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CGPSL

No. 6, “Wijerama House”, Wijerama Mawatha, Colombo 7.

Tele: 2698894 Fax: 2695188 E-mail: cgpsl@sltnet.lk / genprac@sltnet.lk Website: www.cgpsl.org

THE NEWSLETTER OF THE COLLEGE OF GENERAL PRACTITIONERS OF SRI LANKA

MARCH - APRIL 2011

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PUTHUKUDIIRIPPU RE VISITEDHealth Camp at Puthukudiirippu – 27th March 2011

The Department of Family Medicine, Faculty of

Medicine, University of Kelaniya organised a one

day health camp at Puthukudiirippu on the 27th of

March 2011 with the cooperation of the 14th Bat-

talion of the Sinha Regiment, Sri Lanka Army. The

project was initiated by Colonel Wasantha Hewage

Commanding Offi cer of the 14th Battalion, and Lee-

la Rani Jayasinghe (Lecturer, Department of Family

Medicine) with a heartfelt desire to provide some

relief to the residents of the area. Janaka Ramanay-

ake (Head/ Department of Family Medicine) took

the lead in organising, along with Leela Rani, Aru-

ni, Dinusha, Deepama (Lecturers in the department)

and Piyumika and Rudarshi (Demonstrators).

Puthukudiiruppu is one of the most remote and un-

der developed areas in the Vanni region with a pop-

ulation of about 1000 people with more than 300

children. These people have borne the brunt of the

30 year war, and are still struggling to recover from

the consequences.

We thought that this would be an ideal opportuni-

ty to strengthen our relationship with our long es-

tranged brothers and sisters living there.

The camp was held at the Muthiyankattu Kulam

Government Tamil Mixed School.

In This Issue

v Puthukudiirippu re visited – P1,2 v South Asia Conference of Family Doctors – P2

v Well done and thank you – P3,4 v Sanath impresses the BML – P4

v More about papaya – P5 v Preventing and mitigating risk – P6

v The children they leave behind – P7,8 v Workshops on Clinical Teaching & Examining

in Family Medicine – P8,10

2

– Mar - Apr 2011 Puthukudiirippu Re Visited FROM DINUSHA

Our main objectives were to

• Provide health care services to the health camp

attendees.

• Distribute the donations among the villagers

Eighteen doctors attended - Janaka Ramanayake,

Leela Rani Jayasinghe, Aruni Weerakoon, Dinusha

de Silva, Deepama Sumanasekera, S I Wickrama-

singhe, S Arulanandan, Tyrell Fernando, Niroshini

de Silva, Indika de Saram, S Kumaran, S Ihagama,

Thushan Wijesinghe, B P S Chandrasiri, K W D R

C K Gunasekera, P K Godage, R K J T S Samaras-

inghe and M I Mithuarachchi to medical problems.

Medicine was provided free of charge. More than

400 patients sought treatment during the day.

Four hundred and fi fty of those registering were

screened for evidence of nutritional defi ciencies,

and vision impairment.

A team from Helpage Sri Lanka screened the el-

derly population for health problems, and arrange-

ments were made to deliver spectacles free within

two weeks for the needy. A health team headed by

Dr Kalaichelvam MOH of the area conducted an

immunization campaign. Health education posters

provided by the Health Education Bureau were dis-

played at the premises.

Our request for donations received an outstanding

response in cash and kind from our generous sup-

porters. We were able to distribute 160 family packs,

each containing a mammoty, plastic bucket and es-

sential items, 200 school packs containing uniform

material and stationery, 60 preschool packs contain-

ing a playkit, toys and food items. Also we have

been able to procure sports items for two schools

and preschool equipment for two pre schools.

The Dean of the Faculty of Medicine, Kelaniya, the

extended faculty, General Practitioners, post gradu-

ate trainees, private organizations and associations

all joined hands with us to make this event a re-

sounding success. The commanding offi cer and the

14th battalion had made all the arrangements and

extended their fullest cooperation to conduct this

health camp, and aid distribution.

