29th August 1999
Pregnancy is a major event in any woman's life. A pregnant mother should be having regular check-ups and be informed by the doctor about how the baby is growing. But as the date that is awaited by all gets closer, all mothers are nervous and have many questions to ask. Here are some helpful hints for those anxious days:
*The due date:
The most important fact about the due date is that it is only a guideline-there is no guarantee that labour will begin on that day and women, more often than not, will not give birth on that date. The actual beginning of labour is unpredictable and often happens a little earlier or later. This should be no cause for alarm. In fact, labour may begin as much as two weeks before or after the due date and will still be considered normal.
*Plan on calling your doctor:
Prepare for your delivery, knowing that labour, when it does begin, may occur at an awkward time. Find out from your doctor where he can be reached after-hours and whether he- or his assistant- should be informed. Most mothers do not do this and panic when labour begins. So, now is the time to clarify these matters.
*How to get to hospital:
This is so obvious, but many will not think about it until the situation arises. Decide beforehand which hospital to enter and consider how far it is from home. Arrange your options for a comfortable means of transport-even if labour begins at night. Pack the essential requirements into a suitcase and have it ready.
That way valuable time would not be lost and more importantly, there would be no panic because the baby towel is missing!
*How can labour pains be recognised?
In the last weeks of pregnancy, it may be noticed that the abdomen becomes alternatively soft and hard. As the delivery date approaches, 'false' contractions become uncomfortable and even painful. It is no cause for embarrassment to believe these are the real contractions but a few signs might indicate whether they are in fact signs of true labour. Try to time each 'contraction'. In true labour, the contractions last about 30- 60 seconds, they occur at regular intervals and they do not go away during other activity. But it's best to be cautious, so call your doctor if you are in doubt.
*Other reasons to call your doctor:
There are reasons other than labour to contact the doctor immediately. If the membranes rupture (or, as they say, the 'waterbag breaks'), if there is bleeding from the vagina or if there is constant severe pain the doctor should be consulted without delay.
The Minister of Health announced last week that new laws to regulate private healthcare institutions would be presented in Parliament shortly and this is a most welcome move.
But the public would be pardoned if they view this announcement with more skepticism than relief for they have been at the receiving end of these institutions for a long, long time now.
When the free economy took over in 1977, private institutions- which existed even then- mushroomed and there was a steady demand for them, which by itself is an indictment on the kind of service offered by the state sector.
There is nothing untoward in that development. In fact, it would have benefited the poorer sections of society by draining a segment of patients who would otherwise have been an added burden on the meagre resources of the state sector.
But as the private hospitals thrived a dangerous trend emerged- they were not regulated in any manner leading to what has today become unsupervised exploitation of the patient population, both by doctors and private hospitals.
Healthcare, by its very nature is difficult to quantify and therefore regulate. For instance, it is difficult to inform a patient being admitted for chest pain as to what investigations would be required and what his final bill would be. It is readily conceded that fixing charges in healthcare are not as easy as say, regulating telephone services.
Nevertheless, what happens now is a total abdication of responsibility by the government in regulating these institutions. And, the institutions make no secret of the fact that their profits are sky high- at the expense of patients.
Yes, these institutions must run at a profit and there is no grouse with that. But it should not be at the expense of exploitation and that is what must be regulated. And indeed there is enough opportunity for the state to set clear guidelines in this trade.
For instance, charges for the different types of rooms available in private hospitals can be regulated with the state laying down fees for rooms with different facilities- like in the hospitality industry.
Then, it is common knowledge that drugs are surcharged at these institutions and that is a matter that can easily be dealt with by fixing maximum retail prices for all registered drugs. The same may be applied to standard investigations and procedures.
Even if these three aspects alone are dealt with, that would ensure considerable monitoring of private health care and reduce patient exploitation to a large extent.
Doctors' fees are less easily regulated. The white-coated gentry will vociferously claim that theirs is a profession where the contingencies are many and that it is therefore nearly impossible to fix fees, say for a surgery.
There is an element of truth in this claim but we feel that channelled consultation fees at least can be regulated depending on the qualifications of the doctor and the time spent with the patient.
We do not know whether the Minister of Health has addressed these issues in the new legislation that he proposes to present in Parliament. What we do know is that patients are yet reluctant to remember Nimal Siripala de Silva as one of the better ministers of health. But he has the chance to still make history, if only he can remedy the concerns raised in this comment.
Child abuse has always been recognised by the medical profession as a significant problem but in recent times in Sri Lanka it has come to the forefront as a major social issue. Just how bad is the problem and what can be done about it?
At present, it is estimated that as many as one in twelve households currently employ poor children under the age of 14 years as domestic servants. Press reports indicate the detected cases where they have sometimes been subjected to torture and harassment.
Employers should therefore know that new penalties now apply to this offence of cruelty to children, carrying a punishment of imprisonment for a minimum of two years or a fine.
Also, an estimated 20% of girls and 10% of boys are subjected to sexual abuse at very young ages. Street children are often forced by poverty to prostitute themselves. Aiding and abetting these offences also carry heavy penalties now.
Education is a fundamental right of children in this country but some 14% of them do not receive a proper schooling. Parents should therefore know that schooling is compulsory for all children under 14 years.
