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UNIVERSITY C- child Cave
DR. ARUNASALAM S
Second Mer
Socio-cultur
Chile
PROF. C. SIVAG
MBBS(Cey.), DPH
1992

Y OF JAFFNA
XUSTOMOels
O Y
OT
TAIWAS
SIVAPATHASUNDARAM
morial Lecture
Het Nepalm of Conne DR. N. SVAKAJA. MasoreMD.
al Challenges
in
a Care
by
ENANASUNDRAM,
(Lond.), Ph.D.(Lond.)
May 12

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Socio-cultura
Child

al Challenges
Care

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The Vice-Chanceller Sp
It gives me great pleasure to p memory of the Late Dr. A. Sivapatha
Dr. Arunasalam Sivapathasunda Pedro and had his early education a and Hartley College.
He obtained the Diplomas in Ch in 1970 and 1975 respectively and t of Physicians in 1975. During his disciplined and conscientious and se late Dr. Sivapathasundaram was paediatricians in the Island, whose s and whose qualities are worthy of er
It is very appropriate that this by Professor C. Sivagnanasundram about whom an introduction is scarc to the University Community as well

eaks
reside over this lecture to mark the Isundaram.
iram was born in 1939 in Puloly, Point tVadamaradchy Hindu Girls College
ild Health in Sri Lanka and in London he membership of the Royal College career, as a Paediatrician, he was !rved in many parts of the Island. The
one among the most celebrated services are well worth remembering
mulation.
Memorial Lecture is being delivered 1, Professor of Community Medicine ely necessary since he is well known
as to the Public.

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Socio-cultural Chal
Mr. Chairman, Members of the mbers of the Council, Colleagues, La
It gives me great satisfaction Sivapathasundaram memorial oratior of the Faculty of Medicine for inviting
My subject, is “Socio-cultural CF the subject is vast, it is as old as the challenges and demands are brough new terms to describe them — Sociocal and so on. All these challenges in all his stages, at first the infant, me then the whining school boy, with h creeping like a snail, unwilling to sc and the school boy described by Shak or the pre-school child, passionately as:
'GOGO BLİS), Fljimas súlq, ALGU நெய்யுடை அடிசில் மெய்பட விதிர்த்து These early stages of the human
I believe that it is a suitable topic as a paediatrician not only cured sicko to child health and was interested in of child care. Association with a perso by fortune. I was one of these peop started in 1981 at the Base Hospital children for treatment by him. Later clinical teaching of AMP students a excellence. When Dr. Siva moved to th students benefitted by watching him pr a close colleague of mine and we w a play co- actors.
I take the liberty to repeat the w Dr Siva:
"Dedication to duty and cause, c and integrity are the attributes of Dr. Gandhian principles, sincere without sense of responsiblity and a spirit of He never sacrificed principles for expe

lenges in Child Care
family of Dr. Sivapathasundaram, Medies and Gentlemen and Students, and pleasure to deliver this second 1. I thank the sponsors and the Board
me to deliver it. hallenges in Child Care". The scope of human child and is ever growing. New t into the Sociological field, introducing Economic, socio-cultural, Socio-Politiaffect the welfare of the human being, awling and puking in the nurse's arms, his satchel and shining morning face, hool'. Of course inbetween the infant espeare is yet another stage the toddler described by Pandian Arivudai Nambi
i agmLab suluyó, SUBSID, SÓ DWS (GO Db5GİT 12
life forms the subject of my talk today. e to honour the memory of a man who =hildren, but also had a holistic approach the preventive and promotive aspects n like the late Dr. Siva occurs to anyone ble with luck. My association with him
, Point Pedro, where I took two of my. | approached him to participate in the t Point Pedro. He was a teacher par ne teaching hospital, Jaffna, the medical ractise Paediatrics. In Jaffna, he became ere co-examiners in Paediatrics and in
ords of a colleague of both of us about
ourage in adversity, simplicity, honesty A.Sivapathasudaram. He followed the
making a fuss about it. He instilled a service in those who worked with him. =diency. He could have amassed wealth

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with his clinical ability and popularity, bi in the hospital". I am sure that those period would endorse these words by
He was a poor child's doctor, and and political milieu in which his child Ratnapura, Balangoda, Ragama, Kulit mbo, Chilaw, Pt. Pedro or Jaffna eve race, religion or region. With these fe to a subject, he would have approved.
Man cannot be isolated from socie with the socio-cultural milieu in which h of this environment is best seen in his ci the child grows at his best – physica In an environment where peace is n necessities are deficient or given low practices have elements inimical to he
many challenges. The chance of attain is high. Its rate, the infant mortality rat index of the socio-economic and health
Infant mortality rate (IMR)
The IMR is the number of deaths per 1000 live births in a given year. Ni was in the region of 180, fifty years a Table 1 shows the fall in the rates in re
Table Infant mortality ra Year 1945 1950 1955 1960 1965 1970 1975 1980 1985
1989 Provisional Source: Registrar General
The fall in the rates have been at of malaria mortality (especially the drai forties), and improvement in environme

