Honorable Dr. Lalitha Wijeratne Interview QuestionsLeave a comment

1) In the past, Sri Lanka has achieved a number of noteworthy successes in the case of health security with infant mortality decreasing and life expectancy increasing. What do you think was the best achievement in 2017?

 The healthcare of any country is measured by the health indices which has the life expectancy and infant/maternal mortality. Fortunately, Sri Lanka over the last few years has done very well and I’m proud to say that compared to the country’s region we are almost at the top when it comes to the health indices. We are coming close to the health indices of developed countries such as the USA and other countries in Europe. In 2017, we are just moving more and more in improving our facilities. What comes to my mind in terms of physical health is that dengue fever has been a major threat to us over the last few years and in 2017, the health ministry was able to set up the dengue secretariat and through that more information was given, more awareness was made through various public media. At the same time from the health side, the nurses, paramedical staff and others were trained on how to diagnose it early and give effective treatment. Many international conferences were held overseas and in Sri Lanka and because of this, the mortality rate is not quite high thanks to the invention and development that has taken place over the last year.

From the mental side, as you know there is a very high prevalence of depression. Some time back the suicide rate in sri lanka was number 1 in Asia now we are number 7 which the figure itself shows we have improved in the care of depressed people over the last few years and I think 2017 be named as a year where awareness, detection and early treatment in all areas have improved quite a lot. 

2) With the rapidly changing demographics in Sri Lanka come some major Healthcare challenges especially with the aging What do you think would be the first step to combat these challenges?

As one of the fastest aging populations in SouthEast Asia, all the people should be prepared to accept aging and keep themselves healthy. The WHO has implemented a program called Healthy Ageing which states from middle age (40-50 years) you should prepare yourself to face the biological phenomenon of aging by knowing what aging is all about and the consequences of aging. As you know, non-communicable diseases and aging are the two major problems. So I think from a young age there should be a lot of programs for the public educating them about prevention from non-communicable diseases such as diabetes, high cholesterol, heart attacks and strokes. All these arise from lifestyle factors. So from one side a lot of educational programs must be implemented to prepare the public to have a healthy lifestyle. Secondly, from the health sector, we have to prepare. I am sad to say at the moment we don’t have the facilities. However the post-graduate school has just commenced a specialist geriatric program that will produce some geriatricians in another 5-6 years time. I think we should prepare the health sector more on identifying the problems with aging and the care of elderly people.

3) With the rise of non-communicable diseases, what are the causes of this sudden rise?

That’s a good question, if you look at the past two-three decades, the main cause of death was infectious diseases and now there is a change in that. The main reason I see is the wrong lifestyle where you take into account diet, exercise, recreation and also spiritual life. If you look at our population 30-40 years back, our diet physical activity and spiritual life compared to now there is a huge difference and this may be due to technology, education, the expanding population etc.Diet has changed – people are prefer a lot of fast food (artificial food sources) and the food patterns are changing. The quantity of food we take is not healthy especially when we are watching TV or on your computers you unknowingly take a lot of food which is more than required. A sedentary life coupled with anxiety and depression you don’t realize the amount you’re eating. Today there is no physical activity at all due to a variety of reasons. The education pressure does not allow children much time to play and then there is no place to play due to poor availability of playgrounds etc. there is a lot of indoor technology games, TV and social media have made people sedentary  . The improvement of transport facilities have also added to this. Sports, recreation and even physical activity in our day to day life has reduced.

I think if you look at the amount of spiritual work that our population does now compared to the past is very poor. Religion is not very important and religion brings a lot of discipline.  Your habits and the way you live with indulgences in smoking and alcohol as well as diet is controlled by religion. When you’re not religious, you're opening the doors to your inhibitions so your lifestyle changes. It is mainly a lifestyle factor that has led to the rise of non-communicable diseases.

4) Communicable diseases such as dengue still pose a threat in Sri Lanka. Why is this so?

There are many reasons for that. Dengue fever is caused by a virus and each time we have a new epidemic, the antigen structural shape keeps on changing and producing vaccines is difficult especially with the disease pattern changing. Lack of responsibility taken by the public as if you want to prevent dengue every citizen is responsible because the vector spreads through mosquitoes and mosquito breeding comes from the community. I am sad to say it still hasn’t gone into the minds of the people. If each citizen in the country is careful on how they dispose of their garbage and how the drainage systems work we can reduce the threat to a great extent. I think the public themselves should take the responsibility for the poor control of dengue as it is very difficult for one sector to do it should come from the citizens themselves. There is a need for research into dengue as it is an evolving specialty and compared to 3-4 years back, now our specialists understand more about it with different mutations being identified and the exposure internationally. I think the reason for the spread of dengue is the public as the health sector has taken all the measures it has and the public is at fault for the mosquito population breeding. Also a lack of interest of the public to learn about dengue as many people still do not go to the hospital dengue two-three days of fever and postpone to the last moment where the complications increase to a point where the doctors are unable to handle it.

