Plus - Letters to the editor

Everyone’s baby but nobody’s child: child-care homes as good as abandoned by the state

Thank you for highlighting the plight of orphaned, abandoned and vulnerable children (Sunday Times, October 23). I would like to point out areas that need to be addressed if we are to build a safe and secure future for these unfortunate youngsters.

I serve on the managing committees of three girls’ homes, and I am a regular visitor to other girls’ homes in the area. It was with great expectations that one of our matrons and I attended a recent two-day workshop organised by the Probation Department. The workshop was held at Caritas Sri Lanka, Kynsey Road.

Many important matters could have been discussed and sorted out. Unfortunately, the Probation and Child Care people did not stay with us all day. We discussed matters that concerned all of us, and how difficult it was to manage these homes. But there was no one from the government present to hear us and offer a solution to the many problems we face.

On the positive side, there were some good presentations by professionals: Dr. Prathiba Mahanama Hewa, a senior lecturer of the Colombo University; Ms. Sajeewani Abeykoon, adviser to the Legal Aid Commission, and others. The workshop was conducted by Sister Nilanthi Ranasinghe of Caritas Sri Lanka.

I wish to make some observations from my many visits to these homes for orphans and abandoned children. The National Child Protection Authority (NCPA) is an investigating unit, and works closely with the police and the Probation and Child Care people. They do a very good job with the limited resources at their disposal. But our matrons require more cooperation from the judiciary.

The juvenile judges are very kind to the children produced before them by the Probation and Child Care people. Some even clear the court in order to speak to the child alone. All this is very good. But before arriving at a decision, the judges should also consult the probation people and the matron of the home. The matron lives with the child 24 hours a day; the judge sees the child only once – in court.

When children in homes are produced in court, a van from the Prisons Department turns up at the home and the child is taken like a criminal. When a Prisons vehicle is parked in front of the Home, it leaves a negative impression in the neighbourhood. Residents imagine a “small-scale” criminal has been brought to the home.

The Courts and the Prison authorities should work out a system and a strategy that puts the child’s interests first, and not do insensitive things that would harm the child’s self-esteem and mental state.
Most of our homes are run on a beggar’s budget. The government gives us only Rs. 20 a day per child. It is almost impossible for the homes to run on such tiny budgets, especially with the ever-increasing cost of living.

The matrons and staff are paid very poor salaries. While the management appreciates the tremendous work put in by these matrons, they are unable to give them reasonable salaries because they get only a pittance from the government.

When a child is warded in a hospital, the nurses insist that someone stays with the child. What happens is that one of the matrons stays with the child day and night, and the other matron has to look after the home all alone. The matrons do their duties ungrudgingly. The least the state can do is pay them a decent salary. We must remember that the matron of a home is the orphan’s stepmother – and the matron must give the children the love and kindness they would have received from their real mothers.

Many of the irregularities that take place in orphans’ homes can be avoided or limited if Probation officers visited these homes regularly. Most homes would be lucky if a probation officer visited even once a month. But even this does not happen. This is unacceptable. Regular visits are a must. Senior officers should inspect these homes at least once in three months.

In the good old days, there was a category of officers known as Hospital Visitors, appointed by the Ministry of Health. The Probation Department should consider appointing responsible persons as Home Visitors until the Probation Department beefs up its staff numbers.

The matrons and management committees of these homes for orphans and abandoned children want to make sure our children have a happy, healthy and safe upbringing.

We must ensure that these children have access to education and health care, and can develop to their fullest potential and grow up in an environment of happiness, love and understanding.

Social Service Worker, Colombo

It is not at all bad but use in moderation

When I saw the article (Sunday Times Plus October 16, 2011) titled “Coconut oil: It’s good for you after all” by Kumudini Hettiarachchi and Shaveen Jeewandara reporting on the work by Prof. Kapila Seneviratne (KS), both as a retired physiologist and as a coconut grower trying to supplement my meagre earnings with income from agriculture, I was very glad that at long last someone was doing research on coconut oil. I also hoped that people will continue to eat coconut and use coconut oil in their cooking! Now after reading the response by Prof. Gamini Weerasekera(GW) in The Sunday Times November 13, 2011, I have only two choices; either to show the readers that using coconut is not at all bad but to use coconut oil (CNO) in moderation or to uproot the coconut palms and see if I can grow Olive or Canola in its place. I propose to do the former.

The controversy over coconut came up in another English daily in 2006 and I wrote a comprehensive article outlining the current knowledge as I knew it on whether or not coconut is good for us humans particularly in relation to the risks of ischaemic heart disease (IHD). In it I gave several references when quoting scientific publications of relevance (The Island – Sat Mag May 20th 2006). Subsequently my colleague and I published a comprehensive review (Amarasiri WADL, Dissanayake AS.

Cey.Med.J.2006;51:48-51) which I believe has been well received. What surprises me is that in his response to the ST article, GW has made sweeping statements and as KS has pointed out not backed it up with at least some references. I’m afraid GW is still under the influence of the US Soya bean lobby!
GW correctly states that the saturated fat (SF) content of CNO is the highest of that in all cooking oils. Over 95% of coconut oil is fat while the fat content of scraped coconut is around 34% and that of coconut milk around 20%. It is also true that around 92% of the coconut fat is saturated fat. However, unlike SF of animal origin, over 65% of the fatty acids in coconut fat (CF) are medium chain fatty acids (MCFAs). Almost 50% of the fatty acid in coconut fats is a MCFA called Lauric acid (LA). The only two natural fats with such a high content of LA are Human Breast Milk and the secretion of the Sebaceous glands in our skin. Therein lies the difference. The way we handle fats in our diet depends on the number of carbon atoms in the fatty acids in dietary fats. Our diet has little or no short chain fatty acids (less than 8 carbons). Once digested in our small intestines, Medium Chain Fatty Acids (MCFAs) with 8 to 12 carbons, from the diet, are absorbed and metabolised in a manner entirely different to dietary Long Chain Fatty Acids (LCFAs) containing 14 or more carbons. This irrespective of whether the fatty acid is saturated or unsaturated. Thus how the body handles fatty acids derived from CNO is different to the manner in which those derived from butter or lard is handled. It surprises me that GW has made a sweeping statement “it is even better to use butter or tallow than coconut oil”. Coconut fat is also totally devoid of trans-fatty acids which are now thought to be more harmful than saturated fatty acids and by virtue of almost all of its fat being saturated is less affected by re-use a practice which for economic reasons is probably very prevalent in Sri Lanka.