ut he elected to serve the poor patients
who knew Dr. Siva even for a short Dr.S.Ponnambalam with all sincerity.
was totally aware of the socio-cutural ren were brought up, whether it be apitiya, Matara, Anuradhapura, Colorywhere he worked. Siva was above =w words about Dr. Siva, I move on
ety. His health is intimately connected e lives. Any positive or negative effect nildhood. In a favourable environment ally, socially, mentally and spiritually. sot the aim of politics, where social priority, and where the customs and alth, childhood is insecure and faces ning adulthood is low. Death in infants e is therefore taken as a measure or i status of a society in which they live.
of infants up to the age of one year nety years ago the IMR in Sri Lanka go it was 140. Today it is about 20. cent years.
21. tes - Sri Lanka
Rate/1000 live birth
140
82.0 71.0 57.0 53.2 47.5 45.1 34.4 24.2 19.4
tributed to various factors — control natic fall in all death rates in the late ntal sanitation, water supply, nutrition,

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standards of living, and education esp care, which includes the use of antibio
The IMR of a country as a whole progress of a country does not show various sections of its people. It varies w PHM areas and so on. It also varies religious groups. In many countries, inf cal areas or social groups is not avai accurate; and on these false figures, a built up by library based researchers to mortality rates and other death rates conclusions lie and their statistics lies. illustrate what I have said.
Tab Sri Lanka: Infant
Selected dis District
IMR Polonnaruwa
9.0 Mullaitivu
10.6 Hambantota
12.3 Vavuniya
12.7 Jaffna
16.9 Galle
17.2 Matale
17.4 Gampaha
17.5 Kalutara
21.3 Source: R.G. Dept. Quoted in Annual Health E
Table 2 shows the differences in Lanka. The IMRs range from 9.0 in P The difference may be due to several deaths, and have been mentioned ea of infant deaths is not complete.
Calculation of IMR depends on tu births and registration of deaths of infar complete because on the registration child and family would receive. But reg one year especially when he is a we even a name is questionable. The des to be registered. We have queried the and Mullaitivu. In fact the rates for Po questionable.

ecially that of the women and medical tics.
e, although indicates the socio-health the socio-health disparity among the with the region, districts, MOH divisions, with, social groups, caste groups and ormation based on smaller geographilable. Even when it is there, it is not arguments and counter arguments are
show causes for the disparity in infant s. Here is where the errors of these I place before you certain data which
le 2 t mortality rates stricts, 1985
District Kegalle Kurunegala Colombo Badulla Ratnapura Kandy
Nuwara Eliya
IMR 22.2 24.3 32.2 33.5 33.8 35.5 46.2
24.2
Sri Lanka Bulletin, Sri Lanka 1989
the IMRs of selected districts in Sri olonnaruwa to 46.2 in Nuwara Eliya. factors usually associated with infant rlier or it may be that the registration
vo registrations -- registration of live nts; The former can be taken as nearly of a live birth depend the benefits the gistration of the death of a child under ek or a month old, when he has not ath of this "no name child" is unlikely low rates qouted for Jaffna, Vavuniya lonnaruwa and Hambantota are also

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Inaccuracy of published IMR
Although a report on a survey to death registration in Sri Lanka showe (births ranging from 94% to 99% a experience with infant mortality in th the Annual Health Bulletin of the Min attempt had been made to evaluate th level”4
In 1983 we studied 97 infant dea Kopay with a population of 111,000 infant mortality rate was 34.5 per 10 of 18 given to the Jaffna district. We fo were registered. This would have giv for Kopay region in tune with the pu actual figure is 35.4. In short the officia statistical information on health and care, especially that of the child.
Tat IMR in university field
Population
Area
51,000 Approx 17,636
1. Sri Lanka
(1989) 2. Kotte
(1981) 3. Hindagala
(1982) 4. Baddegama
(1981) KokuvilKondavil (1981)
23,744
28,086
*6. Kopay
MOH Area 111,649
(1982) 1. Annual Health Bulletin, Sri Lanka (1989) 2. Annual Report (1983) Community Heal
Medicine, University of Colombo. (Mimed 3. Malcolm A Fernando (1983) A Report of
the years 1981 and 1982. Department of

estimate the completeness of birth and ed almost complete registration in 1980 nd deaths ranging from 92-94%) our e area of MOH kopay is not so. In fact nistry of Health admits that "not much e completeness of registration at district
aths that took place in the area of MOH and 2738 births during the years. The 00 live births as opposed to the figure ound that only 35 of the 97 infant deaths Jen a figure of 12.8 in official statistics ublished 18 for Jaffna District. But the al figure of IMR is not reliable. Unreliable disease is the first challenge to health
ple 3 project areas and Kopay
Live
Infant Births
Deaths
- IMR
28.4
23.2
8 |
400
20.0
484
31.0
557
46.7
2738
97
35.4
Ministry of Health. th Project, Kotte, Department of Community
graph document) * the Hindagala Community Health Project for
Community Medicine, Peradeniya.

