Maintaining the Divine Connection

"Abide in Me, and I in you. As the branch cannot bear fruit of itself, unless it abides in the vine, neither can you, unless you abide in Me. I am the vine, you are the branches. He who abides in Me, and I in him, bears much fruit; for without Me you can do nothing." (John 15:4-9)

In our multifaceted lives, juggling numerous roles can often feel overwhelming. From personal responsibilities to professional commitments, we find ourselves caught in a whirlwind of tasks and deadlines. Amidst the noise of our devices, the demands of work, and the pressures of family life, it's easy to lose sight of what truly matters.

How can we navigate this complex landscape and find fulfillment? The answer lies in the profound truth of John 15:4-9. Unless we are connected to the Lord, our source of strength and power, we cannot bear fruit in any endeavor, no matter how great or small.

St. Paul, in his letter to the Galatians, emphasized the importance of this divine connection. He declared that the Gospel he preached was not of human origin but a revelation from Jesus Christ. His words and actions were a direct result of his intimate relationship with the Lord. Similarly, the early disciples, by spending time with Jesus, learning from Him, and following His example, were able to accomplish extraordinary feats.

St. Teresa of Calcutta, a remarkable figure of the 20th century, exemplified the power of a deep connection with God. She dedicated hours to prayer and contemplation, drawing strength from her relationship with the Lord. This enabled her to perform countless acts of charity, even in the face of extreme poverty and adversity.

To maintain our connection with God, we must prioritize spiritual practices such as prayer, meditation, and Scripture reading. In the quiet moments of solitude, we can listen to the still, small voice of God and discern His will for our lives. King David, a man after God's own heart, understood the importance of seeking God's guidance. Even as a powerful king, he recognized his dependence on the Lord.

As we strive to live a life that glorifies God, let us remember the words of Jesus: "Abide in Me, and I in you." By staying connected to Him, we can overcome challenges, fulfill our purpose, and experience the fullness of life.

May the peace of Christ be with you always.

HCF PRAYER LETTER-JUNE 23

A Timeless Plea: Reflections on Psalm 90

Psalm 90 is a profound meditation on the fleeting nature of human life and the eternal nature of God. It's a prayer that has resonated with countless generations, offering solace, perspective, and a call to live with purpose.

The psalmist begins by acknowledging God's eternal existence, a stark contrast to the brevity of human life. "Lord, you have been our dwelling place throughout all generations" (Psalm 90:1). This recognition of God's timeless presence is a source of both comfort and awe.

However, the psalm quickly turns to a sobering reflection on the fragility of human existence. "You turn people back to dust" (Psalm 90:3). This stark reminder of mortality echoes throughout Scripture, as in James 4:14: "Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes."

In response to this fleeting existence, the psalmist turns to God in prayer, asking Him to teach His people to number their days. This is a call to live with a sense of urgency and gratitude, making the most of every moment. As Ephesians 5:16 reminds us, "Make the most of every opportunity, because the days are evil."   

The psalm concludes with a hopeful note, as the psalmist prays for God's favor and blessing. He asks God to satisfy His people in the morning, filling their hearts with joy and purpose. This is a beautiful image of God as a loving and generous provider.

As we reflect on Psalm 90, we are reminded of the eternal perspective God offers. While our lives on earth are temporary, His Word endures forever (1 Peter 1:24-25). By turning to God in prayer and seeking His guidance, we can find the strength and wisdom to navigate the challenges of life and live each day to its fullest.

Principles of Family Medicine in Action : The Jaffna Experience

Dr. Shane Malitha Halpe 

Excited to begin my Family Medicine training, I received an appointment at the University of Jaffna's Family Health Center in Kondavil, situated under the Nallur Divisional Secretariat. The center primarily served Sri Lankan Tamil patients who communicated in their native language. This presented a unique challenge, but also a fascinating opportunity to work with a culturally and religiously diverse population. Having grown up in Colombo, this experience offered a chance to broaden my horizons and become a more well-rounded physician.

I had the privilege of training under the supervision of Dr. S. Kumaran, Consultant Family Physician and Senior Lecturer in the Department of Community and Family Medicine at the University of Jaffna's Faculty of Medicine. 

The University Family Health Center (FHC) at Kondavil boasted a well-equipped consultation room, laboratory, demonstration room, lecture hall, reception area with waiting space, telemedicine room, practice management room, and a counseling room. Working in this comprehensive unit, I witnessed the principles of Family Medicine come alive.

1. Are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique; Unlike some specialties focused on specific diseases or techniques, Family Medicine prioritizes the whole person. At Kondavil, this philosophy was evident. The center offered a wide range of services, including outpatient care, a non-communicable diseases clinic, a healthy lifestyle center, a footcare clinic, laboratory facilities, geriatric care, and a pediatric and neurodevelopmental clinic. This comprehensive approach ensured accessible primary care for all, from children to older adults, men and women, regardless of specific conditions or treatments.