There is no one theory to explain the causation of IHD. The lipid hypothesis is the one which calls in to question the role of plasma lipids in the development of atherosclerosis and IHD. Based on this hypothesis, one may argue that if coconut fats adversely affect plasma lipids (cholesterol components), the whole question of whether CNO is good or bad has been thought to do with blood lipids i.e. cholesterol, low density lipoprotein (LDL) – the bad one and high Density Lipoprotein (HDL) – the good one. A possible harmful role for dietary coconut fats in disturbances of lipid metabolism is also not well established. Many allopathic medical practitioners seem to think that as coconut fats are saturated that they elevate plasma lipids in the same manner as the saturated fats from animal sources. Many of the animal studies on the role of coconut fats in lipid metabolism have used hydrogenated coconut oil. This is an unnatural form of coconut oil that is purposely altered to make it completely devoid of any essential fatty acids.

The conclusion that can be drawn from such animal research is that feeding hydrogenated coconut oil devoid of essential fatty acids enhances the formation of atherosclerosis markers. In human feeding studies, coconut fats without doubt elevate HDL cholesterol. The effect on total cholesterol and LDL cholesterol is probably neutral. Living in a rather remote part of the Gampaha district with no broadband access of any sort I have not been able to read the published work of KS & colleagues. They are reported to have shown that virgin coconut oil (VCO) by virtue of the higher content of phenolic anti-oxidants (PNOs) lower lipid levels in serum and tissues and LDL oxidation. They also state that “most of the phenolic anti-oxidants present in coconut oil are thermally highly stable” making a case for re-use of CNO. When we eat chopped greens mixed with coconut scrapings or as GW says in curries there is the double benefit of PNOs from both sources may confer a double benefit. It has been suggested by KS et al. that PNOs from “poonac” could be extracted and used to fortify copra derived CNO. A good idea if it can be put into practice. Even in rural homes hardly anyone makes CNO the traditional way and ends up buying CNO which is likely adulterated with palm oil, from local grocery stores.

This brings me to another newspaper report sometime back which said “Very soon however we all, especially those susceptible to heart ailments, be prescribed or encouraged to eat ‘Polkudu” or drugs made with ‘coconut galactomannan’”, citing a paper presented at a conference subsequently published as an abstract (Gooneratne J., Samarasinghe K. and Vidanarachchi J. (2009). Galactomannans from coconut lowers serum total and LDL - Cholesterol in hypercholesterolaemic guinea pigs. Annals of Nutrition and Metabolism, 55 : 176.). This work has yet to be substantiated but if shown to be correct, it would be a plus for coconut. It, however, remains to be seen whether we should add Polkudu to our diet or eat more pol sambol!

Another hypothesis for the causation of IHD is one of which invokes an infective agent. Chronic infection with Chlamydia pneumoniae (C. pneumoniae) is thought to be associated with the risk of developing coronary heart disease (CHD). Coconut fats (CFs) contain 50% Lauric acid (LA). Monolaurin (a form in which some of the LA from coconut is absorbed) and even lauric acid have been shown destroy bacteria several types of bacteria including Helicobacter pylori among others. While we cannot conclude that thus LA from CFs may thus reduce the risk of IHD they may at least reduce the risk of gastritis or as the local saying goes protect us from “gastric”!

We lack compelling evidence to implicate coconut fats in the development of atherosclerosis and CHD. There is no doubt that prevalence in Sri Lanka of non-communicable diseases including IHD are increasing at an alarming rate. There is no good epidemiological evidence to link the increase of IHD to the use of CNO & CF. In fact, coconut consumption has fallen in the last decade. The rising incidence of CHD in Sri Lankans coupled with a falling CNO consumption could be attributed to change in lifestyles even among the rural folk who now ride motorcycles or three-wheelers instead of walking, sitting for hours on end watching TV, in the case of women using gas or kerosene to cook without going to search for and carry firewood, grinders or the local grinding mill instead of the mortar& pestle, while men may be heavy smokers who also consume more alcohol particularly illicit liquor and may be eating more animal fat in addition to coconut fats.

After all even kids in the rural areas have taken a liking for sausages etc. Lichtenstein 2003 states “the current data suggest it is necessary to go beyond dietary fat, regardless of whether the emphasis is on quantity or quality, and consider lifestyle. This would include encouraging abstinence from smoking, habitual physical activity, avoidance of weight gain with age, and responsible limited alcohol intake (one drink for females and two drinks for males per day)” (Lichtenstein AH. J Women’s Health (Larchmt). 2003 Mar;12(2):109-14). The one important statement in GW’s response I totally agree with is to follow the middle path. Use coconut especially oil sparingly, do not over eat and that includes sugar and sweets, exercise and do try and be at mental peace - meditate if possible.

By Dr. Asoka s. Dissanayake (Former Professor of Physiology, Faculty of Medicine, Ragama)

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