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4. Preliminary Report (1981) Community
(Mimeograph document) 5. Sivarajah N (1988) Survey of Kokuvil-Ko
rtment of Community Medicine, Faculty
Table 3 shows some IMR statistic are from field project areas of the 4 F IMR for Sri Lanka which cannot be area already discussed by me. You the socio-economic and health status Project Area of the Colombo Faculty of Peradeniya Faculty show IMR in field area of Ruhuna shows 31 and the shows 46.7. It is even higher than the Kokuvil and Kondavil areas belong. T ones that pose a challenge to comm the Kopay regiono, we pointed out tha of labourers who predominantly bel population of the low caste group in Sources was in the region of 30-359 appeared to be a factor associated wi more vulnerable because they are har mic parameters — environmental con We recommended small scale commi due to social disadvantages. It is pod all round poverty of health giving facto in child care especially in community s dictates in the society that, first of developed countries such difference to the social disadvantages sufferred
Causes of Mortality and Morbidity
On a global scale the UNICE condemnation of our time" is that mor should still be dying every week of ea tion. The preventable diseases in ref and tetanus. These can be prevent children are said to die every day. estimated to die of diarrhoea and de almost no cost. Another 6000 die dai by low cost antibiotics. For every cl malnutrition and ill health and are th physical potential with which they are
:These statements made for the applicable and true to Sri Lankan child children like any other, also died of pr

Health Project, Ruhuna University College.
ondavil Community Health Project Area, Depaof Medicine, Jaffna.
os based on reliable data, because they Faculties of Medicine. It also shows the reliable and the IMR for Kopay MOH see the differences and these reflect of the areas concerned. Kotte the Field - of Medicine and Hindagala field area the region of 20-23. Baddegama, the e Jaffna project area of Kokuvil-Kondavil e figure for Kopay area (35.4) to which The causes for these disparities are the nunity child care. In the 1983 study of t half the infants deaths were in families ong to the low social caste. But the the study area obtained from various %. In our study the castes of families ith deaths, the "low caste group” being ndicapped in the important socio-econoditions, educational status and income. unity based studies to expose the risks ossible that apart from the associated prs, caste per se may be a determinant -ituations, because of the discriminatory
all, made caste system possible. In s are seen among ethnic groups, due by some expatriate groups.6
F’ states what it calls the "greatest e than quarter of a million small children sily preventable diseases and malnutriFerence are measles, whooping cough ed by immunization, but almost 8000
Almost an equal number have been ehydration which can be prevented at Fly of pneumonia which can be treated nild who dies “several more live with mereby unable to fulfill the mental and
born”.
world's children by the UNICEF were ren a few years back. In fact, Sri Lankan reventable tuberculosis, diphtheria and

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poliomyelites in addition to measles, w already mentioned. But with the intro of Immunization (EPI) in 1978, on an the incidence of poliomyelitis, diphthe marked decline (Table 4). Whooping decline according to the Epidemiolog
Womens Affairs. I have not presented cases are notorious for being under rep There has been a reduction in the incid immunization in 1985. Reduction of tu has reached a state where over 80 perc
with all six antigens.
Tabl Sri Lanka: Incidence of Poliomyelitis Year
Polio Cases
Rate 1955
102
1.1 1965
382
3.5 *1978
153
1.1 1985
0.1 1988
0.0 Rate: Based on 100,000 population,exceptneo * Year of introduction of Expanded Program Source: Epidemiology Unit, Ministry of Health
16
Gastro-enteritis and lower r At present, half the children death respiratory tract infection. The associa diseases and the triad pose a challeng to our study of deaths in Kopay MOH infant deaths and 44 homes of deaths the parents. From the history and wh were able to arrive at a reliable diagr 5 is a summary that highlights the co Infection (LRTI) and gastroenteritis as infants and 60% of the pre-school de study of 224 infant deaths that occured Peninsula during the latter half of 1990 to aerial bombing, curfews and general investigated by Family Health Workers They produced the signs and symptom the death and the diagnosis was mad when available. The likelihood of error in retis is least when compared with other

hooping cough and neonatal tetanus, duction of the Expanded Programme already existing immunization service ria and neo-natal tetanus has shown cough has been said to show a 75% y Unit of the Ministry of Health and the figures here, as whooping cough ported. The same is true with measles. ence since the introduction of measles uberculosis is less marked. Sri Lanka cent of the infants are being immunized
le 4
B, Diphtheria and Neo-natal tetanus
Diphtheria
Neo-natal tetanus Fases.
Rate
Cases
Rate 179 13.5 232
11.3 1.5
215.9 0.0
56
14.6 0.0
44
12.0 -natal tetanus is calculated per 100,000 births.
me of Immunization (EPI). and Womens Affairs.
216
874
| 7
'espiratory tract infections s are due to gastroenteritis and lower ted factor is malnutrition in these two je to child health. I wish to come back
area, where we visited 97 homes of among 1-5 year olds and interviewed en available from hospital notes we Iosis of the causes of deaths. Table ntribution of Lower Respiratory Tract ; causes of about half the deaths of aths. It also shows figures from our Tin the eight MOH areas in the Jaffna
which was a period of disruption due chaoso. These 224 infant deaths were by visiting the homes of these infants. s of the disease condition that caused e by us or taken from hospital notes the diagnosis of LRTland gastroente* causes.