2. Seek to understand the context of the illness; Family medicine emphasizes understanding the context of illness, incorporating the biopsychosocial model. At Kondavil, healthcare professionals understood this approach, considering each patient's individual environment. This allowed family physicians to provide personalized care tailored to each patient's specific needs. 

3. See every contact with their patient as an opportunity for prevention or health education; Family medicine views every patient interaction as an opportunity for preventive care and health education. This philosophy was central at Kondavil, where preventive and opportunistic screenings were a high priority. All patients over 35 received screenings for common non-communicable diseases, while the healthy lifestyle clinic offered weekly health education sessions.

4. View the patients in their practice as a population at risk; Understanding the high prevalence of Non-Communicable Diseases (NCDs) like diabetes, hypertension, and dyslipidemia within their patient population, the Kondavil Family Health Center prioritized preventive care. The center's laboratory facilitated regular screenings and testing for fasting blood sugar, total cholesterol, and serum creatinine. Notably, paper records were maintained with a copy provided to each patient, ensuring continuity of care and patient empowerment. 

5. See themselves as part of a community-wide network of supportive  and healthcare agencies;

The Family Medicine unit at Kondavil embodied the spirit of community collaboration. It served as the central hub, providing comprehensive primary healthcare services that addressed physical, psychological, and social needs within the region. The Family Physician functioned as a true community leader, fostering collaboration with various stakeholders. This included working alongside government agencies, non-governmental organizations, hospitals, and local and foreign universities.  Through this network, the Family Physician collaborated with policymakers, investors, administrators, specialists, public health officials, allied health staff, and community health workers to improve the community's well-being.  Some key community outreach activities included woman empowerment initiatives, a neurodevelopmental clinic, community-based geriatric care, a community-based nutrition program, and health promotion programs for both probation school children and

individuals struggling with drug addiction

.

7. See patients in their homes; Family medicine emphasizes home visits for certain patients.  The Kondavil Family Health Center implemented this philosophy through regular home visits by the Family Physician accompanied by community health workers.  University vehicles provided transportation, allowing them to reach patients with cerebrovascular accidents, neurological disabilities, limited mobility, psychiatric disorders, or frailty. Witnessing patients in their home environment provided valuable insights into their ongoing health challenges  – particularly beneficial for those facing poverty or transportation limitations.

6. Should ideally share the same habitat as their patients; Ideally, family medicine practitioners share the same environment as their patients. The Kondavil Family Health Center (UHFC) exemplified this principle.  All staff members, including the Family Physician, nutritionist, laboratory technician, demonstrators, telemedicine operator, helpline service operator, and community health workers, hailed from the region.  They spoke the native language fluently and possessed a deep understanding of the local geography. This local presence fostered trust and facilitated better communication with the community.

8. Attach importance to the subjective aspects of medicine; Family medicine recognizes the importance of a patient's background and social context.  As a member of the community and fluent in the native language, the Family Physician at Kondavil leveraged his experience to gather a comprehensive understanding beyond the presenting complaint.  He paid close attention to the patient's emotions, body language, attire, socioeconomic status, and occupation, gaining valuable insights into potential underlying issues.  This holistic approach allowed him to consider factors like poverty, gender-based violence, and narcotic addiction during patient management, leading to more effective care plans.

9. Manage resources; The Kondavil Family Health Center prioritized resource management and community engagement.  Community members, empowered through participation initiatives, were recruited and trained to support service delivery at satellite centers.  Telementoring by the Kondavil Family Physician ensured healthcare staff were well-equipped to provide effective care. Additionally, public access to telemedicine consultations allowed patients to connect with the Family Physician via audio or video platforms.

• My experience at the Kondavil Family Health Center
• solidified my understanding of the "Five Star Doctor"

• concept, first described by Dr. Charles Boelen of the

• WHO in 2000.

• Witnessing a family physician embody these principles

• firsthand was truly inspirational.

The Five Star Doctor:

• CARE PROVIDER: Considers patients holistically, integrating them as individuals within their family and community context. They provide high-quality, comprehensive, continuous, and personalized care, fostering long-term, trusting relationships.

• DECISION MAKER: Utilizes scientific knowledge to make sound judgements about investigations, treatments, and technologies, while prioritizing individual wishes, ethical considerations, cost-effectiveness, and the best possible patient outcomes.

• COMMUNICATOR: Effectively explains and advocates for healthy lifestyles, empowering individuals and communities to enhance and protect their health.

• COMMUNITY LEADER: Earns the trust of the community, reconciles individual and community health needs, advises citizen groups, and initiates actions that benefit the community.

• MANAGER: Works collaboratively with individuals and organizations within and outside the healthcare system to address the needs of individual patients and communities, making efficient use of available health data.

