"WHAT and IF are two words as non-threatening as words can be. But put them together side by side and they have the power to haunt you for the rest of your life.
I don't know how your story ended, but if you felt then was love, then it's never too late. If it was true then, why wouldn't it be true now?
You need only the courage to foll...ow your heart. I don't know what a love like that feels like... a love to leave loved ones for, a love to cross oceans for... but I'd like to believe if I ever felt it. I'd have the courage to seize it"
Quoted from the move, "Letters to Juliet".
The question that has been miming in my mind - "If it was true then, why wouldn't it be true now?". It made me think again, of what I have always been thinking for so many years.
A truth is something which would last forever, something which remains with all the changing myths. It is true, that once a truth is always a truth. That is why we call is as such. Juliet was right. If it was true then, it should be true now too.
Few years back - I mean, since 11 years back - I thought that my love for him was true. I thought it was true enough to make him love me too. Whenever a tear fell down from my eyes, I also had a smile thinking I am crying because of a true love. I had this pride in my head, thinking that I was holding some true love in my heart, that many of others didn't. If it was true then, why shouldn't it be true now? Oh! It's horrible! It isn't true any more....!!!
Then I realise now - may be it was not true then as well. May be it was all fake. May be I was watching too much of movies - that I pretend myself to be some Chandramukhi.
Yes - It was all false. It was just a mistake. Was it? I don't know. But it is not true any more. I do not have any of the feelings for him that I had years ago. I do not have WHAT and IF together anymore, to haunt my mind. I don't have WHAT's any more, neither any IF's.
The truth was that I was to be loved by someone special, and it remains the same. I am to be loved by the special someone - the person who I cherish the most.
Juliet - I have a question for you. What-if the love you had for Romeo was not true? What-if you killed yourself for the wrong person? Give me an answer....
By D.R. De Silva
Sunday, March 6, 2011
Saturday, March 5, 2011
"Better be late than never"
It's been a very long time. A very long time since I last visited my own blog. I am laughing at myself, looking at all the posts I have ever put up here on my blog, thinking how immature I have always been. But with all those childish things, I know I have been learning things about life and love. Thanks again for Chathuri and Awanthi, through whose blogs I remembered that I had created this blog a long time back, and I am here again, may be to share my thoughts about life, for all those who would stop by here for a minute.
It is always difficult to find and link words, when it comes to write your own story. It is always a question where to start and how to end; should I write all the truth, or shall I hide something? I am going through the same situation right now. With all what has happened to me, there are few things that I would keep for myself, or may be shared only with my parents and husband.
So - yes, I got married. But not to the person I have been talking about throughout this blog since I started writing. I know it is little weird, but it is the truth. To add on, I think it is not a thing to hide since almost all the people I have been knowing, know that I didn't get married to him. But I should definitely mention that I love my husband, and I mean that from all my heart.
Now - I found the start for my story. I was in love with 'him', for a long time, a love that cultivated in my mind, grew up in the same dark corner and happened to die without seeing the light. When Chathuri talked to me about Jacob Black in Twlight, I thought he was the Jacob in my life. But reading in real about the character, I would say, he is not. For some reason I thought I loved him. I tried to get his attention on me through so many stupid things all the time. But I know that, above all, I was his best friend, and he was mine too.
Yes - we were the best of friends, but no one ever knew we were. We knew each and everything happened in our lives, we knew each and every feeling we had in our hearts. I have cried on his shoulder, and he has too. He has shared every little bit of his life with me. But they were all unknown to others, just like my love for him.
Life does not always give us what we ask for. I have heard this;
"Live will say YES and give you what is good for you; It would say NO and give you something better. When life says WAIT, it will be giving you the BEST"
And I always believed that best was yet to happen to me. I kept waiting for; waiting for the best. It was not easy. There were countless nights slept on wet pillows. As it was mentioned in "Turning 30", I tried many haircuts and lost my pretty hair. But throughout every day of my life, there was one thing I tried keep doing - to smile. There were people who fell in love with my smile. But I knew that it was not "The Best" that was to happen to me. As I see the Facebook status of some friends of me, who sound to be going through the same series of incidents, I would say, "hang on and keep smiling" because I know that is how we have to get over, though it is the most difficult thing to do.
I still remember getting up one day, realising something was going to happen to me soon. I sensed it - which I still do not understand how. This is the day my new friend first had a chat with me in Facebook! I wrote a note on Facebook the very same day, because I still sensed that something special was there, ready to be happened to me. I didn't know what it was, but I was waiting for it. I cleaned up my heart so that it would have no trouble getting in. I kept my eyes dry, so that I could easily smile when it arrives. This was "The Secret" I learnt through Rhonda Byrne's book which I still cherish as my book of guide.
And - Here I am today, married to that new amazing friend who came into my life so sudden, bringing loads of love than I ever could imagine. Someone would say it has happened all of a sudden, but I would say no. He and I have been getting ready to love each other for a long time, not knowing who the other one is. You call it luck, you call it destiny... but I call it LIFE. Life as I always believed of. Life which kept me waiting to give me the best.
That sums up my learning about life, about love and about keep smiling =)
If you think you are going through the hardest time in your lives, just remember - "Hard times are difficult to live with, but they surely pass by. So keep smiling, keep you ready to accept the best that life has planned for you"
By D.R. De Silva
It is always difficult to find and link words, when it comes to write your own story. It is always a question where to start and how to end; should I write all the truth, or shall I hide something? I am going through the same situation right now. With all what has happened to me, there are few things that I would keep for myself, or may be shared only with my parents and husband.