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Tal
Causes of deaths in
1-5 years |
Causes
Inf
Корау
1982-83 (n=97) 26.8 20.6
L.R.T.I Gastroenteritis
Sub.total
47.4
Low Birthweight & Prematurity Others Unknown
15.5 29.9 7.2
All
100.0
Among the infants, the similarity o enteritis in both studies (Kopay in 19 is noteworthy. Again in both studies I cause of death is 15%. Gastroenteritis years old children is more than LRTI : 64 percent of deaths. In these studies died were also malnourished.
Morbidity data from routine repor are necessary to give the true pictur medically examined 266 children unde derprivileged sector of the Jaffna Mu random sample taken from 2892 chil these children under 5 years was with children. Moderate or severe malnu Between first year of life and second dropped from 34.1% to 9.8% indicatin or both. In addition acute respiratory in diarrhoeas were also major causes to 66% of the infants and 49% of the 1-5 for diarrhoea are 22% for infants and 2
Malnut The story of malnutrition in a chi mother, and is recognized when he is

le 5
infants and children percentages)
nts
1-5 Year Old
Jaffna Peninsula June-Dec 1990 (n=224)
25.0 23.7
1982-83 (n=44)
27.3 36.4
48.7
63.7
15.2
36.2
31.7 4.6
100.1
100.0
f the percentages of LRTI and gastro32-83 and Jaffna Peninsula in 1990) ow birth weight and prematurity as a ; as a cause of death among the 1-5 and together they are responsible for ; we found that half the children who
ing are less reliable. Special studies e of ill health. In 1985-86 Sivarajah
5 years of age living in the urban-unnicipality. This was an age-stratified dren in 3577 families. The weight of in normal range only in 14.3% of the rition was detected among 38.3%.
the percentage of healthy children i poor weaning habits or lack of food ections (ARTI), upper and lower, and ill health. During a two week period 'ear olds had ARTI. The percentages. 2% for 1-5 year olds. ition i actually starts in the womb of the 'eighed naked at birth.

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Birth Weight - Birth weight is an important determ its early months. Low birth weight (LBV is a challenge to child health in develop for example in Sweden, the incidence in some parts of India, Africa and Ca
Work by Priyani and Devikao showed Lankan babies weighed less than 25 babies born in the G.H. Jaffna showe babies was 19, and in 1991 it was 2 imposed on the pregnant mothers in of LBW babies would continue to rise
Breast Feeding
After the birth of the child, malnu if the society's concept of breast feedin the place of the breast. This scenerio Amuthamozhian10, one of our medical
பால் சுமக்கின்ற தாயின் மார்பில்
சாய்ந்தபடி குழந்தையொன்று புட்டிப் பால் குடிக்கின்றது
Ina community study on infant feed Dulitha Fernando and Kamal Abeywici although 99% of the women initiated month only 87% of the rural infants ar were solely on breast milk, indicating e diet. The percentage of infants on exc month was in the rural areas 60%, urb
Priyani comments that all indicatior feeding is likely to continue, particula economic development.
We feel that the duration of brea nutrition of the mother. Our experienci that breast feeding was stopped or i insufficient milk to feed.
More studies are indicated to ide problem of breast feeding as it is a pro
A seven day period prevalence, ir 25% of the non-breast fed children t

inantin child survival, especially during /) defined as birth weight below 2500g ving countries. In developed countries,
of LBW is as low as 3.6%, whereas rribean Islands it is as high as 40%. that in the seventies, 22% of the Sri 00g at birth. Study of birth weight of 1 that in 1989 the percentage of LBW 3. Unless we recognize the hazards the present situation, the percentage
n the troubled areas.
trition continues in the mother's arms g is ultra fashionable, and bottle takes has been lucidly told by a young poet students.
ding patterns in 12 districts of Sri Lanka, krama (Quoted by Priyani°), found that breast feeding, by the end of the first nd 64% of the urban and town infants arly introduction of other milks in infant lusively breast milk by end of the third
an area 47% and town area 41%.
ns are that the trend to decline in breast arly if there is rapid urbanization and
st feeding may be dependent on the e is that the mothers in our clinics say artificial milk was started because of
ntify all variables associated with the tective factor in child health. n the study quoted above showed that vad diarrhoea, while it was only 13%

