statue from Polonnaruwa
One funny thing happens to me daily. I cycle everywhere. The women smile, wave and call out ‘good morning’. The men cycle alongside. The conversation goes like this
Good morning – where you from? – where you going? – where you live? – how many children? – where you husband? Yesterday was a first – a motor bike slowed down, but he asked me to come and talk to the children in his school!
I also get asked how old I am several times a day. It’s quite incredible. Imagine interviewing the Director of a company. He walks you to the door, shakes your hand, looks you straight in the eye and says ‘how old are you?’ I just laugh and say, ‘very old.’ It would never happen in England.
Tuesday I went to a meeting of elders’ representatives from the 14 divisions that make up the district. People over 60 are termed ‘young old’, people over 70 ‘old old’ and people over 80 ‘very old’. We went way out in to a rural area near a 16th century Hindu temple. It was a charming meeting (not least the food combo we were served afterwards) although of course the people who turned up were a non-representative elite. There was one guy who turned up in a male version of the sari, Buddhist monk style, but white. He looked like Ghandi, or Ben Kinsley without the amazing eyes, but better cheek bones and taller with white, tossed back hair. He arrived on his motor bike with his helmet and several chains of rosary like beads and was just deliciously dramatic, a much less pompous version of the man on the beach, but so alive. It was intoxicating. They were giving ‘we are 80 speeches, but we must work to…. blah blah’ – very inspiring.
Wednesday I had to find a doctor and went to the hospital. It was very quick and efficient and I got pills, all free, including vitamin C. I think that must be standard.
In a study of the prevalence of diabetes in Sri Lanka between 2005-6, it was discovered that 20% of adults have diabetes, in comparison with 8.3% in the USA. The doctors would like to run a study in Batticaloa, but would need Rs 1 million to do so. They think that as much as one third of diabetes in the area is not diagnosed.
There is clear evidence from scientific study that diabetes is reversible with lifestyle modification and in extreme cases medication. Untreated it is the commonest cause of heart attacks, blindness and kidney failure.
With financial support, screening and awareness programmes could be run, following up patients with close monitoring and referring them to other specialists.
Poisoning from pesticide exposure is also another big worry in the district. This could be addressed by screening, awareness raising and a transition to organic farming.
The dialysis unit is also overstretched despite recent financial support. Currently they are spending Rs 50,000 per month per patient. Ideally a patient should be able to come to the dialysis unit and be treated without a stay on the ward.
Around 10 new patients are coming in to care per week with coronary artery disease. The risk factors are high blood pressure, smoking, diabetes, high cholesterol, age and family health.
There are very limited treatment facilities. The CCU only has 5 beds and there are no dedicated cardiac wards. Ideally more should be done to educate about diet, exercise and life style management and the sale of foods using transfat and too much salt.
Rheumatic heart disease is associated more with patients from rural areas with low socio economic status and where they have been living in overcrowded conditions. It affects the young.
Congenital heart disease occurs in babies and children and is related to consanguinity, old and diseased parents, malnourishment and other environmental factors.
For the first time in Sri Lanka there is a Chest Pain Hot Line on 065 222 9154.
Mental Health issues
The service in Batticaloa faces a shortage of staff. They need another psychiatrist, a psychologist, 5 MOs, 7 nurses, 3 OTs, a vehicle and a driver. They also have no alcohol rehabilitation unit and no forensic or elderly specialised care.
Many factors trigger poor mental health, but poverty, family conflict, divorce, migrant mothers all play a role. For young people the over emphasis on study to the detriment of play and relaxation in the outdoors is a factor.
Every agency has a role to play in supporting improved emotional well-being. Programmes are needed to highlight community strengths and to increase ‘togetherness’.
Batticaloa District Development Plan DRAFT 2013