So - yes, I got married. But not to the person I have been talking about throughout this blog since I started writing. I know it is little weird, but it is the truth. To add on, I think it is not a thing to hide since almost all the people I have been knowing, know that I didn't get married to him. But I should definitely mention that I love my husband, and I mean that from all my heart.
Now - I found the start for my story. I was in love with 'him', for a long time, a love that cultivated in my mind, grew up in the same dark corner and happened to die without seeing the light. When Chathuri talked to me about Jacob Black in Twlight, I thought he was the Jacob in my life. But reading in real about the character, I would say, he is not. For some reason I thought I loved him. I tried to get his attention on me through so many stupid things all the time. But I know that, above all, I was his best friend, and he was mine too.
Yes - we were the best of friends, but no one ever knew we were. We knew each and everything happened in our lives, we knew each and every feeling we had in our hearts. I have cried on his shoulder, and he has too. He has shared every little bit of his life with me. But they were all unknown to others, just like my love for him.
Life does not always give us what we ask for. I have heard this;
"Live will say YES and give you what is good for you; It would say NO and give you something better. When life says WAIT, it will be giving you the BEST"
And I always believed that best was yet to happen to me. I kept waiting for; waiting for the best. It was not easy. There were countless nights slept on wet pillows. As it was mentioned in "Turning 30", I tried many haircuts and lost my pretty hair. But throughout every day of my life, there was one thing I tried keep doing - to smile. There were people who fell in love with my smile. But I knew that it was not "The Best" that was to happen to me. As I see the Facebook status of some friends of me, who sound to be going through the same series of incidents, I would say, "hang on and keep smiling" because I know that is how we have to get over, though it is the most difficult thing to do.
I still remember getting up one day, realising something was going to happen to me soon. I sensed it - which I still do not understand how. This is the day my new friend first had a chat with me in Facebook! I wrote a note on Facebook the very same day, because I still sensed that something special was there, ready to be happened to me. I didn't know what it was, but I was waiting for it. I cleaned up my heart so that it would have no trouble getting in. I kept my eyes dry, so that I could easily smile when it arrives. This was "The Secret" I learnt through Rhonda Byrne's book which I still cherish as my book of guide.
And - Here I am today, married to that new amazing friend who came into my life so sudden, bringing loads of love than I ever could imagine. Someone would say it has happened all of a sudden, but I would say no. He and I have been getting ready to love each other for a long time, not knowing who the other one is. You call it luck, you call it destiny... but I call it LIFE. Life as I always believed of. Life which kept me waiting to give me the best.
That sums up my learning about life, about love and about keep smiling =)
If you think you are going through the hardest time in your lives, just remember - "Hard times are difficult to live with, but they surely pass by. So keep smiling, keep you ready to accept the best that life has planned for you"
By D.R. De Silva
Sunday, May 31, 2009
In The Verge of a Breakdown....
In The Verge of a Breakdown....
By Ravini De Silva
Many of us go through very stressful times. We may have problems at work, or even lose jobs, have relationship splits, go through times of financial difficulty, and suffer bereavements. It can often be triggered by a distressing event such as a loss of job, financial difficulty, bereavement or relationship crisis. Overwork, stress and bullying are other triggers. Or a breakdown could be a combination of factors. Though they were manageable on their own, combined they can be too much.
At these times, you may keep on thinking too much, lose your appetite for a few days, drink more than usual, and find it hard to stop crying. But there are key differences between this sort of life crisis and a true nervous breakdown. In a breakdown, someone is no longer able to function in the way they were able to. During a stressful time, people have feelings of loss of control over your life, have paranoid thoughts, lose the interest in life for more than a few days, see or hear things, find it difficult to leave home or to talk to people, act very out of character, change in appetite or sleep patterns for more than a few days.
Some people may have a stronger tendency to breakdown. You may be more sensitive, your past can also be a factor. If you had an experience that went badly, you may be less resilient to dealing with a similar experience now. If you were brought up to hide your emotions, you're more likely to reach the point of being overwhelmed because there is no outlet for them. Heavy drinkers or drug users may be at risk, too. People may use these to self-medicate difficult feelings, but they can lead to changes in brain chemistry which will make things worse.
If you are in a stressful time, take steps to prevent a breakdown. Talking to someone, whether that's a friend or a qualified counsellor, can be very helpful. Bring some balance and routine into your life - take days off, make time for relaxation, try to eat regular meals, and get to bed early. Avoid alcohol, caffeine and sugary junk foods, which can exacerbate feelings of depression and anxiety. Exercise is also important. It can help you work out feelings of stress and anxiety.
People take different lengths of time to recover sufficiently to go back to normal life - it can take anything from a few weeks to many months, and you may need to maintain the support of counselling.
There’s a very good chance of recovery from such a breakdown. If a breakdown has a temporary cause, such as bereavement or work stress, it's likely someone will be able to move on and go back to a normal way of life. There can even be a silver lining, when people rebuild their lives afterwards, they frequently report they are happier than they were before. This can be because they made some big changes.
Specially, if you are after a breakdown of a close relationship, best thing to do is try to keep as busy as possible, give yourself goals for the new year. Get fit, join clubs, go out with friends, meet up with family, best to keep active. You will have good days and bad days. Do the things that interest you and put yourself first. Take up new interests or "dust off" old ones. You will go through many emotions, and although the whole experience is absolutely horrible, you can become a stronger person for it.
