Thursday, July 20, 2017

When I was recognized for my social work and media time !

UNFDA, launches their web based media plattform and I was honored to be apart of it as to give my opinion on social media, youth and its use

I feel that anyone with the necessary tools can reach out to the community through social media and we have been seeing that it can improve the socio-economic well being of a community.

Having said that I feel reluctant to say that its an all good deal, but I guess it all depends on the user it self.
If we look at its ability to reach and connect, social media tops the list  it serves as an emergency response tool to form a sort of a highly resourceful communication network during devastating times to mobilize youth and resources. We have seen this during floods, landslides and many incidents and catastrophes that youth with their informative response through social media has formed various kinds of volunteer services and this has helped the community while taking the social services to a greater level

 As a health care worker I find it easy gain attention for higher social issues through social media and I can see the response within seconds to minutes. When I started blogging and writing on the internet I felt that one doesnt have to be a novice to address the public or gain attention to community based issues.
Also as a Healthcare Professional, I myself have utilized social media to call out for immediate responses, and it has proven itself as one of the most effective tools in this regard, especially to mobilize youth for community requirements. 
This data or information we share is not lost. It is retained and circulated. We could always go back and recall or share over and over again and it is within our finger tips.

Even if the Majority of the elderly population is not active on social media, they can be reached through their family members or the mass media which uses social networks as news sources. So as a whole I think the youth is involved in finding solutions to major community based issues through social media as they use it as a connecting tool within resources and information. It has changed many situations and given us a better outcome even though there are draw backs due to false information.
 Of course, I feel I should also remind you that the same features of social media that allows us to make positive change - can make an equally large negative impact if used by the wrong people with the wrong intentions. It's after all a tool, like a knife - which can save a life in surgery or take a life in murder.

dengue diary...july 17

Its the end of another hectic day and I keep on staring at her monitor... which now doesnt make that alarming noise...
It is a blessing to help them all, but a curse to feel so much. Tired of getting sick with all the viral outbreaks, probably had them all and i tend to forget that getting sick is also humane. Two down with viral fever from the team.of 6 doctors in paeds wards.
I Hear there's going to be an extra allowance to all who work during the dengue crisis. "We didnt even get a risk allowance even when we asked for that doctor" a nursing officer quotes on past issues. yes ! Its an occupational hazard to be at risk to catch these diseases while treating them. Life is a struggle right now and I carry all burden on my shoulders thinking "this too shall pass like it did before"
"If u can sit still for a while i can draw you doctor" he says with a smile...without even asking him to do so...such a talented young kid who copied all the wall paintings of our paeds unit. I told the mom to help him with his passion and talent. He is the one who drew the dengue poster which i posted earlier.

So dengue was in its pandemic, creating a never ending headache for those of us who were working in wards full of dengue fevers and even with patients who were critical in dengue hemorrhagic state

For most of the time, these kids who come in with shock symptoms are those who have had fever in first 2 days but parents dont do a blood count as fever resolves on 3rd day. 
They come in faintish, cold peripheries and on the examination bed with resuscitate them with fluid boluses ( bolus - a large amount given via intravenous route over a shorter period) as the pulse is weaker  with low volume and blood pressure drops than the normal.
it takes quite a lot of time to monitor them and the oncalls seem to be tiring that usual with the hourly monitoring of the critical side where most of the kids are leaking. 
Leaking means fluid leakage from the blood vessels into the spaces in our body, which are around organs in abdominal cavity ( where liver kidneys n bowel lies) , in pleural cavity which is around lungs etc.
So we are vigilant on symptoms and signs which indicates clear cut signals of leaking such as reduced input and increase of pcv ( packed cell volume)

today I explained how we manage dengue and how to identify leaking by our parameters to mothers in critical side. all worried about platelets. We had one who leaked and had a good platelet count and another who didnt leak but platelet was 10 000 so its a very tricky game.
All those "kasaaya" people and "thel, beheth" people will really rotten in hell for making it a business in such a crucial time. All were concerned to give papaya leaf juice, and not bothered to even feed their kid the main meals.
All who complained of epigastric pain didnt have a proper meal as the kids said they "cant eat"

I dont remember our mothers letting us stay in peace if we tried to miss a meal.
Had a very worried time when a 1 year old was admitted with 100 000 platelet from ETU... on day 3 of fever they have done a count at pvt sector, platelet 120 with reduced WBC, doctor has adviced to admit but some one near the house has told its normal.
so they took the so called known nonmedical persons advice just like those who run behind, oils to apply on forehead until the disease resolves by its natural immune pathway or kanji to give throughout by asking how much the doctors in ward gives fluids. but not given to any critically ill ICU patients ever.
I really dont know what is wrong with mothers these days. All are bothered about everything else and not what they ought to do !
fed up. yes the numbers still rising.
We received 15 nets from Dr. Vasana Ketagoda and 27 nets from Gihashi Pravindika and her friends today thank you Nadie Wasalamudaliarachchi akka for coordinating ...