A large number of villagers both from the area and

from far away, participated in the events of the day

making our efforts worthwhile.

Dinusha de Silva

South Asia Conference of Family Doctors

WONCA-WORLD ORGANIZATION OF FAMILY DOCTORS: South Asia Region

December 16-17-18, 2011

Renaissance Convention Centre Hotel, Powai, MUMBAI, INDIA

Hosted by: Federation of Family Physicians’ Associations of India [FFPAI]

Organized by: General Practitioners’ Association – Greater Bombay [GPA]

Theme: Only Family Doctors Can Provide Accessible, Cost-benefi cial and Equitable Healthcare

E-mail: woncasar2011@gmail.com

www.woncasar2011.com / www.thespiceroute.co / www.ffpai.org

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Editor – Nalin Ashubodha Editorial assistance – Pushpa Weerasinghe & Preethi Wijegoonewardene

Type setting, page setting & formatting – Tharanga Sendanayake

– Mar - Apr 2011 Council & Committee News FROM JAYANTHA

WELL DONE AND THANK YOUHighlights of mid-term review

It is with pleasure that I present highlights of the mid-term review of the work of the current Council. I con-

gratulate the members of the Council and the committee for their efforts towards these signifi cant develop-

ments. I thank the membership for electing good team players into the Council. Given below are the highlights

of the mid-term review.

Ø 13.06.2010 - Sri Lanka Drug Index was purchased

from the Department of Pharamacology and made

available to the Membership at no cost

Ø Special Medical Package for Members, Associ-

ates and their staff – Hemas Hospitals (Pvt) Lim-

ited

Ø Orientation in Post Graduate/Family Medicine

Assessment was worked out with 81 PG Train-

ees and 24 Teachers and Examiners participating.

This was the 1st such exercise of this magnitude

and scope in the history of the College. The Col-

lege was commended by the Director / PGIM

Ø Video recording of CPD Programme commenced

Ø A Memorandum of Understanding with Royal

College of General Practitioners was signed

Ø Collaborated with the RCGP in conducting the

MRCGP [INT] OSCE Examination

Ø Successful Academic Sessions held on 3rd, 10th

and 11th October 2010. Highest Registrant

participation (137)

Ø Collaborated with the RCGP in conducting the

MRCGP [INT] MCQ Examination

Ø Print CPD Programme commenced-sponsorship

obtained for 4. Approval obtained from CMJ and

SLMA for carrying educational materials

From Day 1

By Jul 2010

By Aug 2010

By Sep 2010

By Oct 2010

By Nov 2010

By Dec 2010

Ø The Certifi cate Course in Occupational Medi-

cine which was worked out in collaboration with

NIOSH and ILO was successfully completed with

the full participation of the 17 practitioners who

commenced the course

Ø SMS Network connecting Dialog subscribing

members and associates installed (210)

Ø Website uploaded with:

• Sri Lankan Family Physician

• Sri Lanka Prescriber

• Epidemiology Unit

• SLMA – CMJ

• Australian Prescriber

• Video recording of CPD Programme

• Family Planning - A Global Handbook for

providers

• Australian Family Physician

Ø Practice Management Committee was set up:

• Development of Locum Pool

• Identifi ed and working with provider for Elec

tronic Record System

Ø Elderly Medicine

• College nominee was appointed to the Board

of Study, Elderly Medicine

Ø Offi ce

• Removing termite infested fi ling cupboard

• Purchasing six numbers new steel cupboards

• Purchasing one number Nokia Mobile phone

• One number Toshiba Laptop

• One number Multimedia Projector

• Repairing and painting the Lecture Room.