Also remember to leave the guilt alone. Most of the time we want to wonder what we did to mess up this relationship and push some one away, and the truth is that it had nothing to do with you. Some times a relationship doesn’t work just because, and its no ones fault, so don't be so quick to take on guilt, its no ones fault. Accept that it is over and be ready to move on. What most of us do is build a life around our partner and depend on them for our happiness and security. So unbalanced and unhealthy as well as smothering and way to needy.
Sometimes relationships just end. That has to be accepted. It's not taught in movies or culture but it's a reality. A relationship cannot sustain itself if one party is absent or chooses to get out.
By Ravini De Silva
Many of us go through very stressful times. We may have problems at work, or even lose jobs, have relationship splits, go through times of financial difficulty, and suffer bereavements. It can often be triggered by a distressing event such as a loss of job, financial difficulty, bereavement or relationship crisis. Overwork, stress and bullying are other triggers. Or a breakdown could be a combination of factors. Though they were manageable on their own, combined they can be too much.
At these times, you may keep on thinking too much, lose your appetite for a few days, drink more than usual, and find it hard to stop crying. But there are key differences between this sort of life crisis and a true nervous breakdown. In a breakdown, someone is no longer able to function in the way they were able to. During a stressful time, people have feelings of loss of control over your life, have paranoid thoughts, lose the interest in life for more than a few days, see or hear things, find it difficult to leave home or to talk to people, act very out of character, change in appetite or sleep patterns for more than a few days.
Some people may have a stronger tendency to breakdown. You may be more sensitive, your past can also be a factor. If you had an experience that went badly, you may be less resilient to dealing with a similar experience now. If you were brought up to hide your emotions, you're more likely to reach the point of being overwhelmed because there is no outlet for them. Heavy drinkers or drug users may be at risk, too. People may use these to self-medicate difficult feelings, but they can lead to changes in brain chemistry which will make things worse.
If you are in a stressful time, take steps to prevent a breakdown. Talking to someone, whether that's a friend or a qualified counsellor, can be very helpful. Bring some balance and routine into your life - take days off, make time for relaxation, try to eat regular meals, and get to bed early. Avoid alcohol, caffeine and sugary junk foods, which can exacerbate feelings of depression and anxiety. Exercise is also important. It can help you work out feelings of stress and anxiety.
People take different lengths of time to recover sufficiently to go back to normal life - it can take anything from a few weeks to many months, and you may need to maintain the support of counselling.
There’s a very good chance of recovery from such a breakdown. If a breakdown has a temporary cause, such as bereavement or work stress, it's likely someone will be able to move on and go back to a normal way of life. There can even be a silver lining, when people rebuild their lives afterwards, they frequently report they are happier than they were before. This can be because they made some big changes.
Specially, if you are after a breakdown of a close relationship, best thing to do is try to keep as busy as possible, give yourself goals for the new year. Get fit, join clubs, go out with friends, meet up with family, best to keep active. You will have good days and bad days. Do the things that interest you and put yourself first. Take up new interests or "dust off" old ones. You will go through many emotions, and although the whole experience is absolutely horrible, you can become a stronger person for it.
Also remember to leave the guilt alone. Most of the time we want to wonder what we did to mess up this relationship and push some one away, and the truth is that it had nothing to do with you. Some times a relationship doesn’t work just because, and its no ones fault, so don't be so quick to take on guilt, its no ones fault. Accept that it is over and be ready to move on. What most of us do is build a life around our partner and depend on them for our happiness and security. So unbalanced and unhealthy as well as smothering and way to needy.
Sometimes relationships just end. That has to be accepted. It's not taught in movies or culture but it's a reality. A relationship cannot sustain itself if one party is absent or chooses to get out.
Tuesday, February 3, 2009
Population Ageing & Geriatric Services in Sri Lanka
Introduction
Population ageing has become one of the leading demographic issues the world has to face. As a developing Asian Country, Sri Lanka is no exception to the global trend of population ageing and the social and economic problems stemming from it as a result.
Sri Lanka ranks top as a country with a rapidly ageing population. Out of a population of 18.9 millions in 2000, around 9% was estimated to be over 60 years of age. In 2025, the ageing population is estimated to increase to 18% and in 2050 up to around 27 %. It is also expected, that by 2050 Sri Lanka would have a population of which 50% would be over 50 years of age. Hence the current situation of the elderly in Sri Lanka and the emerging trends need serious consideration. It is also noted that Sri Lanka is a country with a longer life span. Life expectancy was 43 years in 1946, and it increased up to 69 years in 1998. This demographic transition has resulted in changes in the population structure where there is a considerable increase of the elderly compared to the young people.
1920-22 1946 1953 1962 1967 1971 1981 1991-96 96-2001
Male 32.7 43.9 58.8 61.9 64.8 64.2 67.7 69.5 70.7
Female 30.7 41.6 57.5 61.4 66.9 67.1 72.1 74.2 75.4
Chart I: Expectation of life at birth
Source: Dept of Census & Statistics
Year 1991 1996 2001 2006 2011 E 2016 E 2021 E 2026 E 2031 E
Percentage of Elderly (%) 8 9 10 11.4 13.1 15.5 17.7 20 22
Chart II: Number of Percentage of Elders
Source: Dept of Census & Statistics
The rising rates of old age dependency would place a greater pressure on the family, community and the country with regard to providing support for the elderly. With the increase in longevity, there is a need of concern in respect of the increasing number of ageing population as a specific group with their high dependency rates, and geriatric health needs. Geriatric care has assumed to play an important role as a specialized medical care, which is not available adequately at the moment [Geriatrics is the branch of medicine that focuses on health care of the elderly. Its aim is to promote health and to prevent and treat diseases and disabilities in older adults. The term comes from the Greek geron meaning "old man" and iatros meaning "healer"]. The healthcare systems need to be geared to the ageing process and caring for illnesses stemming from the longevity.