Friday, June 30, 2017

I'm worried and concerned !

"is there any problem doctor ?"
a troubled mothers ask me during ward rounds...

"hows are the reports ?(hows my child's blood report) another mom asks me.

some even ask me to explain the counts... once in awhile I get a few mothers who are not bothered of whats happening around... and most of them are diagnosed with a psychiatry disorder.
Ever clinic day I worry too much about the referrals we get from Mental health institution... these mothers are inward patients who have post -partum depression or psychosis, some are known patients with psychiatry disorders which have aggravated after child birth.
I am stressed and worried about these kids who end up with no proper care or love from their parents.
Yes ! all most all of these mothers are single parents who are left after pregnancy by multiple partners.
Why cant we have a legal process for these psychiatry patients to have a proper birth control method and follow up ?
why cant we mend the laws to legalize termination of pregnancy for these kind of patients rather than putting the burden of few tiny souls on them regardless of the shitty situation that these mothers undergo in society ! How can we expect the future generations to be healthy if they are not given a proper childhood and growth ?

Most of them are vulnerable to get sexually abused and raped there for we need to revise the laws and make them more permeable to these kind of problems which hits the society in a way that we cant bear.

There are billions of problems in Health sector. So many loop holes we need to repair.
I am concerned and there for I worry !

Tuesday, June 20, 2017

; living is semicolon story !

"your tattoo looks interesting, what does it mean ? "
I asked the foreign student who was sitting next to me during the lecture.

She had a semicolon tattoo on her left arm.

"don't you know what this means ?" she asked with widened eyes

She told me her story with a brave smile.
"I was growing up with my mother, who was a busy scientist who had a very little time to spend with me. I was a trouble maker at home and school and failed class a few times. when I was 15 I was into many violent acts and a my mother said I was a huge disappointment to her. I felt like killing my self. I did climb up to the roof top of the apartment building many many times but gave up walked to the railway path and still couldn't bear the feeling of losing a life time. I told these troubling, disappointing thoughts to a teacher and she helped me go for counselling and therapy. I survived and this tattoo reminds me of my survival "

yes !
Life is a constant struggle.
Ever one of us go through thousands of hardships each day but what makes us heroic is leaving through these moments when we feel like giving up.

Even though I don't have a semicolon tattooed on my wrist I too have a story to tell.
I studied amidst great difficulties. Problems never left me even after becoming a doctor but my ways of interacting them changed and I didn’t worry much about pain and anger afterwards. I didn’t become a victim of them.

People will hurt you and many will take all that you have gained. they will destroy you and blast you into many tiny pieces but In times like these you’ll learn that you’re strong enough to gather your self up but that doesn't happen in a minute or two. you need to give some time to your own mind to heal. To regret and to heal itself. You will learn the hidden strengths in your soul that you never came across. Yes it has happened to me and to many of us. 

I wanted to tell you how I survive my hectic life with work stress, house hold duties , writer duties and so on.
1. build your own support system. - you need a friendly ear , who can listen to your troubles and daily rumblings but not be a gossiper in the same time. I have a such friends whom we have created a group chat through an app and we tend to share our tears fears and even funny situations we came across throughout the day. that serve like a mind cleansing system where we all support each other verbally mutually as we cant be in one place and discuss.

2. listen to a song, watch a film, draw, bake or do something you love to do and it will take your mind off of the current situation

3. Do not take further actions if you cant make up your mind. Go to a counselling / supportive center or the mental health unit situated in each hospital. If you are reluctant to visit your village hospital you could try the other places. 

persuade your mind that this is not the end. You have survived through many and will definitely overcome this too. 
Or write about it in a diary and one day you will laugh at your self and how foolish you were to give up at that time. 
Yes its not an idiotic to feel this way. At such moments full of immense pain try to hold on ! do not give up
cause I repeat once again... Living is heroic ! indeed

Tuesday, April 25, 2017

The little boy with a bag of stones

A three year old was sitting beside the doctor’s table, outside the labor room. He was surprisingly calm and quiet. He seemed to enjoy the tea we had given him while his mother delivered her fourth child. He had no father or any known relative to take care of them. His mother was a psychiatric patient on regular follow up and treatment.