A 5-star doctor goes beyond simply treating illnesses. They empower patients to take charge of their own health. By building trusting relationships, they foster better communication and improved adherence to treatment plans, ultimately leading to better health outcomes. These exceptional doctors not only enhance individual well-being but also advocate for a more positive and patient

 The Long Road to White Coats: A Story of Resilience

Dr. Shane Malitha Halpe MBBS (SAITM) 

It was January 2019. Three years had passed since Dhilmi Suriyarachchi and 79 other Sri Lankan graduates of the South Asian Institute of Technology and Medicine (SAITM) earned their MBBS degrees. Yet, they were still waiting to begin their internship training, a crucial step towards obtaining their licenses to practice medicine in their home country.

Their ordeal began in June 2016 when the Sri Lanka Medical Council (SLMC) refused to register Ms. Suriyarachchi, offering no explanation. This defied the Medical Ordinance, which mandated the SLMC to register any Sri Lankan medical graduate with a valid degree and good character. Left with no other option, Ms. Suriyarachchi, with the backing of SAITM chairman Dr. Neville Fernando, petitioned the Court of Appeal through President Counsel Mr. Romesh de Silva.

In a major win for SAITM in 2017, the Court of Appeal ruled in their favor. Judges Vijith K. Malalgoda and S. Thurairaja ordered the SLMC to register Ms. Suriyarachchi, validating the MBBS degrees. But their victory was short-lived. The then-president of the SLMC, Prof. Carlo Fonseka, refused to accept the decision and appealed it. This dragged the case through the Supreme Court for another year and a half, leaving the graduates in limbo. 

The wait became agonizing for the SAITM graduates. Their dreams of medical careers were put on hold amidst intensifying protests from government medical students and doctors. The country seemed divided, with 80 young graduates fighting for their legitimate right to education and employment.

In an attempt to quell protests, President Sirisena absorbed remaining SAITM students into the Kotalawala Defence University in 2018, effectively shutting down the college. However, the Government Medical Officers Association (GMOA), the Inter-University Students' Front, and state medical students continued their demonstrations. They spread leaflets and banners with slogans like "Upadi Kade" (Degree Shops) and "Hora Dosthara" (Rogue Doctors), stirring public fear against SAITM graduates. Despite a September 2018 Supreme Court verdict by Justices Wanasundara, Perera, and Jayawardena upholding the lower court's decision and ordering Ms. Suriyarachchi's registration, the Sri Lanka Medical Council (SLMC) threw up another hurdle by demanding a new online application. This bureaucratic delay led to contempt charges against the SLMC.

As the crucial February 2019 internship intake loomed, the graduates faced another blow. Despite the favorable Supreme Court judgment, the Ministry of Health shockingly excluded SAITM graduates. They sought legal help, but their lawyer refused to challenge the omission. Months dragged on with postponed court dates, and with Chairman Dr. Neville Fernando's resources depleted, the fight seemed to stall. However, the graduates remained determined. They found a beacon of hope in Mr. Upul Jayasuriya PC, who generously offered his legal expertise free of charge.

Three graduates, Shane Halpe, Diluka Panduwawela, and Kavindya Marapana, became the petitioners in a new case (SC/FR/54/2019). With their futures hanging in the balance, they filed an injunction to halt the internship intake until SAITM graduates were included.

On the day of the final hearing, tension filled the air at the Supreme Court. The fate of 270 graduates, both state and foreign, hung in the balance alongside the futures of the SAITM graduates. In a landmark decision, the Court ruled in favor of the SAITM graduates, granting the injunction and stopping the internship intake.

While this was a victory for the SAITM graduates, it caused anger and despair among the other aspiring interns. The injunction was eventually lifted after a month, but not before Mr. Jayasuriya secured a condition: the SAITM graduates would retain seniority alongside the new interns.

The legal battle dragged on for months, reaching its climax on August 5th, 2019. The Supreme Court justices, Buwaneka Aluvihare, L.T.B. Dehideniya, and Padman Surasena, delivered a landmark verdict. The court ruled in favor of the SAITM graduates on all counts. The verdict condemned the Sri Lanka Medical Council (SLMC) for violating the graduates' fundamental rights to equality and the freedom to pursue their chosen profession, as guaranteed by the Sri Lankan Constitution (Articles 12(1) and 14(1)(g)). It ordered the SLMC to provisionally register the graduates under the Medical Ordinance (Section 29(2)). The verdict further declared the Ministry of Health's exclusion of SAITM graduates from the internship program illegal and directed their inclusion. The SLMC was also ordered to compensate the three petitioners with Rs. 200,000 each and to ensure the SAITM graduates maintained seniority alongside the other interns. The court mandated the implementation of this verdict within three weeks.

Justice, though delayed, was finally served. Years of suffering culminated in immense joy and a renewed faith in the justice system. The doors were finally open for a brighter future for the SAITM graduates.