Why Geriatrics?
The traditional and cultural background of Sri Lanka would need that older people would be cared for at home by family members, relatives or neighbours. In our society, older people are respected as valuable resources with skills, experience and wisdom. The problem of the elderly was not a major issue in traditional societies with their extended family systems. As a result of the socio-economic changes in modern society, specially moving away from the extended family system to the nuclear family concept, the elderly population is forced to face many different issues. Most of the elderly people have to live alone and face other accompanying problems stemming from inadequate family incomes, high cost of living together with health care problems. Migration of young people has resulted in the emotional stress of older persons. The ethnic crisis in the country has also created feelings of insecurity and uncertainty in the minds of older people. Some families have been displaced due to the ethnic conflict and others have migrated either to safer areas or to other countries leaving the older family members alone at home or in a "home for elderly" with no love, care or support. Elderly patients are at high risk for medication-related problems due to age-related physiological changes, a higher incidence of co-morbid illnesses and greater use of both prescription and over-the-counter medications. There we see an urgent need to find the ways of caring for the elderly by developing community-based systems for the same.
Figure I: Birth rate and death rate in Sri Lanka (Births/Deaths per 1000 of population)
Source: Dept. of Census & Statistics
Figure II: Birth rate and death rate - Worldwide (Births/Deaths per 1000 of population)
Source: Dept. of Census & Statistics
Sri Lanka has developed the health care systems
Sri Lanka has developed considerably in terms of health care and nutrition. The mortality rates (deaths per 1000 live births) have declined. The crude birth rates have increased while the crude death rates have declined. The gap between these values is narrowing resulting in a higher percentage of elderly (natural growth of population). This is common worldwide, but the increasing elder population in Sri Lanka is alarming. It is estimated that for Sri Lanka, the natural growth of population is 1.06% at present. The child nutrition has also improved a lot. With many health care campaigns, we have been able to minimize many wide-spreading diseases such as malaria, filaria, diarrhea, etc. From 2000 to 2005, the number of P.falciparum (malaria) patients has been reduced from 59650 to 130, while the number of P.vivax patients has been reduced from 150389 to 1506. The number of Filaria patients recorded has been reduced to 580 from 2233 during the decade of 1993-2003. Sri Lanka has been continuously being improved in many health aspects. New clinical practices have been introduced, and with many number of private hospitals together with government funding for public hospitals, we have been able to experience the advantages of new technologies in medicine. In addition, there are many examples of numeric improvements in health aspects, such as tuberculosis, smallpox, measles, dengue, epidemic diseases, skin diseases like leprosy, etc. It should be praised that the ministry of health care and nutrition has recently launched many campaigns such as the campaigns for AIDS, Tuberculosis, Diabetes, Cancer and the also the newest anti-smoking advertisement featured by Pradeep Rangana, which is aimed at the longevity of people and result in a healthy population.
The numbers, as mentioned above, look better with regard to the health care systems and the new campaigns which have been launched so far. Comparing the situation before and after 1948, it is apparent that the country has achieved the quantitative goals in health care.
What about qualitative improvement?
However it is questionable if we have still achieved the required quality in health care. The infrastructure has to be improved a lot. The expenditure on health is calculated as 1.57% in 2008 (4.1% of government expenditure). By 2004, there were only 3.1 hospital beds per one person; 2224 persons per one doctor; and only 4.5 nurses per 10,000 persons. Although the medications for many diseases have been improved, majority of the people cannot get those services due to many reasons. Despite of the improvement in the clinical practices and also in diagnosis enhancement through sophisticated equipment, there is a considerable gap between the availability of such services and the ability of the general public to receive them. When there are 6.6% of the population whose income is less than 1 US$ per day and 45.5% of the population whose income is less than 2 US$ per day, it is questionable if they can receive these advanced medication services available at the moment.
There is a group of people who do not get proper health education. The performance of the health care system is still measured in numbers, not in the quality. We do not have enough proportion of doctors per person. Much programmes have been carried out in the health care services in the last 50 years giving much emphasis to mother and child programme with special concern on controlling population. There is few or no concern put on the elderly, other than the increasing number of homes for elderly. According to the latest figures, there are about 167 elders’ homes functioning now and around 10,000 are living in them. It is also found that the homicide and suicides among the elderly has been on the increase while abuse has caused depression and distress among them. Sri Lanka being one of the top countries with highest suicide rates, also reports high suicide rate among elderly due to above mentioned reasons.
There is a clear tendency for suicide rates to increase with age (Figure III). By comparison with a global suicide rate of 26.9 deaths per 100,000 for men in 1998, the rates for specific age groups start at 1.2 (in the age group 5-14 years) and gradually increase up to 55.7 (in the age group over 75 years). The same positive relationship between age and suicide rates is observed in females. This is alarming and this is one aspect that Geriatric care has to look into.
Figure III: Global Suicide Rate Among All Age Groups
Source: World Psychiatric Association
Geriatrics still not identified as a special area to be concerned
Geriatric services are not functioning significantly at present in Sri Lanka. Even the available geriatric services are inadequate to cater the ageing population. In Sri Lanka, we do not have a specialized course for geriatric in any of the medical colleges in the country. If the curriculum of colleges such as Faculty of Medicine – Colombo and Peradeniya are considered, it is apparent that areas such as Anatomy, Physiology, Biochemistry, Micro biology, Parasitology, Forensic Medicine & Toxicology, Community diseases, Clinical Medicine, Surgery, Obsterics & Gynacology, Paedeatrics and Psychology are given much concern, but not specializing in Geriatrics. May be the reason is that the country as a whole has not identified the need of geriatricians, or at least that more concentrated health care is needed for the aging population. However it is a good initiative that the Asiri Group of Hospitals is going to start with a geriatric care unit with a day care facility for elders.