• Obtained access to RCGP Shredder for offi ce

use

By Dec 2010

By Jan 2011

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– Mar - Apr 2011 Council & Committee News FROM JAYANTHA

By Feb 2011

Ø Rs.1,400,000/= was deposited in two FD accounts

during the period under review

Ø Research Questionnaire for profi le of Elderly Pa-

tients in Family Practice fi nalised

Ø Data entry sheet for survey of GPs catering to el-

derly patients fi nalised

Ø Free copies of Dengue Guidelines (2 numbers each)

distributed to members

Ø Seven new Members, three Life Members and elev-

en Associates enrolled

Ø Another historic fi rst for the College – The devel-

opment of the training modules for doctors in Pri-

mary Care is being fi nalised by the DIG Group of

the College in the NIROGI Lanka Project

Ø College’s nominee appointed by Minister of Health

to the Ceylon Medical College Council

Ø Negotiation with Director / National Tuberculosis

Control Campaign for inclusion of College mem-

bers and associates as stakeholders in DOTs and

PAL (Practical Approach to Lung Disease in Pri-

mary Care) programmes

Ø SMS network connecting all members and as-

sociates (320) who have provided their mobile

numbers completed.

Ø First SMS and e-mail pilot survey carried out

Our Council Members

Eugene Corea (President), K Chandrasekher (Vice Presi-

dent), K Sri Ranjan (Immediate Past President), Nanda-

ni de Silva, Jayantha Jayatissa (Hony. Secretary), Push-

pa Weerasinghe (Hony. Treasurer), Dennis J Aloysius,

Leela De A Karunaratne, Neil Abeysekera, Preethi Wije-

goonewardene, D G A Abeygunaratne, N K Ashubodha,

Joel Fernando, C E I Fernandopulle, Sanath Hettige, M

K Muruganandan, Sampath Nanayakkara, Antoinette

Perera, B Karunaratne, Kamala Nonis and Shreen Wil-

latgamuwa

Members of College Committees

Eugene Corea, Dinusha de Silva, L Amarasekera, K. Sri

Ranjan, Susil Gunasekera, Nalin K Ashubodha, Dee-

pama Sumanasekera, Preethi Wijegoonewardene, K

Chandrasekher, D G A Abeygunaratne, Sanjaani Chan-

drasekera, H.P.S. Damayanthi, Titus Fernando, Janthy

Gunasekera, Jayantha Jayatissa, D D N Kaluarachchi,

Kamala Nonis, Antoinette Perera, S V Rabel, Yamuna

Rajapakshe, Shyamalee Samaranayaka, Narme Wickre-

masinghe, B Karunaratne, M.K.Muruganandan, Dennis J

Aloysius, Leela De A Karunaratne, Desmond Fernando,

W A Ferdinand, Erandie Ediriweera, Jayantha Thambar,

Percy Motha, Prasadth Fernando, Asela Anthony, Shob-

havi Kohombange, A.J. Jameel, S J V Cooray, M R Han-

iffa, K P Jayawardena, H D Wijesinghe, K. Sri Ranjan,

H.B. Jayasinghe, Ariyasena Gamage, Sampath Nanaya-

kara, Pushpa Weerasinghe, Shreen Willatgamuwa, Joel

Fernando, Roy Rajapakse, Nandani de Silva, K P Piyas-

ena, Janaka Ramanayake, Dushyanthi Weerasekera, Neil

Abeysekera, A.L.P. De.S.Seneviratne, Sanath Hettige,

Sarath Paranavitane, Prasanna Siriwardena, Ananda Per-

era, Seneth Samaranayake, M.G.H. Thilakaratne, Shani

De Silva, Tyrell Fernando, F.A. Rajakulendran, Mahinda

Hemapriya, Sunera Fernando, Nishalie Fernandopulle,

Shyama Hettiarachchi, Niroshini De Silva, Clement

Prasantha Perera,.K.H.D.Milroy, Yasas Abeywickrema,

Senarupa Jayawardena, Aranjan Karunanayake, Carmel

Fernandopulle, D Athukorala, B G D Bujawansa, Lucky

Jayasekera, Thivanka Munasinghe, Chandima Nama-

ratne, Ashley Perera, P.J.K.M.S. Rupasinghe, Sagarie

Gunasekera, Shahina Anees, V Sri Kantha, Aruni de

Silva, A.U.Piyaratne, Pradeep Gunawardene,

Jayantha Jayatissa

Hony. Secretary

ABOUT YOU

SANATH IMPRESSES THE BMJPapaya to the fore

Sanath Hettige, Council Member and a pioneer in

the use of papaya for patients in general practice

affl icted with Dengue in Sri Lanka, has been com-

mended by the BMJ for his entry submitted for the

BMJ Awards 2011 which was based on his work

with papaya among patients with dengue.