>> You’re essentially saying that awareness in rural areas is very low?

Yes and I’m putting the blame on the people themselves as they need to be more cautious. Every person in this country is a potential victim of dengue including your children, your family and your friends – they need to be very careful and know the proper measures to be taken if there is a risk of getting dengue fever and the treatment options.

5) The Impact of Ayurvedic Medicine is arguable. What is your opinion?

Sri Lanka has one of the world’s earliest healthcare systems and we have our own ayurvedic system as well. I think sadly what I see is that western medicine is evidence-based as all our knowledge comes from medical research and we are in a position to explain to the patient on how drugs work unfortunately, the ayurvedic side nothing much has been done on research wise therefore people who practice medicine with a evidence-based approach, we can’t comment exactly on how these drugs work but what I see from outside, there are many people who recover from ayurvedic medicine. I don’t think it is right to say these drugs have no effect as I’m sure these traditional herbs have a lot of good effects. What we need is proper research and real authentic ayurvedic products. I personally feel as a doctor we need to work with the ayurvedic physician to carry out research and I’m sure some products can be used with our patients provided research can prove their effectiveness.

>> Some people have a dependency on using ayurvedic products compared to western medicine – why is this?

The main reason for this is that the western drugs have a lot of side effects such as skin rash and intestine problems such as diarrhea and vomiting even sometimes your kidneys can get affected. A lot of people are very fearful of the side effects and I know my own patients are. The western drugs are chemicals produced in a lab where ayurvedic ones are made from herbs so obviously the side effects are less. So they prefer ayurvedic products despite the slow recovery and difficult preparation as they are fearful of the potential side effects.

6) What made you decide to become a doctor?

From my childhood, in my neighborhood and in my family, I saw a lot of people suffering from illness and as a child I thought it would be nice if I could do a job to care for the sick. I saw when a person is sick, how helpless they are and how much mental and physical caring they need which made an impression on me. I thought when I became an adult to get into a profession to care for the sick – I thought that was what I needed to do, that's why I studied and got into medical school.

7) Describe your favorite moment as a doctor.

There are many favorite moments for a doctor but I think for me, my most favorite moment is when I’m taking care of a patient, they come to me and tell me – they are feeling better, more comfortable or that they are cured. A person getting rid of pain and relieved of suffering if I can know that and see it in front of my eyes – that’s what I need and that’s my favorite moment.

8) What do you think the future holds for Sri Lanka Healthcare?

Looking at how things are evolving, there is a greater demand for the healthcare Mainly due to three reasons. Firstly, Sri Lanka has a very fast aging population so in the years to come % of elderly people will increase and the elderly have a lot of illnesses which are unique from person to person. Secondly, there is a rise in non-communicable diseases from a young age. Thirdly, we are getting more and more people suffering from illness due to change in lifestyle. I can see in the future the numbers are going to increase so there is huge demand for the health sector.

As you know, Sri Lanka has a free healthcare system which is the main reason our indices’ is as good as western countries because from medical consultation to lab tests and drugs everything is free. This makes healthcare facilities more available to the public and keeps our population healthy. But I don’t think with the rising economic costs and things changing Sri Lanka can keep providing healthcare to every single person. Right now, over 55 % of help is given by the private sector, especially outstation. So I think  we have to thank the private sector as well as a lot of people who seek medical assistance from the private sector therefore I think we need to improve the private sector as well. We have to make more facilities available and equally important to ensure the quality of service is maintained.

I am very proud to say we have a good Pharmaceutical industry and they do a great service to the country as they bring in drugs from other countries as well as helping carry out workshops and medical programs investing a lot of money in improving the care of the sick people. I think the pharmaceutical industry has to get more involved by importing quality products into the country. There are so many generics for a given drug and I think the ministry should have a system to limit the amount of generics they bring for each drug and a way of ensuring the quality is maintained. The pharmaceutical sector need s to import drugs which are affordable to our public and what I see there needs to be co-operation between the pharmaceutical industry, the medical sector and the ministry to improve this.  We need to have a more efficient health education program from school age about non-communicable diseases. Everyone needs to be aware of the importance a healthy lifestyle to ensure a healthy population.