What are the obstacles elderly have to face?
Since majority of the people live in the rural areas and need to commute to the urban sectors in order to get health services, transportation is a major concern. Poverty, changes in the family structure, and fewer or insufficient medical services make the situation of elders more insecure. Out of all the social security schemes implemented by various agencies in Sri Lanka, Public Service Pension Scheme and the Employees Provident Fund (EPF) scheme are the two major schemes providing social security for the Government and the private sector employees in their old age. The poverty levels of elderly may vary according to the living condition and support available. The support of children is given as 46% of number surveyed, 13% from pensions, 10% from casual earning, 8 % from property, and 6% from both Samurdhi and public assistance as per a recent survey. However, this does not adequately cover the expenditure needs of the elderly at their retirement. In addition, the longevity of life implies that the real income available for a retired person's living is going to decline and be inadequate in the future.
The affluent can seek geriatric services from the private sector whereas the others cannot afford such facilities. The geriatric facility in the private sector is still lagging behind the demand for the same. Since it is very expensive, the majority of the elderly would need this service in larger scale, and also a considerable public support. Hence, the introduction of an institutionalised geriatric care system is essential especially for the very old.
Other health aspects should also improve
Apart from above mentioned facilities, it is essential that other sanitation services should also be improved along with. It is only 71.5% in Sri Lanka who can access safe water, while 28% have access to pipe born water. The percentage of under nourished population being around 22% proves that there is a proportion of population who suffers from unavailability of good health care services and also proper education on health. Number of married women per Midwife is 576 while number of pupils per teacher is 22.
Rest of the world has identified the need of geriatrics, why not us?
Although we don’t have a properly functioning geriatric system in Sri Lanka, there are many other countries with even lower elderly population, having many institutes providing this service. They have medication systems, day care centers, exercise schemes for old people, and many more. Those institutes contribute in keeping the elderly people healthy in both aspects, physically and mentally. They have identified some diseases emerging with getting old, such as Alzheimer’s disease, Parkinson’s disease, Arthritic conditions, cataract, hyper tension, type 2 diabetes, Cancer, Cardiac ailments and Osteoporosis. Many countries now practice martial arts for elderly, like Tai Chi Qigong, which is a system of movements and positions developed in China. It is similar to Yoga, because it addresses the body and mind as an integral system. It is worldwide practiced for it health benefits. Tai chi is an attractive option for disabled and elderly people because they can practice it anywhere. The most common metabolic bone disorder is Osteoporosis. Couples with medication, there should be a comprehensive approach to exercise and fall prevention. Stretching, strengthening, impact, and balance exercises are effective. Of the balance exercises, Tai Chi has proved to be the most successful in decreasing falls. Tai Chi is specially beneficial in chronic illness and fatigue. These practices are still new to Sri Lanka.
Contrary to this situation in Sri Lanka, many western countries have identified the need of Geriatric care systems. They have separate Geriatric Societies dedicated specially for care of elderly and their diseases. American Geriatric Society, British Geriatric Society and the same for Canada. They actively take initiatives for the care of elderly and geriatric health care. Even India has identified this situation and has launched the Geriatric Society of India. They recently conducted a series of seminars and a forum regarding the geriatric health care. However, despite of increasing the quality of health care systems in the country, Sri Lanka is still lagging behind with regard to this branch of medicine.
Are we ready?
Lack of thorough planning for the growing issue with regard to the lack of geriatric health care systems, lack of state support for the needs of elderly in low income categories, decrease of pensionable jobs with the expansion of the private sector and also dealing with the stigma are the challenges we are going to face in the near future. There has to be proper infrastructure, legal systems (for the elderly), insurance schemes, physical health improvement programmes, regular health checks, and other services for the mental and physical well being of the aged. Therefore it is becoming apparent that we need a proper healthcare staff trained to handle the ageing population as one of many aspects of this problem. Are we ready to accept the challenge?
Dinu De Silva
Send your comments to:
geriatrics.comments@gmail.com
Population ageing has become one of the leading demographic issues the world has to face. As a developing Asian Country, Sri Lanka is no exception to the global trend of population ageing and the social and economic problems stemming from it as a result.
Sri Lanka ranks top as a country with a rapidly ageing population. Out of a population of 18.9 millions in 2000, around 9% was estimated to be over 60 years of age. In 2025, the ageing population is estimated to increase to 18% and in 2050 up to around 27 %. It is also expected, that by 2050 Sri Lanka would have a population of which 50% would be over 50 years of age. Hence the current situation of the elderly in Sri Lanka and the emerging trends need serious consideration. It is also noted that Sri Lanka is a country with a longer life span. Life expectancy was 43 years in 1946, and it increased up to 69 years in 1998. This demographic transition has resulted in changes in the population structure where there is a considerable increase of the elderly compared to the young people.