Fiona Godlee, Editor BMJ has e-mailed Sanath that

“the judges read his submission with great interest

and was impressed with the quality of his entry”.

As is evident by Sanath’s contribution in this issue

his partiality for papaya as a medicine is still con-

tinuing. Well done Sanath!

5

– Mar - Apr 2011 Papol FROM SANATH

MORE ABOUT PAPAYAUF researchers fi nd cancer-fi ghting properties in papaya tea

The humble papaya is gaining credibility in West-

ern medicine for anti-cancer powers that folk cul-

tures have recognized for generations.

University of Florida researcher Nam Dang, M.D.,

Ph.D., and colleagues in Japan have documented

papaya’s dramatic anti-cancer effect against a broad

range of lab-grown tumors, including cancers of

the cervix, breast, liver, lung and pancreas. The re-

searchers used an extract made from dried papaya

leaves, and the anticancer effects were stronger

when cells received larger doses of the tea.

In a paper published in the Feb. 17 issue of the Jour-

nal of Ethnopharmacology, Dang and his colleagues

also documented for the fi rst time that papaya leaf

extract boosts the production of key signaling mol-

ecules called Th1-type cytokines. This regulation of

the immune system, in addition to papaya’s direct

antitumor effect on various cancers, suggests pos-

sible therapeutic strategies that use the immune sys-

tem to fi ght cancers.

The papaya extract did not have any toxic effects

on normal cells, avoiding a common and devastat-

ing consequence of many cancer therapy regimens.

The success of the papaya extract in acting on can-

cer without toxicity is consistent with reports from

indigenous populations in Australia and his native

Vietnam, said Dang, a professor of medicine and

medical director of the UF Shands Cancer Center

Clinical Trials Offi ce.

Researchers exposed 10 different types of cancer

cell cultures to four strengths of papaya leaf ex-

tract and measured the effect after 24 hours. Papaya

slowed the growth of tumors in all the cultures.

To identify the mechanism by which papaya checked

the growth of the cultures, the team focused on a

cell line for T lymphoma. Their results suggested

that at least one of the mechanisms employed by the

papaya extract is inducing cell death.

In a similar analysis, the team also looked at the

effect of papaya extract on the production of anti-

tumor molecules known as cytokines. Papaya was

shown to promote the production of Th1-type cy-

tokines, important in the regulation of the immune

system. For that reason, the study fi ndings raise the

possibility of future use of papaya extract compo-

nents in immune-related conditions such as infl am-

mation, autoimmune disease and some cancers.

Dang and a colleague have applied to patent the

process to distill the papaya extract through the

University of Tokyo; the next step in the research

is to identify the specifi c compounds in the papaya

extract active against the cancer cell lines. For this

stage, Dang has partnered with Hendrick Luesch,

Ph.D., a fellow UF Shands Cancer Center member

and a professor of medicinal chemistry. Luesch is an

expert in the identifi cation and synthesis of natural

products for medicinal purposes, and recently dis-

covered a coral reef compound that inhibits cancer

cell growth in cell lines.

By ELIZABETH CONNOR • Published: March

9th, 2010

Courtesy Sanath Hettige

WRITE TO US. KEEP IN TOUCH. SHARE YOUR VIEWS. GIVE US YOUR ADVICE.

BUT FOR GOD’S SAKE DON’T KEEP QUIET!

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– Mar - Apr 2011 Risk Management FROM THE EDITOR

PREVENTING AND MITIGATING RISK

(1) American Heart Association Recommendations

Some of the risk factors are cessation of smoking, controlling blood pressure and using a low salt diet.