In an attempt to combat these problems a Child Protection Authority (CPA) has been set up, the relevant laws being passed in parliament unanimously in November 1998. The authority will not only initiate measures to tackle child abuse but also co-ordinate with the various sectors involved- the law enforcement authorities, social services and rehabilitation centres and the tourist industry, being some of them.
In hospitals, medical officers have been instructed to identify and report suspected cases of child abuse to the police and the Child Protection Authority. Doctors are now being put through a special training programme to recognise child abuse.
As parents or as a citizen, if child abuse is suspected anywhere, a person has the right to contact the Child Protection Authority on a hotline- Telephone No. 444444- and the informant's confidentiality will be respected.
Dengue haemorr- hagic fever, the dreaded mosquito borne disease that has been fatal at times and affects children mostly is back again. After a lull, many cases have been reported and it is panic time again.
Here are some facts regarding the disease that would be most helpful:
Dengue is a viral disease which is transmitted through two species of mosquitoes, Aedes egypti and Aedes albopticus.
What are its symptoms? -High fever, headache, vomiting, body aches and stomach pain are the commonest symptoms- but these symptoms are common to many other illnesses as well. In Dengue fever, these symptoms subside in three to four days but a minority of patients develop Dengue haemorrhagic fever, the more dangerous form of the disease.
What are the symptoms of Dengue haemorrhagic fever? -Red patches appearing on the skin, red eyes, bleeding from the nose, passage of red coloured urine, bleeding from the gums and a coffee-like vomitus are the characteristic symptoms of Dengue haemorrhagic fever. Appearance of these symptoms should always be brought to the notice of the doctor.
What if the fever subsides? -The fever of Dengue haemorrhagic fever victim may subside suddenly but the patient will still appear ill. In such a patient, a pale skin colour, a cold skin, lethargy or restlessness and over-breathing are dangerous signs.
What should be done? -If a child has fever encourage rest; keep them at home instead of coaxing him to go to school. Do not give Aspirin. Give him plenty of fluid to drink.
If there is a doubt always seek help from a doctor. A 'wait and see' policy is not the best. It is better to err on the side of caution, because Dengue can be fatal.
What can be done to prevent the spread of Dengue? -Keep the environment around the home clean. Burn or bury garbage. Destroy empty coconut shells or any other such vessels that collect water. If there is stagnant water, add a little salt to it, or drain it to prevent mosquito breeding.
Hippocrates, reckoned as the father of mod ern medicine, recommended garlic for many diseases, particularly intestinal disorders. In ancient Egypt, the builders of the pyramids served a compulsory meal of raw garlic to the workers to maintain their health. People used garlic daily when Europe was ravaged by plague. Early immigrants to America discovered that the natives knew about the healing powers of garlic and relied on the plant for afflictions that ranged from snakebite to intestinal disorders. English settlers strapped garlic cloves to the feet of smallpox victims as a cure for the disease. Even today, some Greek, Jew and Chinese grandmothers present a clove of garlic to their infant grandsons as protection against the evil eye.
Botanists describe garlic as a bulbous lilaceous plant bearing the name Allium sativa, possessing a pungent taste and a strong smell. Indian mythology has a delightful account about the divine origin of garlic. Ayurveda or the Science of Life, which is as old as the Indian civilization, ascribes a host of qualities to garlic, both prophylactic and curative.
Ayurveda describes garlic in the treatment of intestinal dysentery and flatulence. Garlic is said to have a special role in curing 'vata roga' or nervous ailments. Furthermore, it is used to prevent aging and promote longevity. Whether these beliefs are due to garlic's own capacity for an astonishing long shelf life is a moot point, but it is a fact that garlic retains its moisture and freshness for months together unlike other vegetables that wither and decay within hours or days.
Louis Pasteur verified the antiseptic properties of garlic in 1858. Garlic oil has been found to wipe out many strains of fungus and yeast including some that cause vaginitis.
Garlic is potent in combating and preventing many ailments. Garlic slows down the growth of breast cancer cells and prostate cells under laboratory conditions. Garlic also inhibits the growth of tumours of the colon, rectum, esophagus and skin in rodents. Garlic may lower the risk of cancer by preventing free radicals from forming. These molecules - normal products of cell metabolism - are prime suspects in the development of tumours because of their tendency to change DNA, cell membranes and cellular proteins. Garlic may also cut down thickening and hardening of arteries known as arthesclerosis by preventing them from adhering to the lining of the blood vessels. Garlic also reduces cholesterol levels up to nine per cent and every one per cent reduction in cholesterol translates into a two per cent reduction in risk of a cardiac condition. Garlic also helps the reduction of body fat. The Chinese too had listed garlic in their indigenous pharmacopoeia. Medical investigations show that fresh garlic contains the odourless sulfur compound known as alliin. When cut open, alliin reacts with the enzyme alliinase and is decomposed to form the foul-smelling alliicin which further breaks into a number of smelly sulphur products.
Research findings have shown that garlic is an effective diet supplement for lowering cholesterol or as a substitute for other cholesterol- lowering drugs. The two sulphur compounds found in garlic - diallyl sulphide and s- allyl cysteine have prevented the development of cancer in laboratory tests on animals.
Please send your comments and suggestions on this web site to