1920-22 1946 1953 1962 1967 1971 1981 1991-96 96-2001
Male 32.7 43.9 58.8 61.9 64.8 64.2 67.7 69.5 70.7
Female 30.7 41.6 57.5 61.4 66.9 67.1 72.1 74.2 75.4
Chart I: Expectation of life at birth
Source: Dept of Census & Statistics
Year 1991 1996 2001 2006 2011 E 2016 E 2021 E 2026 E 2031 E
Percentage of Elderly (%) 8 9 10 11.4 13.1 15.5 17.7 20 22
Chart II: Number of Percentage of Elders
Source: Dept of Census & Statistics
The rising rates of old age dependency would place a greater pressure on the family, community and the country with regard to providing support for the elderly. With the increase in longevity, there is a need of concern in respect of the increasing number of ageing population as a specific group with their high dependency rates, and geriatric health needs. Geriatric care has assumed to play an important role as a specialized medical care, which is not available adequately at the moment [Geriatrics is the branch of medicine that focuses on health care of the elderly. Its aim is to promote health and to prevent and treat diseases and disabilities in older adults. The term comes from the Greek geron meaning "old man" and iatros meaning "healer"]. The healthcare systems need to be geared to the ageing process and caring for illnesses stemming from the longevity.
Why Geriatrics?
The traditional and cultural background of Sri Lanka would need that older people would be cared for at home by family members, relatives or neighbours. In our society, older people are respected as valuable resources with skills, experience and wisdom. The problem of the elderly was not a major issue in traditional societies with their extended family systems. As a result of the socio-economic changes in modern society, specially moving away from the extended family system to the nuclear family concept, the elderly population is forced to face many different issues. Most of the elderly people have to live alone and face other accompanying problems stemming from inadequate family incomes, high cost of living together with health care problems. Migration of young people has resulted in the emotional stress of older persons. The ethnic crisis in the country has also created feelings of insecurity and uncertainty in the minds of older people. Some families have been displaced due to the ethnic conflict and others have migrated either to safer areas or to other countries leaving the older family members alone at home or in a "home for elderly" with no love, care or support. Elderly patients are at high risk for medication-related problems due to age-related physiological changes, a higher incidence of co-morbid illnesses and greater use of both prescription and over-the-counter medications. There we see an urgent need to find the ways of caring for the elderly by developing community-based systems for the same.
Figure I: Birth rate and death rate in Sri Lanka (Births/Deaths per 1000 of population)
Source: Dept. of Census & Statistics
Figure II: Birth rate and death rate - Worldwide (Births/Deaths per 1000 of population)
Source: Dept. of Census & Statistics
Sri Lanka has developed the health care systems
Sri Lanka has developed considerably in terms of health care and nutrition. The mortality rates (deaths per 1000 live births) have declined. The crude birth rates have increased while the crude death rates have declined. The gap between these values is narrowing resulting in a higher percentage of elderly (natural growth of population). This is common worldwide, but the increasing elder population in Sri Lanka is alarming. It is estimated that for Sri Lanka, the natural growth of population is 1.06% at present. The child nutrition has also improved a lot. With many health care campaigns, we have been able to minimize many wide-spreading diseases such as malaria, filaria, diarrhea, etc. From 2000 to 2005, the number of P.falciparum (malaria) patients has been reduced from 59650 to 130, while the number of P.vivax patients has been reduced from 150389 to 1506. The number of Filaria patients recorded has been reduced to 580 from 2233 during the decade of 1993-2003. Sri Lanka has been continuously being improved in many health aspects. New clinical practices have been introduced, and with many number of private hospitals together with government funding for public hospitals, we have been able to experience the advantages of new technologies in medicine. In addition, there are many examples of numeric improvements in health aspects, such as tuberculosis, smallpox, measles, dengue, epidemic diseases, skin diseases like leprosy, etc. It should be praised that the ministry of health care and nutrition has recently launched many campaigns such as the campaigns for AIDS, Tuberculosis, Diabetes, Cancer and the also the newest anti-smoking advertisement featured by Pradeep Rangana, which is aimed at the longevity of people and result in a healthy population.
The numbers, as mentioned above, look better with regard to the health care systems and the new campaigns which have been launched so far. Comparing the situation before and after 1948, it is apparent that the country has achieved the quantitative goals in health care.
What about qualitative improvement?
However it is questionable if we have still achieved the required quality in health care. The infrastructure has to be improved a lot. The expenditure on health is calculated as 1.57% in 2008 (4.1% of government expenditure). By 2004, there were only 3.1 hospital beds per one person; 2224 persons per one doctor; and only 4.5 nurses per 10,000 persons. Although the medications for many diseases have been improved, majority of the people cannot get those services due to many reasons. Despite of the improvement in the clinical practices and also in diagnosis enhancement through sophisticated equipment, there is a considerable gap between the availability of such services and the ability of the general public to receive them. When there are 6.6% of the population whose income is less than 1 US$ per day and 45.5% of the population whose income is less than 2 US$ per day, it is questionable if they can receive these advanced medication services available at the moment.
There is a group of people who do not get proper health education. The performance of the health care system is still measured in numbers, not in the quality. We do not have enough proportion of doctors per person. Much programmes have been carried out in the health care services in the last 50 years giving much emphasis to mother and child programme with special concern on controlling population. There is few or no concern put on the elderly, other than the increasing number of homes for elderly. According to the latest figures, there are about 167 elders’ homes functioning now and around 10,000 are living in them. It is also found that the homicide and suicides among the elderly has been on the increase while abuse has caused depression and distress among them. Sri Lanka being one of the top countries with highest suicide rates, also reports high suicide rate among elderly due to above mentioned reasons.
There is a clear tendency for suicide rates to increase with age (Figure III). By comparison with a global suicide rate of 26.9 deaths per 100,000 for men in 1998, the rates for specific age groups start at 1.2 (in the age group 5-14 years) and gradually increase up to 55.7 (in the age group over 75 years). The same positive relationship between age and suicide rates is observed in females. This is alarming and this is one aspect that Geriatric care has to look into.