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among the breast fed. Weight charts i up well up to about 4 months but fell s probably related to inadequate com another stage in infant malnutrition-w
Weaning and Pre-School stages
If the child is spared of malnutrit chance of getting it at six months. As can be eliminated by better infant fe respiratory infections and diarrhoeas play havoc on the child's health. I pre-school age. (Table 6).
Tat Prevalence of maln Age (months)
6-11 12-23 24-35 36-47 48-59
60-71 Sri Lanka (average) (From Priyanio)
In Sri Lanka the percentage of a was 6.6 in 1977 and in Jaffna during it that the nutrition of the Jaffna child w child. A recent study by the SCF in I acute malnutrition in a refugee camp w
measurements.
Figures for chronic malnutrition () as follows. In 1977 the percentage o degree protein-energy malnutrition in in Jaffna. The Ketpali study of the S 67.7% suffer fromchronic malnutrition. camps in the Jaffna Municipality showe chronic malnutrition is a community h our customs, beliefs and practices of feeding in childhood when child is wel Beliefs and Customs
The cultural milieu of the people superstitions etc has a strong say in

also showed the breast-fed infants grow hort of NCHS standards in late infancy, plementary feeding. This leads us to eaning.
on when on breast milk, it has a great pointed out by Priyanio this early trend eding practices. It is at this time acute supervene on malnutrition and the trio Malnutrition continues throughout the
ple 6 sutrition in Sri Lanka
Acute
Chronic 5.0
11.8 10.8
24.8
33.1 4.8
40.8 5.0 6.2
46.2 6.6
34.7
6.9
41.9
cute malnutrition among 1-4 year olds he same year it was only 3.7, showing as better than the average Sri Lankan Ketpali1", Chavakachcheri shows that ras 6.8% as shown by weight for height
veight for age) in the 1-4 year olds are f children suffering from 2nd and 3rd Sri Lanka was 42.0 while it was 32.5 CF quoted earlier shows that in 1992, Astudy by Theivendram12 in 12 refugee dthat 73.0% were malnourished. Thus ealth problem, and is interrelated with not only weaning in infancy but also or ill.
with its traditions, religious practices natters pertaining to health, especially

Page 16
that of the child. At present child care social rather than in the medico-scien science of Community Medicine has : the behaviour, beliefs and motives in studies have been undertaken by some gists but the potential for such work ha system. Further it is well known that permeates into every aspect of health necessarily the poor, and this cannot be relating to disease which are products and not explicitly derived from the conc has been described as a discipline ano discipline also deals with the beliefs rela doers, ancestors and other ghosts wh forgotten and people who live with us b beliefs and customs are good to health no difference to health. Some times v is helpful or harmful, but it may act as a
Our st I now place before you some of t and customs related to child health amo by us in 1983, and it covered 7 MOH including Kilinochchi. During a three mo noted down what the mothers in their when they visited homes, and the pra the F.H.Ws were trained by us on the They were given instructions and files to headings. No questionnaires or pre-de study included customs, beliefs and pr: situations, but only those pertaining to opinion are bad for the child are given !
Tables 7 & 8 show those practice given are the number among the 97 F practices in their area. In spite of our he about 25% of the FHWs reported tha to the infants and 11% said that brea day. Although water is good to the cl neonate and in 40% of the FHW are
milk and egg yolk are also not given i reasons given are that they cause “ infants. Similarly food taboo includes fr diarrhoea or are too "cold" for the child
10

finds its strongest challenges in the ific field. However epidemiology, the signally omitted any serious study of relation to health and disease. Such health workers and social arthropolos not been incorporated in the health the thinking of traditional medicine care by the people of all strata, not e ignored. In fact beliefs and practices i of indigenous cultural development eptual framework of Modern Medicine I given a name, ethno medicine. This ted to angry deities that punish wrong o feel that they have been too soon iut have an "evil eye". Some of these
care, some are harmful, many make ve do not know whether the custom I useful placebo.
tudy
he findings of a study on the beliefs ng our people. This study13 was done areas in the Jaffna Health Division, nths period 97 Family Health Workers - area said during their conversation ctices actually observed by them. All objectives and method of the study. note down their findings under several signed record forms were given. The actices in health pertaining to several - child care and that too those in our here. es' harmful to the child. The numbers HWs who reported these beliefs and alth education regards breast feeding, t the mothers do not give colostrum Lst milk is started only after the third nild, palmyra jaggary is harmful to a as this practice was reported. Cows n about 40% of the FHW areas and Nandam", "Vayu" and indigestion in uits to the infants, as they may cause

