Managing and moulding a medical school
Book review
Developing a Medical School- Concepts, Constraints and Challenges'
by Prof. M. T. M. Jiffry. Reviewed by Carlo Fonseka.
Professor M. T. M. Jiffry, Founder Dean of the Faculty of Medical Sciences
of University of Sri Jayewardenepura, has completed almost six years as
the Dean of the Faculty. Recently, at the Inauguration of the Fifth Annual
Scientific Sessions of the Faculty of Medical Sciences, the above book
authored by Prof Jiffry was launched.
Prof. Jiffry has used his medical educational expertise combined with
his managerial abilities into practical strategies in moulding this developing
medical school towards its present status. He has described this process
in five chapters. Professor Jiffry methodically deals with the especial
nature of a medical school - the main functions of a medical school and
the attributes of its product, namely the health care professionals are
spelt out.
Although in administering a medical school, we may carry out certain
important acts, Prof Jiffry has diligently categorized into 14 areas the
activities involved in the administration of a medical school. He defines
Medical Education as a discipline that adopts a scientific and cost-effective
approach to initiate, implement, monitor and review the learning/teaching
exercises adopted in a medical school to produce a graduate who is motivated
to carry out self learning and competent to fulfil the current health needs
of society.
He highlights the key issues recommended for implementation at global,
regional, national and institutional levels. The attention of the medical
educationists is drawn to the role of five key stakeholders in health care
as conceptually accepted by the WHO in its TUFH (Towards Unity for Health)
declaration; they are the policy makers, health managers, health professions,
academic institutions and the community it serves.
The details of the process of development of the Faculty of Medical
Sciences of University of Sri Jayewardenepura are then described. One of
the key areas amongst the fourteen subheadings which attracted my attention
was 'Management and Organizational Health' of an institution. Here, in
addition to the commonly addressed issues such as curriculum, students,
funds, research and service functions etc. associated with a Medical School,
the concept of management has been stressed. This issue has been addressed
fully and very thoroughly.
Prof Jiffry elaborates the strategies he had adopted in the development
of human resources associated with a medical school and its curriculum.
The problems, successes, failures, frustrations and constraints as well
as criticisms are discussed at length. An attempt is made to sensitise
readers to these aspects. The last chapter concentrates on the present
constraints and the future perspectives.
The entire book is written in a concise and logical manner encompassing
the salient issues related to medical education. In his prologue Prof Jiffry
states that "In this booklet I have attempted to briefly describe the underlying
educational principles and managerial concepts on which I have based the
strategies, the way they were implemented overcoming constraints and challenges.
.." and "I believe my writing about what I have experienced and executed
in developing this medical school would serve as resource material to someone
in the future."
Amen, I say.
No need for Anthrax panic in SL
Older medical textbooks refer to Anthrax as Malignant Oedema or Woolsorters'
Disease. It was all but forgotten until it recently hit the headlines in
the United States, raising suspicions that its sudden spread was deliberate
biological warfare rather than an epidemic. But are we in Sri Lanka really
at risk from Anthrax and if so, what can we do?
Anthrax is an acute infectious disease caused by the spore-forming bacterium
Bacillus anthracis. Anthrax most commonly occurs in warm-blooded animals,
but can also infect man. Anthrax spores can be produced in a dry form which
may be stored and ground into particles. When inhaled by humans, these
particles cause respiratory failure and death within a week, if not treated
satisfactorily. This is the form of Anthrax that is causing all the current
controversy.
Symptoms of disease vary depending on how the disease was contracted,
but symptoms usually occur within seven days of infection. Most anthrax
infections occur when the bacterium enters a cut or abrasion on the skin,
such as when handling contaminated wool, hides, leather or hair products
(especially goat hair) of infected animals. Skin infection begins as a
raised itchy bump that resembles an insect bite but within days develops
into a vesicle and then a painless ulcer, with a characteristic black area
in the centre.
Lymph glands in the adjacent area may swell. About a fifth of untreated
cases of cutaneous anthrax will result in death. Deaths are rare with appropriate
antibiotic therapy.