Figure III: Global Suicide Rate Among All Age Groups
Source: World Psychiatric Association
Geriatrics still not identified as a special area to be concerned
Geriatric services are not functioning significantly at present in Sri Lanka. Even the available geriatric services are inadequate to cater the ageing population. In Sri Lanka, we do not have a specialized course for geriatric in any of the medical colleges in the country. If the curriculum of colleges such as Faculty of Medicine – Colombo and Peradeniya are considered, it is apparent that areas such as Anatomy, Physiology, Biochemistry, Micro biology, Parasitology, Forensic Medicine & Toxicology, Community diseases, Clinical Medicine, Surgery, Obsterics & Gynacology, Paedeatrics and Psychology are given much concern, but not specializing in Geriatrics. May be the reason is that the country as a whole has not identified the need of geriatricians, or at least that more concentrated health care is needed for the aging population. However it is a good initiative that the Asiri Group of Hospitals is going to start with a geriatric care unit with a day care facility for elders.
What are the obstacles elderly have to face?
Since majority of the people live in the rural areas and need to commute to the urban sectors in order to get health services, transportation is a major concern. Poverty, changes in the family structure, and fewer or insufficient medical services make the situation of elders more insecure. Out of all the social security schemes implemented by various agencies in Sri Lanka, Public Service Pension Scheme and the Employees Provident Fund (EPF) scheme are the two major schemes providing social security for the Government and the private sector employees in their old age. The poverty levels of elderly may vary according to the living condition and support available. The support of children is given as 46% of number surveyed, 13% from pensions, 10% from casual earning, 8 % from property, and 6% from both Samurdhi and public assistance as per a recent survey. However, this does not adequately cover the expenditure needs of the elderly at their retirement. In addition, the longevity of life implies that the real income available for a retired person's living is going to decline and be inadequate in the future.
The affluent can seek geriatric services from the private sector whereas the others cannot afford such facilities. The geriatric facility in the private sector is still lagging behind the demand for the same. Since it is very expensive, the majority of the elderly would need this service in larger scale, and also a considerable public support. Hence, the introduction of an institutionalised geriatric care system is essential especially for the very old.
Other health aspects should also improve
Apart from above mentioned facilities, it is essential that other sanitation services should also be improved along with. It is only 71.5% in Sri Lanka who can access safe water, while 28% have access to pipe born water. The percentage of under nourished population being around 22% proves that there is a proportion of population who suffers from unavailability of good health care services and also proper education on health. Number of married women per Midwife is 576 while number of pupils per teacher is 22.
Rest of the world has identified the need of geriatrics, why not us?
Although we don’t have a properly functioning geriatric system in Sri Lanka, there are many other countries with even lower elderly population, having many institutes providing this service. They have medication systems, day care centers, exercise schemes for old people, and many more. Those institutes contribute in keeping the elderly people healthy in both aspects, physically and mentally. They have identified some diseases emerging with getting old, such as Alzheimer’s disease, Parkinson’s disease, Arthritic conditions, cataract, hyper tension, type 2 diabetes, Cancer, Cardiac ailments and Osteoporosis. Many countries now practice martial arts for elderly, like Tai Chi Qigong, which is a system of movements and positions developed in China. It is similar to Yoga, because it addresses the body and mind as an integral system. It is worldwide practiced for it health benefits. Tai chi is an attractive option for disabled and elderly people because they can practice it anywhere. The most common metabolic bone disorder is Osteoporosis. Couples with medication, there should be a comprehensive approach to exercise and fall prevention. Stretching, strengthening, impact, and balance exercises are effective. Of the balance exercises, Tai Chi has proved to be the most successful in decreasing falls. Tai Chi is specially beneficial in chronic illness and fatigue. These practices are still new to Sri Lanka.
Contrary to this situation in Sri Lanka, many western countries have identified the need of Geriatric care systems. They have separate Geriatric Societies dedicated specially for care of elderly and their diseases. American Geriatric Society, British Geriatric Society and the same for Canada. They actively take initiatives for the care of elderly and geriatric health care. Even India has identified this situation and has launched the Geriatric Society of India. They recently conducted a series of seminars and a forum regarding the geriatric health care. However, despite of increasing the quality of health care systems in the country, Sri Lanka is still lagging behind with regard to this branch of medicine.
Are we ready?
Lack of thorough planning for the growing issue with regard to the lack of geriatric health care systems, lack of state support for the needs of elderly in low income categories, decrease of pensionable jobs with the expansion of the private sector and also dealing with the stigma are the challenges we are going to face in the near future. There has to be proper infrastructure, legal systems (for the elderly), insurance schemes, physical health improvement programmes, regular health checks, and other services for the mental and physical well being of the aged. Therefore it is becoming apparent that we need a proper healthcare staff trained to handle the ageing population as one of many aspects of this problem. Are we ready to accept the challenge?
Dinu De Silva
Send your comments to:
geriatrics.comments@gmail.com
Thursday, December 4, 2008
Tuesday, December 2, 2008
Pass Book
Monica married Nick this day. At the end of the wedding party,Monica's mother gave her a newly opened bank saving passbook with Rs.1000 deposit amount.
Mother: 'Monica, take this passbook. Keep it as a record of yourmarriage life. When there's something happy and memorable happenedin your new life, put some money in. Write down what it's about nextto the line. The more memorable the event is, the more money you canput in. I've done the first one for you today. Do the others with Nick. When you look back after years, you can know how muchhappiness you've had.'
