mellitus, nutrition and lifestyle in urban Sri Lankan women I Waidyatilaka, PHIU Waidyatilaka, A de Silva, S Atukorala, N Somasundaram, P Lanerolle, R Wickremasinghe

Sir Frank Gunasekera Prize for the best paper in Community Medicine & Tuberculosis

H K T Fernando Prize

Community incidence of snakebite in the Anuradhapura district

Intramuscular haloperidol vs. olanzapine for rapid tranquillization: a double blind randomised controlled trial

A Kasturiratne, NK Gunawardena, BA Wijayawickrama, SF Jayamanne, A Pathmeswaran, G Isbister, A Dawson, HJ

de Silva

Kumaradasa Rajasuriya Prize for the best paper in Tropical Medicine Meeting challenges of microscopic diagnosis in malaria surveillance under field conditions in Sri Lanka SD Fernando, RL Ihalamulla, J Tillekeratne, R Wickremasinghe, P Wijeyaratne, NL de Silva, R Premarathna

Special prize in Cardiology Audit on timelines for administration of acute reperfusion therapy in acute ST elevation myocardial infraction at the National Hospital of Sri Lanka AK Pathirana, WS Santharaj, RAI Ekanayake, JB Jayawardena, V Senaratne, MP Seneviratne, KKAO Walawwatta, KGV Saranga

S Ramachandran Prize for the best paper in Nephrology Differences in estimation of glomerular filtration rate using three standard formulae in selected type 2 Diabetic patients NN Wijayatunga, PPR Perera, K Wanigasuriya, H Peiris

Daphne Attygalle Prize for the best paper in Cancer – Not awarded The SLMA wishes to thank all participants, reviewers of the abstracts, and judges of the free papers.

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SLMANEWS

July, 2013

Professor Sir Sabaratnam Arulkumaran’s speech as the Chief Guest at the 126th Anniversary Scientific Medical Congress of SLMA - 2013

I

t is a great pleasure and privilege to be the chief guest for the 126th annual scientific sessions of SLMA in 2013 for several reasons. The first reason is that I am a Sri Lankan having regular ties with the Sri Lankan College of Obstetrics and Gynaecology for several years and it makes me happy that I will be able to do that with the SLMA too. The second reason is the ties that the SLMA has with the British Medical Association (BMA) in which I am the incumbent President. The SLMA started as the Ceylon branch of the BMA on 17th December 1887 with 65 members and Dr PD Anthoniz as the first President. The idea of forming this branch was mooted by Sir Kynsey in February 1887. It became the Ceylon Medical Association in 1951 and with the birth of the Republic of Sri Lanka it became the Sri Lanka Medical Association in 1972. Probably as the first Sri Lankan President of the BMA, I am happy to be here and bring greetings to you from the chief officers and members of the BMA. The third reason is that Dr BJC Perera, current President of SLMA and I shared adjacent rooms with a common bathroom at Lady Ridgeway Hospital for Children many years ago as junior doctors – we called ourselves the ‘bathroom mates’. He was senior and I was a house officer to Prof Priyani E Soysa. We had a strong friendship and I had great admiration for his professional wisdom. The fourth reason – The SLMA is the most influential medical professional organisation in Sri Lanka, true to the word as indicated in your vision statement; it humbles me to be invited by you. Your members look after the health of the Nation admirably. Without your help there will be no health, wealth or happiness in mother Lanka. You should be proud of the SLMA as it is held in high esteem nationally and globally.

4

Internationally, there has been a spate of adverse publicity about health care at clinical, managerial and organisational level. We need to rectify the shortcomings and stand up to the challenges as indicated in the theme of your conference ‘Safety and Quality’. Your President in his induction speech expressed this. Every one of us will face the health care provided by our country at some stage in our lives. If we want the best for us, then we have to do our best individually and collectively and as an organisation we should strive to further enhance the safety and quality of health care we provide. Mahathma Gandhi said ‘If you want a change you should be the change’. To provide the best care to patients, our knowledge, skills and attitudes has to be the best and that is what the SLMA is doing day after day - engineering better CPD programmes, guidelines and ethical codes of practice for you to provide the best care. These are actions of the SLMA as witnessed by me from your web site and as stated in your mission statement. My best wishes for you to continue this march for the best care for your patients. The introduction of the Sri Lankan clinical trials registry by the visionaries of your organisation will take you further; research today is practice tomorrow and I wish you well in this endeavour. The image of the SLMA as a great organisation within Sri Lanka and globally should continue. This can be done by highlighting what you do at work, outside work and by advocacy. To maintain this respect, the SLMA should have continuous interactions with four groups of people - its members, the public, the politicians and sister organisations globally. Membership issues are the core functions of the SLMA, but the public civic-based activities gives you a better professional image, attract your members and gain the support from the public. I would like to explore four avenues