The bacteria may also be inhaled. Initial symptoms may resemble a common
cold. After several days, the symptoms may progress to severe breathing
problems. Inhalation of anthrax usually results in death in 1-2 days after
onset of the acute symptoms if untreated. The intestinal disease form of
anthrax may follow the consumption of contaminated meat and is characterized
by an acute inflammation of the intestinal tract. Initial signs of nausea,
loss of appetite, vomiting, fever are followed by abdominal pain, vomiting
of blood, and severe diarrhoea. Intestinal anthrax, when untreated, results
in death in about a third of cases. Fortunately, there are no reports of
the disease spreading from human to human. Direct person-to-person spread
of anthrax most likely does not occur. Also, past infection with anthrax
makes a person immune to the disease; a second attack is extremely unlikely.
Further, many effective antibiotics are available. Usually penicillins
are preferred, but erythromycin, tetracycline, or chloramphenicol can also
be used. To be effective, treatment should be initiated early. An Anthrax
vaccine is available and the United States has now begun vaccinating some
high-risk professions following the recent outbreak. It uses dead bacteria
as opposed to live bacteria. So far, it has not been recommended for use
in Sri Lanka because the disease has recently not been reported despite
many suspicious cases being investigated and therefore, there is really
no need for panic regarding Anthrax in Sri Lanka.
Jaundice: when you turn yellow
The term 'jaundice' means a yellowish discoloration of the skin and other
tissues. It is not an illness in its own right but a manifestation of underlying
disease. Here's how that can happen - Red blood cells that are a major
constituent of blood last for around one hundred and twenty days and then
they are removed from the blood. In the spleen red blood cells are broken
down and it is as a result of this breakdown process that a substance called
bilirubin is made. Bilirubin is transferred to the liver where it is processed
and incorporated into 'bile' which is then stored in the gall bladder.
If too much bilirubin is found in the blood the skin and the whites
of the eyes become yellow. This is called jaundice and means that somewhere
along the processing route there is a defect. If more red blood cells than
normal are being broken down then greater amounts of bilirubin will be
produced. The liver may not be able to cope with the increased demand being
placed on it and hence bilirubin accumulates in the blood. An example of
when this might happen is in a condition called haemolytic anaemia where
red blood cells have a shorter lifespan than normal-as it occurs in Malaria.
This means they are broken down more quickly causing the amount of bilirubin
that needs processing by the liver to mount up. If something damages the
liver, then like any processing factory it will not be able to function
properly. Infections such as hepatitis may be responsible for this, as
may the effects of some drugs. Another common cause of liver cell damage
is alcohol abuse.
If the problem isn't because of an excessive supply of bilirubin, or
because the liver is damaged and malfunctioning, then a problem with delivery
of the bile will be responsible. If the bile can't get out then it collects
in the liver and bilirubin is forced back into the blood causing jaundice.
Gallstones, for example, are a common cause of this type of obstruction.
Jaundice is therefore a sign of an underlying health problem, so it's
always important to identify where the problem might be if it is going
to be corrected. Performing blood tests helps to identify whether too many
red blood cells are being broken down, examine how well the liver is functioning,
establish whether a viral infection is affecting the liver or uncover other
information to help diagnose the cause of the problem. Scans may also be
used since these can help identify whether there's an obstruction or whether
the liver is inflamed. Sometimes a liver biopsy is performed to examine
whether the liver is diseased. When the cause of the jaundice is identified
and if this cause can be treated then the jaundice quickly disappears.
Don't look down on Down's Syndrome
Down's Syndrome- more often referred to as 'Mongolism'- is among the commonest
causes of learning handicap in children. Yet, the stigma surrounding the
condition is immense especially in Sri Lankan society and the issue is
rarely discussed. With recent advances, the condition is becoming increasingly
predictable and every mother-to-be must be aware of the related facts.
Down's Syndrome is a genetic condition.
It's the most common cause of learning disability and is estimated to
affect around one in 1000 babies born. The chances of having a child with
Down's Syndrome increases as a woman gets older: At a maternal age of 35,
the chance is about 1 in 400; it trebles for every five years thereafter.
It's also more likely if a woman has already had a child with Down's Syndrome,
or if a close family member has had an affected child.
