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Rapid Responses: Rapid Responses published:
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Wrong reference
- Sisira H Siribaddana (19 June 2004)
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Regarding reference 3
- Saroj Jayasinghe (19 June 2004)
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Re: Wrong reference
- Jay Ilangaratne (19 June 2004)
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Stagnation health status or not?
- Saroj Jayasinghe (20 June 2004)
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Doctors can do a better job than politiciians
- Tissa Wijeratne (24 June 2004)
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Sisira H Siribaddana, Team Leader, Sri Lankan Twin Registry Project 259, Temple Raod. thalapthpitiya, Nugegoda, 10250
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Refernce 3 does not show any evidence or connection to, what is descibed in the text. sisira Competing interests: None declared |
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Saroj Jayasinghe, Associate Professor University of Colombo
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Thank you for the response. Reference 3 in the letter was accessed in April 2004. As stated by Dr. Sisira Siribeddana the current figure given at the quoted website is different (16 per 1000 live births for the year 2002, while the letter quotes 17 per 1000 for 2001). This maybe because of a recent update of the site. Another site of the World Bank continues to give the infant mortality rates for 2001 as 17 per 1000. (http://devdata.worldbank.org/hnpstats/files/Tab2_19.xls) accessed 19 June 2004. The new data for 2002 supports the observation that the health statistics have stagnated. Competing interests: author of letter |
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Jay Ilangaratne, Founder Medical-Journals.com
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It would have been helpful if Dr Siribaddana provided an explanation to support his assertion regarding reference number 3[1]. However, a quick glance at the World Bank Group table[1] shows that no figure has been provided(as for Infant Mortality Rate)for year 1998 and 2001,but gives the 2002 rate as 16/1000.As Dr Jayasinghe is citing a further reference(the original editorial;ref.no.1),one assumes the figures he cite for 1998 and 2001 originate from that editorial. However,it is clear from the World Bank Group table[3] that the Infant Mortality Rate for 2002 is 16/1000--which clearly is an improvement --compared to the 2001 figure of 17/1000 that Dr Jayasinghe cites in his letter.Hence,is it correct to call it a "stagnation" of health gains? I wonder whether Dr Sirbaddana is also impliedly referring to the same point. Refernces [1]World Bank Group. Sri Lanka data profile. http://devdata.worldbank.org/external/CPProfile.asp? SelectedCountry=LKA&CCODE=LKA&CNAME =Sri+Lanka&PTYPE=CP (accessed 19 June 2004). Competing interests: None declared |
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Saroj Jayasinghe, Associate Professor University of Colombo
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Summarising the data from the editorial, letter and responses, we see that infant mortality was around 16 / 1000 for 4 years (1998-2002), i.e. some degree of stagnation. These figures too can be challenged by many because of the reliability of our data sets. The concern is whether the figures for infant mortality are in fact higher than those quoted. Two examples come to mind: (a) Historically deprived areas in the South such as Moneragala District have unbelievably low infant mortality rates (2.7 per 1000 in 2000). (Ref: Annual Health Bulletin, 2001, Department of Health Services, Sri Lanka, figure 1.6 in page 6). (b) Data is not available from certain areas of the North and East of the country. These areas are likely to have high infant mortality rates. Furthermore, a majority of registrars of deaths are non-medical persons, which could also lead to errors in documentation. Even hospital statistics on infant deaths completed by medically trained personnel in a premier teaching hospital have been found to be of poor quality (Ref: de Silva MVC et al, Accuracy of cause of death in hospital death declaration forms. Ceylon Medical Journal, 2002;47:35-36). Saroj Jayasinghe Competing interests: author of letter |
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Tissa Wijeratne, Senior Registrar in Neurology Christchurch Hospital, Christchurch, New Zealand
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Editor, We congratulate Jayasinghe for his valuable comments on Sri Lankan health system and the burning need to build on its strength and gain(1) . We would like to comment on current referral system in Sri Lankan health system. At present Sri Lanka does not enjoy a proper referral system within it’s infra structure. (Between family practitioners and specialist services, there is a referral system between public health institutions). Because of this, it is almost impossible for a family practitioner (similar to a GP in UK system) to discuss one of their difficult clinical problem with a specialist or a registrar in the public health system. This has created a sense of confusion among average Sri Lankan when it comes to seek health care. At present majority of Sri Lankan will directly seek specialist advice even for minor ailments (self referral). Sri Lankan specialist may need to see 100- 150 patients per session as a result of this. There are some specialist physicians in Colombo end up seeing three patients at once in the consult room! At the private sector, majority of Sri Lankan specialists cannot spend more than 3-5 minutes per consult per patient. Lack of a proper referral system, self referral, lack of proper documentation has made the situation verse. Of note, a Sri Lankan specialist would charge only a small amount of money per consultation in comparison to Western world (Sri Lankan Rs 200-300). However this should not be a satisfactory explanation to see three patients at once in a consult room. Postgraduate Institute of Medicine (PGIM) in Sri Lanka has a strong relationship with UK, New Zealand, Australia and Singapore when it come to postgraduate exams in Sri Lanka(2). Emergency Medicine is still not a recognized subspecialty in Sri Lanka. It is high time for PGIM to move on and have a serous thought about this. Introduction of Emergency Medicine as a novel sub specialty will definitely attract young, enthusiastic medical graduates. Specialists in Emergency Medicine in developed world are willing to offer their cooperation if PGIM have the initiative from their end (personnel communication, Martin Than, Emergency Medicine specialist, Christchurch). Once Emergency medicine is developed, it will essentially take over current “admitting medical officers” who have no formal postgraduate training. Sri Lanka needs to organize its chaotic primary health care system in to a proper order. It is high time for Government Medical Officers Association (GMOA) to have a friendly discussion with Assistant Medical Officers (AMO) and Registered Medical officers (RMO). They should be an integral part of primary health care and their recognition is important. (These are a group of medical work force in Sri Lanka. This group has gone through a two and half year course of medical education. They do not have a medical degree as such). Sri Lankan doctors should be able to do a much better job compared to its politicians. It is high time to think like a team and act like a team. A proper referral system is a burning need and measures to build this up this would certainly help Sri Lanka to build on its strengths and gains. References: 1.Jayasinghe S. Health in South Asia:Sri Lanka needs to build on its strengths and gains. BMJ 2004;328:1497-a 2.Postgraduate medical education in South Asia Time to move on from post colonial era.Mendis L,Adkoli BV,Adhikari RK,Huq MM,Qureshi AF.BMJ 2004;328:779 Competing interests: None declared |
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