He didn’t trouble us at all and never asked where his mom was. This little one was wearing the same old clothes that he wore when he came here few months back (We had seen him with the mother on her previous two admissions) and this mom, didn’t have any clothes for her new born either. The little fellow had a brown paper bag, which had stones, bottle caps and other junk, probably he picked up while coming to the hospital. These were his toys.

These people collected the single use, plastic water bottles from us because it was the nearest thing to a toy they knew. They filled them with stones and pebbles to create rattles for babies.

The nurse returned from the labor room with a troubled look.

“Doctor,” she said. “She has no clothes for the new born, and not even for herself. We gave her a bed sheet.”

“Don’t we have extras from the donations?” I asked.

“No,” she said. “Nothing’s left as we gave away everything from time to time.”

It was a very common scenario at this general hospital of the other end, as the population here had been battling with poverty, war and hunger for decades. Since the war ended, they had no more fears of untimely death or losing their loved ones, but the constant struggle with poverty continued.

This mother, who was now delivering her fourth baby, was seen by us at the ante-natal clinics as she was referred to us by the mental health unit. We couldn’t gather much information on her as no one came to visit her. She was a psychiatric patient and was apprehensive and reluctant to talk to us.

One of the midwives came to us with tea and biscuits for this little three year old, awaiting for his mother.

“He’s wearing the same old clothes, miss,” I told her.

“Doctor, if you could provide some clothes I will wash him up and tidy him,” she said to me, knowing that I would go to any length to achieve this. I was so thankful that we were blessed with such kind-hearted midwives and nurses. They never said no to our requests and helped us in everything as our hands were always full in operating theaters and labor room.

We called up the pediatric ward, but they had no extra clothes. I made a quick decision and walked over to the shop on the other side of the A9 Road. I bought some clothes for him and also for the new-born baby. For the mom, I got a new bed jacket and a lungi (a wrap-around cloth). We were bound to help them, as there were no other means.

A few days ago, a mother who was admitted for childbirth told us that she was willing to give the newborn away, as she was a single parent of a teen daughter. The man had left her while she was pregnant and she was ashamed to go back to the village. No one knew her situation and her plan was to deliver this child, give it away to the probation authority and return to her village to take care of her daughter.

She was willing to undergo Caesarean section as she had undergone surgery during the previous childbirth. We always used to visit the patients who underwent surgery, as soon as we returned from the operating theater. When I came back to our ward after six hours, I couldn’t see the mother who was operated on that morning. When we finally found her, she was washing clothes in the bathroom with the urine catheter pinned up into her waist. I was shocked to see her up and walking like that as we always had a struggle to make them walk after a surgery. Post-surgical patients prefer to stay in bed due to pain caused by surgical wounds.

“What on earth do you think you are doing?” all were scolding her for getting up without assistance.

“I had only those two nappies and a baby shirt you gave me the other day doctor, so I had to wash this for the baby,” she said with tears rolling down her cheeks.

I kept sets of baby clothes in my table drawer, to be given to those in need. When she told me all her social problems and situations I gave her the last few pieces I had left. Back at the store, remembering her, I bought a few extra sets of baby clothes. I knew it was not my duty to provide them everything. I have been told by many seniors to work up to my limits, but the humane side of me never let me rest. I feel so much pain seeing them suffer like this.

I shared these incidents few years ago, in my Sinhala blog ‘Anithkona’. It was an attempt to share what they were going through after the war. After a few days, I got a feedback from a kind-hearted Sri Lankan lady residing in Australia that she was willing to help these people. I refused their help as the sole purpose of my writing was to show the misery and struggle of the North End and had no intention to trouble anyone else.

Regardless of my objections, they sent clothes and other goods and it was collected by two temples in Australia. When I told about this to the Military, they were willing to help with the transportation and distribution.

I heard that they received the goods and had distributed them among the poor and the orphans.

My cousin residing in the USA had sent baby clothes, and we distributed them among the needy mothers in our wards.

When I went to post-natal wards to check on the mother, sinna thambi (little brother) was sitting on the corner of the bed with a sad face.

“I wanted a baby brother, but mom got me a sister instead. I don’t want a sister,” he sighed.

We arranged counseling and follow up for the mother for her psychological issues. With the help of mental health unit, she was donated goods for her baby.

Some evenings this little boy was seen at our nurses’ station where he learned to write. Our wonderful nurses and midwives were teaching the kid to write and speak because he was so shy and timid as his mom almost never spoke with him.