that I proposed for the BMA for you to consider to help maintain your good reputation. These proposals should also help the population you serve nationally and in some activities you can work in partnership with your sister organisations. The first activity is a simple survey for building your image and to promote voluntary activity for the betterment of your society. Hundreds of SLMA members spend days, weeks and months on voluntary activity nationally and globally in clinical and non-clinical activities. They do this on their own goodwill as individuals or through various charities. With a simple electronic questionnaire it will be good to capture the number of days per year they spend on such activities and information on the specific activities. I hope this would come to thousands of days per year. If it is the case you should publicise that information for the public and the politicians to recognise the good things done by the members of the SLMA. They should talk about the good things your members do at the sacrifice of their own time, energy and money rather than talking negatively about the members of the SLMA. If the information obtained suggests that you as members of SLMA are not volunteering part of your time for public good you should explore avenues as to how the SLMA can catalyse such activities. The second and third activities, I would like you to consider is national and international advocacy and action for climate change and non-communicable diseases (NCDs). The BMA would be happy to work with you on these issues. The BMJ under the leadership of Dr Fiona Godlee provides science and messages for advocacy and action. The same is true of the SLMA Newsletter and Ceylon Medical Journal and advocacy messages could be enhanced. Contd. on page 06


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SLMANEWS

July, 2013 Contd. from page 04

Professor...

These activities on climate change and NCDs should help us to improve national and international health. Climate change by the greenhouse effect is a killer of the human race. The vast changes in the climate lead to the tsunami and thousands of deaths, in Indonesia, Thailand and Sri Lanka. The recent smoke and smog affecting Indonesia, Singapore and Malaysia by the deforestation in Sumatra by the slash and burn technique to clear lands for agriculture has created havoc - affecting the health of all and the lives of the elderly in addition to a major indent in the economy in these countries. SLMA should work with sister associations and colleges to advocate steps to reduce global warming.

By not acting collectively with our sister international organisations, our generation is said to be stealing the environment from our future generations. The editorial of BMJ last week states that asthma inhalers are responsible for 2 million of the 20 million tons of CO2 equivalent greenhouse gases that the NHS emits annually. That is the equivalent of the CO2 emitted by Estonia. Dry powder inhalers can be substituted in nearly all cases. All that is needed is a change in doctors’ prescribing habits. The NHS Sustainable Development Unit, British Thoracic Society and Lung Foundation are working on this issue by building an alliance. The SLMA could lead the campaign to bring about a change in prescription habits to tackle this issue. We need to engage with major pharmaceutical companies and our sister international organisations to tackle this problem. Health organisations are major consumers of energy and use fossil fuels as the main energy source. All health organisations in the world should work towards the goal of using 100% renewable energy. Solar energy is found in plenty in Sri Lanka and SLMA should moot activities with the government to achieve this.

6

The third issue is about non-communicable diseases, especially obesity and awareness of its adverse consequences as mentioned by Dr BJC Perera in his Presidential Message in the SLMA website. Tackling the seven S’s reduces NCDs but do not eliminate it. The seven S’s are sugar, salt, saturated fatty acids, sedentary life, spirits in excess, smoking and starvation of nutritious food. Obesity is a ticking time bomb for health as it leads to diabetes, infertility, cardiovascular, liver and other diseases. There is a contribution of Nature and Nurture to obesity. Barker proposed fetal origins of adult diseases two decades ago. A baby born with a smaller birth weight or born preterm is more prone to syndrome X of diabetes, liver, cardiac and other system disorder and faces premature death. This is thought to be due to less angiogenesis and tissue mass in all the organs. The process is exacerbated if the small for dates or preterm babies are overfed and become obese. Current studies indicate the importance of epigenetics at the time of conception and afterwards due to nutritional factors as a major contributor to obesity and stress the importance of the first 1000 days from the day of conception. Good birth weight, avoidance of prematurity, breast feeding, appropriate childhood and adolescent nutrition through to pregnancy is important to break this cycle; hence the need for good nutritional advice for the adolescent, for the mother and children in school. I believe a simple proposal like a ‘square plate concept’ with each quarter of the plate providing equal proportion of carbohydrate, proteins, vegetables and fruits may do the trick to promote a healthy diet (provided the plate is of standard size and there is no second serving!). This can be practised in our own lives and passed on to our patients. Healthy eating reduces NCDs but also helps with the climate change agenda. One day a week vegetarian food consumption helps with climate change as the land area