Page 17
S. S. < < : :
Tab Harmful practices in infant care INFANT FEEDING
Colostrum not given to infant Breast milk given after 3 days Water & Palmyrrha Jaggary g Cows milk not given. Eggs yolk not given
Only egg white given after 8 n vii
Fruits cause diarrhora viii
Rice given after 1 year Other
Umbilical stump dressed with rlic or Tobacco Make a mark on gum for teeth Drawing a picture of a lion for Impetigo)
ii
Tabl Harmful practices record During Diarrhoea
Stop breast feeding. Do not give king coconut w Reduce water and liquids
Fruits not given For Constipation
Use of following suppositor
Wick soaked in castor Tobacco stalk Piece of soap Give purgative
Give 'Kallakaram' During Convulsions
Give ayurvedic medicine
Give salt water orally Although only 3 FHW reported trea obnoxious substances, this was not es
mini surgery for appearance of the teet is staphyloccal impetigo still exist in our
Table 8 shows the harmful prac constipation or convulsions. The practi to drink during diarrhoea, which is rep of note. The fact that in 23 FHW areas, th

le 7 recorded by FHW (n = 97 FHW).
iven 1st 3 days
40
40 11.
months
16
roasted pepper, ash of ga
03
2
51
ning 'AKKI' (Staphylococcus
28
e 8
ed by FHW (n = 97 FHW)
03
ater
16
06
bil
24
25
08
06 17
ment of the umbilical stump with such pected at the present time. Similarly 1, and “lion drawing" for "ákki” which
homes. ices when the child has diarrhoea, te of refusing to give sufficient liquids orted by 62 of the 97 FHWs worthy e habit of giving salt water orayurvedic

Page 18
medicine orally during convulsions, a child who is semi-conscious during
Recently Aponso 14 has quoted 1000 families in the Mahaveli area. Ir that did not believe that certain foo
months are as follows:
Pulses
Green leaves Dry fish Egg Rice canjee Fruits
The beliefs and customs of the influenced heavily by the tenets of
Siddha. Ayurveda lays great empha treatment — the concept of "Pathy childhood diarrhoea, some of thes Ayurveda, religious customs and astr addition delay or complicate treatme identify the part played by Ayurvedici
Ganlath Obeysekara15 gives the by Final Year students (n =54) in Colle most effectively be treated by ayurve diseases
I, Rheumatism and arthritis
Rashes, skin diseases and e iii. Paralysis of limbs etc iv.
Neuralgia, neuritis, swelling i
veins V. Haemorrhoids
ii.
It is important to note that exce none of the other diseases are chile of cases admitted to ayurvedic hoss pattern or diseases as identified by s Obeysekara, Ayurvedic Medicine wa those described by him as "cultural d
However in a study16 done by Ayurvedic Physicians in the Kandy Dis Obeysekara's study, we found that Physicians' and 37% of the Tradition of children under 5 years. Ganlath's was based on private practices. Bi Conservative estimate was that the 1 in the island in 1978 were seeing a

s very disturbing. This habit could kill :he fits.
similar child feeding practices among this study the percentages of families I should be given to an infant after 6.
32.5% 40.5% 49.5% 28.5% 9.0% 4.5%
people, especially the food taboos are traditional medicine - Ayurveda and sis on regulation of diet as part of the am". In child care, especially during e concepts can be harmful. Further ology are inter-related. These could in !nt. Planned studies are necessary to
medicine in these situations. five most common diseases identified ege of Ayurveda as diseases that could edic medicine. They include groups of
eczema
and cracking below knee, varicose
pt rashes, skin diseases and eczema, dhood diseases. In his study, analysis pital, Colombo, also showed the same students. In short according to Ganlath s dealing with the chronic diseases and iseases”.
us at Peradeniya on 201 Registered strict, at almost the same time as Ganlath
about 45% of the Ayurvedic School al physicians' practices were composed
study was hospital based, while ours ased on our 201 physician study our 1,000 Registered Ayurvedic Physicians pout 30,000 children under 5 years of

Page 19
age, daily. These were a formidablı physicians which could be profitabi Education.
We suggested that physicians ti be used at the preventive health clini
Western practitioners they should volunteers.
These findings and statements w It is not possible to say to what extent as practised in the Tamil areas. Stu to bring to light the various practices a both traditional as well as those tra especially in the field of child care. Wh ntary to modern paediatrics or poses studies could reveal.
The concept that medical studen be acquainted with the beliefs and cu was put forward by two pioneers in C Prof C.C.de Silva, Professor of Pae Professor of Public Health. At first the students, and later made provisions or Preventive and Social Medicine for Faculties of Medicine and the North practice areas for this purpose.
Our field practice area is the Koku with a population of 32,500 people. St to a family consisting of an infant, ch one year and they submit a report wh From 1981, eight batches of students The average number of visits made The beliefs and customs observed recorded by the FHWs in our earlier stu
Socio-Political Challenge
The political climate of a country the maintenance of health of the mor It affects the development of the ch behaviour. In short it moulds his or h has been the cradle of children in m Ireland, Israel, Palastine, Lebanon, Nia The children belonging to the Northe joined these unfortunate victims, sino or close kith and kin killed in their pre They lived in refugee camps and form
The challenge to the body, mind