Remember the mom who got down from her bed after surgery? After a week, she withdrew her request to give away the child.

“I breast fed her for one week doctor… I can’t give her up….I love her,” she said. I met her when she was ready to be discharged. “My eldest has attained puberty while I was here. I have to go to my village to arrange her ceremony. I will take care of my kids somehow, doctor,” she said with a hopeful smile.

We arranged social support for them by informing the Psychiatric Social Worker (PSW) of that area.

Every hospital admission is traumatic, but seeing them go home recovered and healed is a blessing indeed.

Indu and the face book !

Indu (pseudonym) was one of the permanent patients of our unit. She had nowhere else to go other than the orphanage which sheltered her. We took over her care, whenever she troubled her care takers. Keeping her in one place was hard as she had a habit of running away from every home that sheltered her. She became one of our unit’s heaviest burdens.

When she was hospitalized, we had to keep an eye on her, as she was fond of wondering in corridors, outside hospital premises and suddenly went missing during visiting hours. She was in her twenties when she was diagnosed with her mental illness. She was good in her studies but couldn’t continue as her mental status worsened. On top of this she had no family support. Her mother who was treated for the same illness showed no interest in building a healthy relationship with her daughter. The efforts we took to create a good family support, failed as it was impossible to make the mother and daughter understand each other’s situation. They had no insight to it.

This time she was hospitalized after she ran away from the orphanage for the third time and was found hiding inside a canal by the side of the road. She had cuts and bruises all over her arms and legs and we feared of her being sexually assaulted or abused when she ran away. Bringing her back to our ward was a struggle. Her medications were on higher doses but still showed no improvement. She was hasty and showed no interest in occupational therapy. As she had no family support, her recovery was not in the right path.

She fights with anyone around her, whenever she’s irritated, mostly for no reason. Hallucinations, delusions, sleep deprivations, over eating or loss of appetite, she piles them all in front of us and complains about each and every feeling she gets. She accuses us or other patients for everything that happens to her in ward.

During these temper tantrums she is often locked away in the isolation room until she calms down as she becomes a threat to her own life sometimes. Our efforts to calm her down never work when she’s afflicted, she beats whoever comes near her. Yes I have been hit with a pile of BHT files, and with her fist too. When she’s locked in, she cries and weeps for her mother, pleading her to come and rescue her.

“Why have you left me all alone here amma, am I not your child…. Why couldn’t you kill me if you didn’t want me” she weeps. I feel awful hearing her, crying and yelling for her lost childhood and mother’s love.

Every one of us needs love, care and compassion to ease our way through life. When one becomes mentally ill they need a multi disciplinary healing system. Any mental illness carries a stigma, emotional instability and a feeling of fear with lack of insight to their disease that often results in social isolation.

The poor psycho–social support system in our country has hindered the recovery and healing. Helping Indu to heal was a challenge when there is no family care or support. Her own brother who lived in a village nearby couldn’t take care of her, and mother wasn’t aware of anything as she had no sound mind.

We were the only family she had and we cared about her wellbeing. We brought clothes for her whenever she tore her clothes into pieces during the temper tantrums. Gave her comfort in every way we could.

We spent most of our time in ward as we all were away from home and our loved ones. My laptop battery was dying and needed charging time to time, and only workable place was at nurse’s station. I was there with my laptop which was near the grilled window of the female ward.

It was one of those evenings when we were free of ward work. When we were checking a photo page of a staff member’s wedding, I heard a voice behind my head, “What’s that doctor” Indu, peeping through the grilled window asks me pointing at the laptop screen.

It was the Face Book which connected me to my community when I’m here.“That’s face book, Indu…” I explained as I was happy that she came out of her lackadaisical behavior. That was the first time she showed some interest in what was happening around her. She wanted to know what I was doing there typing. “Why do we need this” she asks with a surprised look in her face.

“Well, you see, when we are so busy in our own little worlds, it’s hard to keep in touch with friends. We need a media to connect. I’m miles away from home, working here with you guys and it’s hard to meet people or be with them in their life events. Some are even living abroad. Social networks like face book, gives me a chance to reconnect with friends; Talk to them, check their photos and share what’s happening in our day to day life.”

I tell her while flipping through photos, of birthdays, weddings and parties. She doesn’t show any concern on my explanations and wonders off humming.

After few minutes she appears again” it’s such a stupid thing to have a wedding these days. It’s a waste of money doctor” she adds.

“Indu, I agree… you are absolutely right!” hearing this her face brightened.

