Saroj Jayasinghe

Faith-based NGOs and healthcare in poor countries : a preliminary exploration of ethical issues

An increasing number of non-governmental organisations (NGOs) provide humanitarian assistance, including healthcare. Some faith-based NGOs combine proselytising work with humanitarian aid. This can result in ethical dilemmas that are rarely discussed in the literature. The article explores several ethical issues, using four generic activities of faith-based NGOs: (1) It is discriminatory to deny aid to a needy community because it provides less opportunity for proselytising work. Allocating aid to a community with fewer health needs but potential for proselytising work is unjust, since it neither maximises welfare (utilitarianism) nor assists the most needy (egalitarianism). (2) Faith-based-NGOs may state that proselytising work combined with humanitarian assistance improves spiritual wellbeing and overall benefit. However, proselytising work creates religious doubts, which could transiently decrease wellbeing. (3) Proselytising work is unlikely to be a perceived need of the population and, if carried out without consent, breaches the principle of autonomy. Such work also exploits the vulnerability of disaster victims. (4) Governments that decline the assistance of a faith-based NGO involved in proselytising work may deprive the needy of aid. Three strategies are proposed: (a) Increase knowledge to empower communities, individuals and governments; information on NGOs could be provided through an accessible register that discloses objectives, funding sources and intended spiritual activities. (b) Clearly demarcate between humanitarian aid from proselytising work, by setting explicit guidelines for humanitarian assistance. (c) Strengthen self-regulation by modifying the Code of Conduct of the Red Cross to state criteria for selecting communities for assistance and procedures for proselytising work.

Per capita sugar consumption and prevalence of diabetes mellitus - global and regional associations

BackgroundDiabetes mellitus (DM) is a rampant epidemic worldwide. Causative factors and predisposition is postulated to be multi-factorial in origin and include changing life styles and diet. This paper examines the relationship between per capita sugar consumption and diabetes prevalence worldwide and with regard to territorial, economic and geographical regions.MethodsData from 165 countries were extracted for analysis. Associations between the population prevalence of diabetes mellitus and per capita sugar consumption (PCSC) were examined using Pearson’s correlation coefficient (PCC) and multivariate linear regression analysis with, infant mortality rates (IMR, as an general index maternal and child care), low birth weight (LBW, as an index of biological programming) and obesity prevalence included in the model as confounders.ResultsDespite the estimates for PCSC being relatively crude, a strong positive correlation coefficient (0.599 with p < 0.001) was observed between prevalence of diabetes mellitus and per capita sugar consumption using data from all 165 countries. Asia had the highest correlation coefficient with a PCC of 0.660 (p < 0.001) with strongest correlation noted in Central (PCC = 0.968; p < 0.001), South (PCC = 0.684; p = 0.050) and South East Asia (PCC = 0.916; p < 0.001). Per capita sugar consumption (p < 0.001; Beta = 0.360) remained significant at the last stage as associations of DM prevalence (R2 = 0.458) in the multivariate backward linear regression model. The linear regression model was repeated with the data grouped according to the continent. Sugar was noted to be an independent association with DM only with regard to Asia (p < 0.001 Beta = 0.707) and South America (p = 0.010 Beta 0.550). When countries were categorized based on income PCS and DM demonstrated significant association only for upper middle income countries (p < 0.001 Beta 0.656).ConclusionsThese results indicate independent associations between DM prevalence rates and per capita sugar consumption both worldwide and with special regard to the Asian region. Prospective cohort studies are proposed to explore these associations further.

A cross-sectional survey of critical care services in Sri Lanka: A lower middle-income country

PURPOSE To describe the extent and variation of critical care services in Sri Lanka as a first step towards the development of a nationwide critical care unit (CCU) registry. MATERIALS AND METHODS A cross-sectional survey was conducted in all state CCUs by telephone or by visits to determine administration, infrastructure, equipment, staffing, and overall patient outcomes. RESULTS There were 99 CCUs with 2.5 CCU beds per 100000 population and 13 CCU beds per 1 000 hospital beds. The median number of beds per CCU was 5. The overall admissions were 194 per 100000 population per year. The overall bed turnover was 76.5 per unit per year, with CCU mortality being 17%. Most CCUs were headed by an anesthetist. There were a total of 790 doctors (1.6 per bed), 1,989 nurses (3.9 per bed), and 626 health care assistants (1.2 per bed). Majority (87.9%) had 1:1 nurse-to-patient ratio, although few (11.4%) nurses had received formal intensive care unit training. All CCUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (such as electronic monitoring and infusion pumps). CONCLUSION Sri Lanka, a lower middle-income country has an extensive network of critical care facilities but with inequalities in its distribution and facilities.

Review Article: Freedom to Lead a Life We Have Reason to Value? A Spotlight on Health Inequity in the Asia Pacific Region:

The Asia Pacific region is home to more than 60% of the world’s population. Life expectancy at birth differs between countries by as much as 27 years. This article suggests that asymmetric economic growth, unplanned urbanization, marked environmental change, unequal improvements in daily living conditions, and the unequal distribution and access to quality health care have contributed to health inequities in the Asia Pacific region. Contextually specific evidence and action are needed. This requires ongoing monitoring of health inequities and systematic evaluation of societal changes and their impact on health inequities. It requires better understanding of how to translate theoretical and empirical demonstrations of the social and environmental impact on health inequities into evidence-informed policies and programs, in diverse geopolitical, socioeconomic, and sociocultural contexts across the Asia Pacific region and the range of associated complex policy processes. A spotlight is needed on health inequities and their causes else the status quo will persist.