e child cum parent contacts with the e entry points for Community Health
rained by the Ayurvedic School could ics and that in setting up a liason with be given priority over layman health
ere made for practitioners of Ayurveda. they are applicable to Siddha Medicine dies of this nature are recommended mong practitioners of Siddha Medicine, ained in the Siddha Medical School,
ether Siddha Paediatrics is complemes a challenge to safe child care, these
ats in the Faculties of Medicine should ustoms of the people regarding health Community Paediatrics in Sri Lanka -- diatrics and Prof O.E.R. Abhayaratna, ey introduced home visiting by medical in the curriculum of either Paediatrics Family Attachments. At present all four Colombo Medical College have field
avikKondavil Community Health project cudents in groups of three are attached ild or pregnant mother for a period of hich is evaluated for final assessment. s have been attached to 147 families. py the students to their families is 25. by the students are similar to those ndy, as regards food taboos to children.
- is an important determining factor in te vulnerable groups like the children. Fld in all aspects — body, brain and er future. Hostile political environment any countries; South Africa, Northern aragua, Argentina are a few examples. ern and Eastem regions of Sri Lanka ce 1958 when they saw their parents sence in different places in Sri Lanka. ed refugee cargo to safe places. and soul of these children was severe

Page 20
and the consequences have made his
. In a joint publication by the Gov under the title "Children and Women i
"the armed conflicts since 198 and pervasive factor affecti Lanka "(p 93), "Out of a total population of 2, of Jaffna, Mannar, Vavuniya Batticaloa, the 1,180,966 di population in North and Ea of one week, approximately district of Mannar, who flec rough seas, during inter mo
wing tales of children falling This report also states that "al available, all evidence points to a dete in conflict areas. Marasmus has bee Mannar and Batticoloa districts”. (p 96
As regards deaths in infants, in a the later half of 1990 in 119 of the 22 there was delay in taking treatment. In had delayed or no treatment. The delay factors, lack of transport, curfews, ae closest hospital. Lack of transport wa care was therefore a major determine only a sample of a wide picture of mis
As regards mental health of ch selected international literature which a One of these is Fraser's study19. Fra of Northern Ireland emphasises the d that of conventional warfare. He notes where children are not simply expo frequently combatants of violent activ
He also notes the immediate context of and enemy territory are poorly define of this is taken from South Africa wher homes frequently become battlegrou situation during the Vadamarachchi or and the IPKF massacre of Jaffna battleground. The political violence de Ireland researchers are distinguisher and occurs in a situation marked by sc and economic deprivation. It is clear i Northern and Eastern Sri Lanka.

tory.
ernment of Sri Lanka and UNICEF17
Sri Lanka" it is stated that: 33 represent the single most debilitating ng lives of children and women in Sri
577,113 (est. fig.for 1991) in the districts
Trincomalee, Kilinochchi, Ampara and splaced represents 45.8 percent of the ist. In October 1990, during a period
· 75,000 people were evicted from the T in over-crowded open boats across nsoonal rains in October, relate harrooverboard and drowning" (p 94-95).
though no comprehensive data are rioration in nutritional status of children n reported by NGOs working in both
5)
study quoted earlier ie. deaths during 4 infant deaths ie. 53.1% of the deaths
Kayts MOH division 75% of the cases Js were due to a combination of several rial attacks and non-functioning of the s the main factor. Disruption of Health ent of the fate of these infants. This is ery. hildren Kerry Gibson18 has reviewed are useful to researchers in our situation. ser writing on the on going "troubles" Gifferences between the "troubles" and s the personal involvement of civilians, sed to these dangers, but are also ty and the politics that surround them. Fa divided community where the enemy d in violent political conflict. Illustration -e schools, neighbourhood streets and ands. In fact this is applicable to our
slaught by the Sri Lankan army in 1986 in 1987, where hospital was also a escribed by Fraser and other northern d by the fact that it is a chronic strife -cial and political oppression and social hat the scene fits into our plight in the

Page 21
The childrens' reactions to the e as chronic in nature. The acute reacti The chronic reaction lasts a longe symptoms (Jenis, I.L cited by Kerry G
Fraser notes that scarcely any ch some symptoms of acute anxiety. He that children growing up in a violent s retardation.
Somasundaram20 writing on the several studies which are applicable t from traumatic events, it is the lack parents or family disruption and the cc of parents and adults that are sources
We have not still quantified the if we do, it would take several years te "painful childhood memories and psye handicaps of childhood and taking prev of the future is again a challenge to ch
Ladies and gentlemen, I have at my thoughts on the challenges to child and inaccurate data that disturb planni that perpetuate preventable illhealth ar that may endanger life and the presen
Challenges must be responded t if we are to survive and in our conte need people of the calibre of late Dr. to be emulated by the youth of this co knowing that the hospital was no lon him as the Bible says:
"a good name is better than | and the day of death than th
Than