“Why do they post photos, like this, on a web page” she asks pointing at the laptop. Her mind rapidly changes subjects.

“To share all those special events with friends. We can respond with a like, or a comment or even share ideas” I explained.

“What’s the purpose of showing photos to others doctor? Why does one show off all that happens to them?” She asks as she shrugs her shoulders with a startling look.

“Well, that’s a good question Indu, I too have no answers yet, but I guess it makes them happy”

“Happy? Who’s happy?” She asks with a puzzled look on her face.

“Those who share and those who can see them… I guess…” I felt that I was succeeding more in confusing than explaining.

“Hee hee…that’s crazy right…” she tells me with a heavy tone and runs away giggling. For a moment, I was speechless. People love social networks and enjoy sharing their life events, even the plate of food they eat, or make up they put on. I guess it was hard for her to understand the common flow of the modern techno world. She calls it “crazy” to promulgate on our daily whereabouts and feel contented about it.

Indu, who’s on mind medications, finds it confusing that we maintain virtual profiles. She thinks we are “crazy” for wanting to post and proclaim every good thing happening in our lives. We grade her imperceptive, uncomprehending and psychotic, and we obstruct her thinking to put her mind to rest but she laughs at our mundane ego boosters.

Back in those days, I remember painting, cards for birthdays and penning notes for sharing.

We never print a photo or an album these days but we log in to check the photos in time lines instead. We console each other with likes and comments but no effort is taken to meet in a real life event. I guess, this posting and boasting, which she calls crazy makes people feel less lonely and more heroic.

I was lost in my own thoughts about social networks and couldn’t help being dismayed at our ways in finding soul superiority in these virtual platforms.
 Dr. Bodhini Samaratunga

Tuesday, April 18, 2017

Standing Hazards - Women workers

Health Complications Which May Result in Female Workers Who Stand for a Longer Period of Time
Dr. B.R.M. Samaratunga (M.D.)

Women Workers who stands for longer hours at work place are prone to develop health conditions such as musculoskeletal disorders, varicose veins, heart and circulatory problems and pregnancy difficulties. The most frequently and commonly complained symptoms are discomfort, fatigue and swelling in the lower limbs. Standing hazards

· Pain:

o Physical pain – musculoskeletal disorders

o Swollen and painful limbs mainly lower limbs.

o Joint pains (increased risk of knee and him arthritis)

o Neck and shoulder stiffness

· Poor posture (and its effects)

· Plantar fasciitis

· Stretched Achilles tendon. Flat feet and heal spurs

· Varicose veins

· Poor circulation

· Increased risk of carotid atherosclerosis and stroke

· Pregnancy difficulties

· Mental distress and depression which may result due to long term pain. 

Varicose veins are a common complication of standing for a longer periods of time. Standing and walking upright increases the pressure in the veins of your lower body and this in return makes enlarges the veins and bulge out. Varicose veins add a higher risk to circulatory problems.

Even though any vein could become varicose, the most affected are veins on legs. These veins could also get infected or become chronic and painful. It may even cause serious acute illnesses that may need urgent medical help. (Thrombophlebitis, deep vein thrombosis, pulmonary embolism)

Chronic heart disease and circulatory disorders are linked to prolonged standing at work. Prolonged time in an upright posture at work may cause hypertension comparable to 20 years of aging. Strong evidence linking prolonged standing at work to an increased risk of heart problems and stroke has recently come to light. Researchers have linked prolonged standing to an increased risk of carotid atherosclerosis, which in turn can cause an increased risk of heart attack and stroke.[1]

Muscular pains, soreness and numbness of lower limbs, swollen joints and arthritis of hip and knee joints will result in temporarily immobilized or locked joints. This can later result in rheumatic disease too.

Having these work place and work related issues will not only give physical pain but also may alter one’s day to day living and activities. Being in pain for a long term may also add a mental stressor to one’s life. This will create a psycho - social hazard in worker’s life that may ultimately lead to a depressive state.

Some of these medical issues will occur later in life but in return will add a physically and mentally disordered population to the society.

[1] (Krause N and others. Standing at work and progression of carotid atherosclerosis, Scandinavian Journal of Work, Environment and Health, vol.26, no.3, pages 227-36, 2000.)
2. McCulloch J. Health risks associated with prolonged standing. Work, vol.19, no.2, pages 201-5, 2002.
3. Tüchsen F, Krause N and others. Standing at work and varicose veins, Scandinavian Journal of Work, Environment and Health, vol.2 no.5, pages 414-20, 2000.