needed for cultivation of vegetables to feed a certain number of individuals is hundred times less than the land needed to grow animals for red meat. The same goes with the promotion of walking, cycling and public transport that reduces NCDs and helps with the climate change agenda. The fourth activity I would like you to explore is the rights based approach to health care by education. Provision of care based on the principles of human rights would enhance the care given to our patients. The knowledge should be imparted at the formation stages of a doctor when they are in the medical school. The international Federation of Gynaecolgy and Obstetrics (FIGO) have created a syllabus and curriculum and several case examples on rights based approach to women’s health. I have proposed the Student BMA to take over the educational aspects of this curriculum to continuously disseminate the information in their own medical schools. We hope to engage 2 to 3 motivated medical students and a teacher who are members of the BMA, from each medical school in the UK and have a workshop using the FIGO curriculum. We hope to facilitate this internationally by partnering with donor community. The workshop would train the medical students and the teacher as trainers who would then disseminate the information to the rest of the medical students in their school. A monitoring and evaluation mechanism would be developed to identify its effectiveness. Such education would enhance the safety and quality of care given with self-respect and dignity. Delivery of rights based approach to care can be seen in the FIGO web site and that of a free educational platform, the global library of women’s medicine i.e. www.glowm.com. I am grateful to you for providing me the enormous privilege of being the Chief Guest of this prestigious conference. Thank you.


Contd. on page 12

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SLMANEWS

July, 2013

SLMA HEALTH RUN AND WALK 2013

An inclusive walk

The Hon. Minster and his team spent their Sunday morning promoting healthy walking

Dr Sanjeewa Gunasekara the chief organiser of the walk and run explaining the facts to the Hon. Minister

A happy moment for the President

A healthy bowl

of Kolakenda

They contributed in many ways

The treasurer Dr. Hanifa flaging off the event An exctiting ending. the Sports Minsitry officials lending a helping hand to orgniase the health run

Other colleges joined hands

They all joined us

The President with the distingueshed invitiees

First aid for the participants Our partners

Yoga for all Yoga session

14

Contd. on page 18


SLMAN

July, 2013

Inauguration of the 126th Anniversary Scientific Medical Congress

Professor Sir Sabarathnam Arulkumaran was hournored with the SLMA life membership

Lighting of lamp of learning by the chief guest.

SLMA oration by Vidyajyothi Prof. Janaka de Silva

16

SLMA oration by Vidyajyothi Prof. Janaka de Silva

Cultural show “ Thelme Dance� adding colour to the Inauguration


NEWS

July, 2013

Winners of the research grants and award

17


SLMANEWS

July, 2013 Contd. from page 18

SLMA Run...

Our sponsors

Physiotherapy exercises by the Allied Health Sciences Unit, Faculty of Medicine Colombo Contribution by the College of Pulmonologists

Lung function testing was a hit

President handing away the prizes

Tokens of appreciation to our partners

Prizes given away by the sponsors

the vice President awarding the gifts distribution of prizes

They compered

Dr. Prabath Gunawardena, the star amongst stars

team work pays back

18

Full of smiles


SLMANEWS

July, 2013

SNOWDEN’S LEAK   After the bombshell dropped through Wikileaks

Comes in its wake the story of another leak

Snowden of the CIA made the exposure

That upset more the allies’ composure

Angela and Hollande on this side of the Atlantic

Sent calls to Obama, urgent and frantic

The revelations by Snowden are clearly unacceptable

Is this the behaviour of a friend honourable?

Now that there is no more a cold war

Why are friendly countries being spied for

Don’t you consider us as your allies Or are we reckoned as Soviet satellites? Admissions are made that it is a common practice

Bugging and spying continue-let diplomats be at ease!

Even among friendly nations how they dare

Is it that in love and war everything is fair!

To understand the world better we need his type of information

Says Obama, we will answer your spying allegations.

No trade talks, transactions or negotiations ever

European allies may decide whether friendship to sever

Snowden is hero or villain we are compelled to decide

The audience he received was necessarily worldwide

Should a government intrude into citizens’ privacy,

And citizens give in to a state’s piracy?

I wish Snowden is given asylum in a country free

Breaking only man made laws he need not flee

Don’t subject him to inquiry through a moralist’s scan

Can I say, go my friend, you are a free man!

Dr. Nanda Amarasekera Member, SLMA  

24

Winners of the awards for free papers


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July, 2013

SLMANEWS



SLMAnews 2013 07