Jents in this situation are acute as well on represents a normal shock reaction. r and persists after, with debilitating ibson). ild in the troubled area escaped at least e also cites Fields who has suggested pciety suffer a form of moral and social
e "Scarred Mind" has also reviewed pour situation. He points out that apart of emotional support, separation from
mmunicated anxiety, grief and distress - of psychological impact on the child.
effect of these on our children. Even o follow these unfortunate cohorts with cho social handicap". Assessing these ventive steps to avoid a 'Scarred Nation' nild care now. tempted to place before you some of care. I have touched on the inadequate ng for care, socio-economic handicaps ad death, traditionalbeliefs and customs at political situation, that is war.
o with wisdom, sagacity and courage xt love for one's people. For this, we
Sivapathasundaram. He is a person iuntry. He died when he went to work, ger a sanctuary but a battle field. For
precious ointment, e day of one's birth"21 < you.

Page 22
REFERENCES
1. Shakespeare, W. As you like it, 2, 7, 13 2. UT COST IqwÖT SIDymL BÓLI, YPBTOTO (usa 3. Ponnambalam, S. Dr. Arunachalam
Medical Journal. XXII, No. 123, 61-62 (1 4. Ministry of Health, Annual Health Bulletin 5. Sivagnanasundram, C., Sivarajah, N. a
unit area in Northem Sri Lanka. Journa
1985. 6. Douglas, R.N. Gilles et al. Analysis of e
in Bredford 1975-81. J. Epidemial Comr. 7. UNICEF. The state of world's children. 8. Sivagnanasundram, C., Sivarajah, N., Na
shed Data). 9. Soysa Priyani, E. and Jayasuriya Devika
47, 1-15, 1975. Amuthamolizhan, ‘MOTTUKAL ALLA V
OSAI, P 36, 1992. 11. Rebeca, M. Personal Communication, 1 12. Theivendran, R. Personal Communicati 13. Sivagnanasundram, C. and Ponnambal 14. Aponso, H. Looking Beyond the Disease
of Child Health. 19, 10-26, 1990. Ganlath Obeysekara. The impact of Ayur In: Asian Medical System. Ed: Charles
p 201-226, 1976. 16.
Sivagnanasundram, C., Nugegoda, D.E
in five MOH divisions in the Kandy distri 17. Government of Sri Lanka – UNICEF. C 18. Kerry GIBSON. Children in political viole 19. Fraser. Children in conflict. Penguin. He 20. Somasundaram, D.J. "Scarred Mind – 21. Ecclesiastes. 7, 1.
15.

டப்புப் பல படைத்து). ivapathasundaram, an appreciation; Jaffna 987). 1, Sri Lanka, 1989.
nd Wijeratnam, A. Infant deaths in a health I of Tropical Medicine and Hygiene, 88, 401.
hnic influence on stillbirth and infant mortality nunity Health; 38, 214-217. (1984). Oxford University Press. achinarkinian, C.S. and Sivarajah, M. (Unpubli
, S. Birth weight in Ceylonese, Human Biology,
ITHTHUKAL' (Tamil poetry collection) MANI
992. on, 1992. am, G. (Unpublished data).
Palace. (C.C. de silva Oration). Ceylon Joumal
vedic on the culture and individual in Sri Lanka. Leslie. University of Califomia Press. Berkley.
3. Study of Registered Ayurvedic Parctitioners ct. Ceylon Medical Joumal, 1979, 29, 21-28. Children and women in Sri Lanka 1991. ence. Soc. Sci. Med. 28, 659, 1989.
mondsworth. 1974. (cited by Kerry Gibson). in print.

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Professor Chellathurai Sivagnana of Ceylon and gained a Ph.D. (Epi in 1971. At present he holds the University of Jaffna. He has served and is a member of the Council of
Moreover, he has been a Consulta of Health, Kingdom of Jordan; W Systems Research at Institute of P consultant on Health Systems Res and Resource Personnel
-- Na Research in Colombo.
He has also attended several in organised by the Association participated in a Symposium on D London School Of Economics.
He has to his credit several publica In the Tamil literary world Prof. Si and is the author of three novels 1965 and 1989 he was awarded Cultural Affairs, Sri Lanka for the !
Printed by

sundram graduated from the University
demiology) at the University of London e chair of Community Medicine at the d as the Dean of the Faculty of Medicine
this University.
ent on Para-Medical Education, Ministry JHO short term Consultant on Health
ublic Health, Malaysia; WHO short term search at Ministry of Health, Zimbabwe tional Workshop on Health Systems
nternational Seminars and workshops
of Commonwealth Universities and emographic Training, organised by the
ations in local and international journals. vagnanasundram is known as 'Nandhi' and two collections of short stories. In the Sahitya Award by the Ministry of pest novel.
- Mangala Exports