Below is a recommendation given by the AHA (American Heart Association) which recommends that

you eat foods that total less than 300mg of Cholesterol a day. You can raise your HDL – High Density

Lipoprotein (good cholesterol) by not smoking, losing excess weight and being more active. On the

other LDL- Low Density lipoprotein (bad Cholesterol) is found in the plaque formation in coronary

arteries. A high LDL means higher risk of heart disease.

Ref. AHA recommendations Providence Heart Center Los Angeles, Oct. 2010

(2) Tips to stop smoking

1. Get adequate rest

2. Practice relaxation techniques

3. Avoid alcohol beverages

4. Get adequate exercise ( at least 3 times a

week)

5. Try medicines which help to quit smoking

- Nicotine chewing gum (Nicorette)

- Varenicline tartrate (Chantix)

6. Contact a stop smoking support group

7. Discuss the nicotine patch/ spray

Prescription Medicine

A couple of drugs have been approved by the FDA

for smoking cessation. They do not contain nico-

tine, so it is recommended that they be used in con-

junction with nicotine-replacement therapy.

How does it work ?

Unlike nicotine-replacement therapies, prescription

medicines like bupropion SR (Zyban, Wellbutrin)

or varenicline (already mentioned above) do not

provide the body with nicotine. Instead, they reduce

cravings and lessen withdrawal symptoms by alter-

ing chemicals and nicotine receptors in the brain.

Both medicines require strict doctor supervision

and prescription

Nalin Ashubodha

Editor

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– Mar - Apr 2011 WHO Cares? FROM LUCKY

THE CHILDREN THEY LEAVE BEHINDWho cares for them?

But WHO Cares?

Time and again the news hits the headlines of re-

jected infants abandoned in various sites, such as

temple and church premises, dustbins, sanitary pits,

even rivers. The older children who are too young,

immature and naïve to realize the rejection and mal-

treatment of the carers suffer untold misery physi-

cally, psychologically and sexually as they are too

dependent and innocent to even think of running

away from home.

q Whose children are these?

These are the children of very poor families

who have become single parents or carers due

to various situations such as death of a spouse

due to natural causes or war, marital dishar-

mony, divorce or migration of mother to the

Middle East for employment.

My focus today is on the latter group, where

the mother has migrated for foreign employ-

ment leaving the brood behind in temporary

care.

q Who are the Carers?

In some cases it is the husband, grand par-

ent or an older sibling. If the husband is ir-

responsible, or alcoholic (as often is the case)

or if the grandparent is old or feeble and if the

older sibling is “TOO FIT AND ABLE”, very

soon the care arrangements break down and

the dependent children begin to suffer silently

in miserable situations.

In Sri Lanka this “mother migration” has gone

on for over thirty years. We are told that these

mothers bring in the highest foreign exchange

to Sri Lanka over and above tea, rubber and

coconuts or garments. No Government has

taken steps to ban this migration, as the in-

come fattens our coffers and Sri Lanka is now

very dependent on this foreign exchange.

In spite of the breach in the family unit and

social and moral fabric this migration trend

seems to go on.

q But is this morally right?

If these poor women are contributing so much

to the bank balance of Mother Lanka should

not Mother Lanka have a role to play in mak-

ing sure these children, the wealth of our na-

tion are well cared for during this period of

maternal absence.

q What has the government done?

It is heartening to note that the government

has established a foreign employment bureau

to register all migrant workers. They also give

them a month’s training in the relevant fi elds

of employment, use of equipment and appli-

ances and knowledge of the host country lan-

guage, for the purpose.

q What more can the government or foreign

employment bureau do?

As mentioned before the categories of tempo-

rary carers are people who have never played

this role of full time carer before, the mother

having taken most, if not all the responsibility

of loving and caring, including feeding, shel-

tering clothing, schooling and healthcare etc.

q My suggestions

§ Let me suggest that – the Foreign Employ-

ment Bureau should, at registration, get

the details of children to be left behind and

question the mother as to the care arrange-

ments made and have it recorded.