Monica shared this with Nick when getting home. They both thought itwas a great idea and were anxious to know when the second deposit canbe made. This was what they did after certain time:* 7 Feb: Rs.100, first birthday celebration for Nick after marriage* 1 Mar: Rs.300, salary raise for Monica* 20 Mar: Rs.200, vacation trip to Bali* 15 Apr: Rs.2000, Monica got pregnant* 1 Jun: Rs.1000, Nick got promoted* ..... and so on...
However, after years, they started fighting and arguing for trivialthings. They didn't talk much. They regretted that they had marriedthe nastiest people in the world.... no more love...Kind of typicalnowadays, huh?
One day Monica talked to her Mother: 'Mom, we can't stand it anymore.We agree to divorce. I can't imagine how I decided to marry this guy!!!"
Mother: 'Sure, girl, that's no big deal. Just do whatever you want ifyou really can't stand it. But before that, do one thing first.Remember the saving passbook I gave you on your wedding day? Take outall money and spend it first. You shouldn't keep any record of such a poor marriage.'
Monica thought it was true. So she went to the bank, waiting at thequeue and planning to cancel the account. While she was waiting, shetook a look at the passbook record. She looked, and looked, andlooked. Then the memory of all the previous joy and happiness justcame up her mind. Her eyes were then filled with tears. She left andwent home.When she was home, she handed the passbook to Nick, asked him tospend the money before getting divorce.
The next day, Nick gave the passbook back to Monica. She found a newdeposit of Rs.5000. And a line next to the record: 'This is the day Inotice how much I've loved you thru out all these years. How muchhappiness you've brought me.'
They hugged and cried, putting the passbook back to the safe. Do you know how much money they had saved when they retired? I did not ask. Ibelieve the money did not matter any more after they had gone thru allthe good years in their life.
"When you fall in any way, don't see the place where you fell instead see the place from where you slipped. Life is about correcting mistakes."
Mother: 'Monica, take this passbook. Keep it as a record of yourmarriage life. When there's something happy and memorable happenedin your new life, put some money in. Write down what it's about nextto the line. The more memorable the event is, the more money you canput in. I've done the first one for you today. Do the others with Nick. When you look back after years, you can know how muchhappiness you've had.'
Monica shared this with Nick when getting home. They both thought itwas a great idea and were anxious to know when the second deposit canbe made. This was what they did after certain time:* 7 Feb: Rs.100, first birthday celebration for Nick after marriage* 1 Mar: Rs.300, salary raise for Monica* 20 Mar: Rs.200, vacation trip to Bali* 15 Apr: Rs.2000, Monica got pregnant* 1 Jun: Rs.1000, Nick got promoted* ..... and so on...
However, after years, they started fighting and arguing for trivialthings. They didn't talk much. They regretted that they had marriedthe nastiest people in the world.... no more love...Kind of typicalnowadays, huh?
One day Monica talked to her Mother: 'Mom, we can't stand it anymore.We agree to divorce. I can't imagine how I decided to marry this guy!!!"
Mother: 'Sure, girl, that's no big deal. Just do whatever you want ifyou really can't stand it. But before that, do one thing first.Remember the saving passbook I gave you on your wedding day? Take outall money and spend it first. You shouldn't keep any record of such a poor marriage.'
Monica thought it was true. So she went to the bank, waiting at thequeue and planning to cancel the account. While she was waiting, shetook a look at the passbook record. She looked, and looked, andlooked. Then the memory of all the previous joy and happiness justcame up her mind. Her eyes were then filled with tears. She left andwent home.When she was home, she handed the passbook to Nick, asked him tospend the money before getting divorce.
The next day, Nick gave the passbook back to Monica. She found a newdeposit of Rs.5000. And a line next to the record: 'This is the day Inotice how much I've loved you thru out all these years. How muchhappiness you've brought me.'
They hugged and cried, putting the passbook back to the safe. Do you know how much money they had saved when they retired? I did not ask. Ibelieve the money did not matter any more after they had gone thru allthe good years in their life.
"When you fall in any way, don't see the place where you fell instead see the place from where you slipped. Life is about correcting mistakes."
The law of the Garbage truck
I hopped in a taxi and we took off for the airport. We were driving in the right lane when suddenly a black car jumped out of a parking space right in front of us. My taxi driver slammed on his breaks, skidded, and missed the other car by just inches! The driver of the other car whipped his head around and started yelling at us. My taxi driver just smiled and waved at the guy. He was super (even overly) friendly. So I asked, 'Why did you just do that? This guy almost ruined your car and sent us to the hospital!' This is when my taxi driver taught me what I now call, 'The Law of the Garbage Truck.' He explained that many people are like garbage trucks. They run around full of garbage, full of frustration, full of anger and full of disappointment.
As their garbage piles up, they need a place to dump it and sometimes
they'll dump it on you. Don't take it personally, just smile, wave, wish
them well and move on. Don't take their garbage and spread it to other people at work, at home, or on the streets.
The bottom line is that successful people do not let garbage trucks take over their day. Life's too short to wake up in the morning with regrets, so.....
Love the people who treat you right. Pray for the ones who don't.
As their garbage piles up, they need a place to dump it and sometimes
they'll dump it on you. Don't take it personally, just smile, wave, wish
them well and move on. Don't take their garbage and spread it to other people at work, at home, or on the streets.
The bottom line is that successful people do not let garbage trucks take over their day. Life's too short to wake up in the morning with regrets, so.....
Love the people who treat you right. Pray for the ones who don't.
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