Cyclophosphamide-induced posterior reversible encephalopathy syndrome (PRES): a case report

IntroductionPosterior reversible encephalopathy syndrome is a clinicoradiologic entity characterized by headache, seizures, decreased vision, impaired consciousness and white matter oedema in bilateral occipitoparietal regions. Hypertensive encephalopathy, eclampsia, immunosuppressive/cytotoxic drugs, organ transplantation, renal disease, autoimmune diseases and vasculitides are reported risk factors of posterior reversible encephalopathy syndrome. Reports of cyclophosphamide-induced posterior reversible encephalopathy syndrome are rare and occurred in a background of renal failure, fluid overload or active connective tissue disease.Case presentationWe report a case of posterior reversible encephalopathy syndrome developing as a direct consequence of intravenous cyclophosphamide therapy in a 33-year-old normotensive Sri Lankan woman with lupus nephritis but quiescent disease activity and normal renal function.ConclusionsThis case report highlights the need for awareness and early recognition of this rare but serious adverse effect of cyclophosphamide that occurred in the absence of other known risk factors of posterior reversible encephalopathy syndrome and that early appropriate intervention leads to a good outcome.

Medium of Language in Discharge Summaries: Would the Use of Native Language Improve Patients’ Knowledge of Their Illness and Medications?

Sri Lankan inpatients receive a discharge summary in English known as a diagnosis card. The authors investigated whether supplementing the diagnosis summary with native language improved patients’ knowledge of illness and medication. Participants were 130 newly diagnosed patients with noncommunicable chronic diseases (92 men, 70.8%; 38 women, 29.2%; M age = 55.4 years, SD age = 12.8 years) who were randomized to a control group receiving an English discharge summary and intervention group receiving a supplementary native language discharge summary. A questionnaire assessed knowledge of illness and prescribed medications at discharge and at 2 weeks. The groups were comparable for knowledge of diagnosis and prescribed medications at discharge. At 2 weeks, the intervention group had significantly higher scores than did the control group for knowledge on diagnosis, M = 81.41, SD = 34.63, versus M = 27.95, SD = 41.26, respectively, p < .001; and on medications, M = 54.48, SD = 33.91, versus M = 12.55, SD = 20.44, respectively, p < .001. The increase in scores was explained by the dichotomous variable, whether supplementary discharge summary was given or not (p < .001). A higher proportion in the intervention group read the discharge summary to gain knowledge of diagnosis (81.5%) and medication (80%) than in the control group (4.6% and 6.2%, respectively; p < .001). A total of 121 participants (92.1%) preferred a discharge summary in native language. This simple model may be useful to improve patient knowledge relating to illness in countries that predominantly use another language for medical communications, rather than a native language.

Policy approaches to address the social and environmental determinants of health inequity in Asia-pacific.

Asia Pacific is home to over 60% of the world’s population and the fastest growing economies. Many of the leadership in the Asia Pacific region is becoming increasingly aware that improving the conditions for health would go a long way to sustaining economic prosperity in the region, as well as improving global and local health equity. There is no biological reason why males born in Cambodia can expect to live 23 years less than males born in Japan, or why females born in Tuvalu live 23 years shorter than females in New Zealand or why non-Indigenous Australian males live 12 years longer than Indigenous men. The nature and drivers of health inequities vary greatly among different social, cultural and geo-political contexts and effective solutions must take this into account. This paper utilizes the CSDH global recommendations as a basis for looking at the actions that are taking place to address the structural drivers and conditions of daily living that affect health inequities in the Asia Pacific context. While there are signs of action and hope, substantial challenges remain for health equity in Asia Pacific. The gains that have been made to date are not equally distributed and may be unsustainable as the world encounters new economic, social and environmental challenges. Tackling health inequities is a political imperative that requires leadership, political courage, social action, a sound evidence base and progressive public policy.

Hydrogen sulphide inhalational toxicity at a petroleum refinery in Sri Lanka: a case series of seven survivors following an industrial accident and a brief review of medical literature

This case series details clinical observations in 7 survivors of accidental hydrogen sulphide inhalation toxicity at a petroleum refinery in Sri Lanka. One survivor developed status epilepticus and severe neurotoxicity whilst another survivor developed delayed respiratory failure; both patients required intensive care management. One victim manifested mild bronchospasms in the immediate post-exposure period and another developed mild perioral numbness 2 days following the exposure. A brief literature review explores the manifestations, pathophysiology and available modalities of treatment of hydrogen sulphide inhalation toxicity.BackgroundHydrogen sulphide (H2S) is a highly toxic gas. Accidental deaths following H2S exposure is a known hazard amongst petroleum workers exposed to by-products of refineries. Toxicity results mainly due to cellular respiratory poisoning which impairs oxidative phosphorylation. The heart, brain and the lungs are the organs most commonly affected in H2S inhalational toxicity leading to varied clinical presentations.

Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- a case report and literature survey.

BackgroundLeptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge.Case presentationA 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care.ConclusionThis case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.

Complexity Science to Conceptualize Health and Disease: Is It Relevant to Clinical Medicine?

Clinical sciences are based on several implicit and explicit concepts, assumptions, and beliefs. The current discourse on clinical medicine is dominated by a mechanistic, deterministic, and reductionist world view and has much to gain by embracing the concepts in complexity science (CS). This article sets out to achieve 3 objectives: describe the evolution of models or frameworks used in clinical medicine, outline the application of CS to conceptualize the human body in health and disease, and briefly explore how CS sheds light on our understanding of clinical conditions, using severe sepsis as an example.