Many people are not aware that those with Down's Syndrome also often
have medical problems. In recent years it has become possible to more accurately
identify during pregnancy those babies at risk of having Down's Syndrome.
It's very important for women to realise that screening identifies which
women are at an increased risk of having a baby with Down's Syndrome. It
doesn't show whether their baby has Down's Syndrome or not. Those women
who are at a higher risk of having a baby with Down's Syndrome, whether
because of age, or because of the screening test results, are offered the
opportunity of further tests to establish whether their child has Down's
Syndrome or not.
Nevertheless children with Down's Syndrome are usually very happy and
extremely affectionate and many live well into adult years. They may need
special education but many can eventually lead independent lives, provided
they are given the correct care and support.
Medical news
Fellowship award
Professor Ravindra Fernando has been awarded a Fellowship of the College
of the General Practitioners of Sri Lanka. Professor Fernando is Professor
of Forensic Medicine and Toxicology at the University of Colombo and is
also the Director of the Centre for the Study of Human Rights at the University.
He is also a Honorary Fellow of the Ceylon College of Physicians, Royal
College of Physicians (London), Royal College of Physicians and Surgeons
(Glasgow), Royal College of Pathologists and Royal College of Physicians
(Edinburgh). He founded the National Poisons Information Centre at the
National Hospital Colombo. He has worked as a Consultant Forensic Pathologist
for the Home Office, England and Wales and the Crown Office, Scotland.
He was also a Senior Lecturer in the Universities of London and Glasgow.
Rheumatic scourge
Rheumatic fever was a dreaded disease a few decades ago because it caused
serious heart diseases in later life. While these have been minimized in
the developed world, Sri Lanka is still faced with this scourge. Rheumatic
fever is a delayed consequence of an untreated upper respiratory infection
with a bacteria-Streptococcus. While Streptococcal infection is common,
Rheumatic fever is not: probably less than one percent of all people who
have a streptococcal throat infection will develop rheumatic fever. However,
when it does occur, it can cause serious, debilitating damage to the heart
and involve other tissues.
The peak age of incidence for rheumatic fever is in children from the
age of five to fifteen years, but cases do occur in adults. Acute rheumatic
fever is rare in children less than 4 years of age.There is a latent period
of 1 to 5 weeks between the streptococcal throat infection and the initial
episode of acute rheumatic fever. The average duration of an attack of
acute rheumatic fever is 3 months or longer.
After the acute attack has subsided, many people are left with damaged
heart valves (rheumatic heart disease). Some people will have recurrent
acute attacks of rheumatic fever, frequently causing more damage to the
heart valves.
Carditis-or inflammation of the heart- is the most significant manifestation
of rheumatic fever because it may cause permanent organ damage or death.
Carditis is frequently mild or asymptomatic and therefore difficult to
detect. Although not fully understood, a person's immune system response
to a streptococcal infection appears to cause tissue degeneration, most
frequently heart valve tissue, and subsequently, cardiac disability or
death.
Polyarthritis is arthritis or swelling of a number of joints at a time
and may occur as a consequence of Rheumatic fever. Chorea is another sequel
that may appear after a latent period of several months and is seen as
rapid, purposeless, involuntary movements in the limbs and the face. Subcutaneous
nodules-firm, painless lesions that occur over bony surfaces just under
the skin- and 'Erythema marginatum'- a rash that appears mostly on the
trunk and limbs- are other features characteristically associated with
Rheumatic fever.
Those people who have already suffered a rheumatic fever attack are
extremely susceptible to a recurrence if they are again infected with the
Streptococcus bacteria. Patients who have experienced a documented acute
rheumatic fever attack should receive continuous antibiotic prophylaxis
to prevent streptococcal infections at least until reaching adulthood or
at least 5 years after their most recent attack-even if they show no evidence
of damage to the heart during the acute attack.
Patients whose acute rheumatic fever attack has left them with damaged
heart tissue may need lifelong antibiotic prophylaxis. Invasive dental
or surgical procedures may require additional antibiotic prophylaxis for
patients with rheumatic heart disease involving the heart valves. Prevention
of rheumatic fever involves prompt, accurate diagnosis and effective treatment
of streptococcal throat infections especially in school-aged children and
others who live in over-crowded conditions. |