§ I recommend the conduction of a “train-

ing and counseling course” of at least two

weeks duration, to prepare the carers and

instill into them the importance and re-

sponsibility of the new role they will be

burdened with during the mother’s ab-

sence.

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– Mar - Apr 2011 WHO Cares? FROM LUCKY

§ Further the bureau of foreign employment

should set up multi disciplinary commit-

tees (MDC) at district level, to monitor the

care arrangements of the children, and to

step in, when needed to rescue the children

at risk, before irreparable damage is done.

§ I suggest that the following offi cials and

departments should be represented in the

MDC.

Ø Grama Niladaris

Ø Provincial Councils

Ø Department of Probation and Child

Protection

Ø Department of Social Services

§ The Department of Education should in-

volve principals and staff of schools at-

tended by these children, to keep an eye on

them.

§ The health department has fi eld offi cers

such as mid-wives and public health in-

spectors and also the medical offi cers of

health who have been playing an impor-

tant role in the community for so many de-

cades. Let them now get involved with this

new project.

§ Representatives of the MDC could meet

regularly. Elected offi cers could pay ros-

tered visits to the homes of migrant moth-

ers to make sure the child care is progress-

ing well.

§ The carers should be given details of the

hotline of the Foreign Exchange Bureau,

and MDC representative, to contact in case

of need for assistance.

§ In Sri Lanka the neighbours too could give

very valuable information on details of the

day to day situation of the target family.

They too could have access to the hotline.

After all Sri Lanka is small and has a reasonably

good infrastructure, so there is no excuse for not

having a protective umbrella in every nook and

cranny of the country to monitor the caring arrange-

ments for the children of migrant mothers.

The Council of the College of General Practitio-

ners, should think on these proposal and pass the

message on to the relevant departments of the state

without confi ning this to the newsletter.

Lucky Jayasekera

Workshops COUNCIL & COMMITTEE NEWS

WORKSHOPS ON CLINICAL TEACHING AND

EXAMINING IN FAMILY MEDICINE

The Faculty of Teachers of Family Medicine has

developed a programme which will ultimately en-

hance skills, knowledge and attitudes of members

as GP teachers and postgraduate family medicine

examiners.

Towards this end College has been able to obtain

the support of the Royal College of General Practi-

tioners, UK for carrying out two workshops.

Prior to that the faculty will conduct a preparatory

workshop, i.e. three workshops in all.

The tentative programme is as follows (see page

10).

Jayantha Thambar & Shreen Willatgamuwa

Jt. Secretaries

Faculty of Teachers of Family Medicine

If undelivered please return to:

COLLEGE OF GENERAL PRACTITIONERS OF SRI LANKA

No. 6, Wijerama Mawatha, Colombo 7.

– Mar - Apr 2011 Workshops COUNCIL & COMMITTEE NEWS

WORKSHOPS ON CLINICAL TEACHING AND

EXAMINING IN FAMILY MEDICINETentative Programme

Workshop 1

Date: Sunday, 19th June 2011

Venue: SLMA Auditorium

Time: 8.30 am to 1.00 pm.

Session 1

Topic – The Adult learner

Attributes of a good teacher

Communication skills

Resource Persons – K.Chandrasekher, Jayantha

Jayatissa

Duration - 1-1/2 hrs

Format – Lecture/Activity/role play

Session 2

Topic – Task analysis

Resource persons – Antoinette Perera, Jayantha

Thambar

Duration – 1-1/2 hrs

Format – lecture/activity

Session 3

Topic – Teaching in Clinical Practice

Resource persons – Preethi Wijegoonewardene,

Dushyanthi Weerasekera

Duration 1-1/4 hrs

Format – Activity/role play

Workshop 2

Date: Sunday, 31st July 2011

Duration ½ day

Topics – (probably) Clinical Assessment – the

OSCE

Resource Person – Valerie Wass

Workshop 3

Date: Sunday, 2nd October 2011

Topic – to be decided

Resource persons – from (Valerie Wass, Richard

Wakeford, Garth Manning)

Duration – ½ day