Unmasking the Silent Puzzle: Recognizing Autism in Young Children

 Unmasking the Silent Puzzle: Recognizing Autism in Young Children
Dr. Shane Malitha Halpe - Registrar Family Medicine/ GP

Imagine a world where a child, brimming with potential, struggles to connect. A world where simple social interactions feel like a foreign language, where communication is a puzzle with missing pieces, and where routines are a lifeline in a sea of uncertainty. This is the world of a child with autism spectrum disorder (ASD).

Autism, a complex neurodevelopmental condition, affects how people interact, communicate, and behave. Children on the autism spectrum often face challenges in social skills, communication, and sensory processing. They may struggle to understand social cues, maintain eye contact, or engage in back-and-forth conversations. Repetitive behaviors, like lining up toys or flapping hands, are also common.

While the exact prevalence varies, it's estimated that 1-2% of the global population is affected by autism. It's important to note that this figure might be higher in many low- and middle-income countries due to underdiagnosis and reporting.

The Role of the Family Doctor

While family doctors aren't autism specialists, they play a crucial role in early identification. By paying close attention to parents' concerns and observing the child's behavior, family doctors can help spot potential signs of autism. It's essential to take all parental concerns seriously, even if they seem minor or are not shared by others.

Remember, autism is a spectrum condition, and its manifestations can vary widely. A child may have good eye contact or engage in pretend play, yet still exhibit other signs of autism. The doctor should always trust one’s clinical judgment and listen to the parents' insights.

Early Signs and Key Indicators

Early signs of autism often emerge within the first 12 months of life. Identifying these early signs is crucial for timely intervention and support. Some key indicators include:

• Delayed motor development: Unusual movements or delays in reaching milestones like rolling over or sitting up.

• Atypical visual attention: Reduced interest in faces or objects, unusual eye contact.

• Reduced social communication: Less pointing, babbling, gesturing, or responding to their name.

• Impaired joint attention: Difficulty sharing focus on objects or activities with others.

• Atypical eye contact: Less frequent or unusual eye contact.

• Emotional reactivity: Unusual responses to emotions or social situations.

As children grow older, specific signs of autism become more apparent. These may include:

• Communication challenges: Delayed language development, difficulty understanding or using language, and repetitive use of words or phrases.

• Social interaction difficulties: Reduced interest in social interaction, difficulty understanding social cues, and challenges in forming friendships.

• Repetitive behaviors: Repetitive movements, insistence on routines, and strong attachments to objects.

The Importance of Early Intervention

Early diagnosis and intervention are crucial for optimizing the development and well-being of children with autism. The earlier a child receives appropriate support, the greater the potential for positive outcomes. Early intervention services can help children with autism develop essential skills, such as communication, social interaction, and self-care.

The Path to Diagnosis

If you suspect a child may have autism, it's essential to refer them to a multidisciplinary team of specialists involving a paediatrician, occupational therapist and a speech and language therapist. This team will conduct a thorough assessment to confirm or rule out a diagnosis of autism.

Post-Diagnosis Support

Once a diagnosis is made, family doctors continue to play a vital role in supporting families. By offering guidance, information, and referrals to specialized services, family doctors can help families navigate the challenges of raising a child with autism.

By being aware of the signs of autism and referring children for early evaluation, family doctors can make a significant difference in the lives of children with autism and their families.

First Friend

 The first day at campus was a memorable one. I was clad in a blue denim and a tucked in striped dark grey shirt with sneakers. The moment in stepped in to the lecture hall I realized the lecture had already started. There were around forty students inside the hall with the lecturer. Glancing at the students they all looked older than me. I felt intimidated. Nimbly I crept into the back row chairs. A strange feeling came over that everyone is staring at me but I quickly calmed down and started to concentrate on the lecture. 

It was Prof. Shanti giving an introduction to anatomy. I tried hard to listen but I couldn't hear anything. Reflexively I got up and claimed 'Madam sorry I can't hear you'. There was a moment of silence in the lecture hall. All heads were turning towards me which made me anxious. Prof. Shanti nodded and instructed another gentleman to adjust the microphone and increase the volume. The lecture continued as usual. 

To this day I cannot remember the topic of the lecture but vividly remember the incident of the microphone. Afterwards we went to the canteen area wanting to grab bite. It was a decent place but starting to build up. There were only a few options available at the time. I bought a snack sat at a corner alone. Scanning the student area I noticed there only around 8 boys and 30 odd girls. A wave of excitement and anxiety went through my spine. I always used to shy person and never had the courage to speak to girls. Scared and alone I kept munching my snack. 

The next class was Russian language. Didn't have a clue about the language but was excited to attend the class. She said 'Zdrastvuyte' to everyone the classroom which meant hello in Russian. She was a fair skinned, average build woman clad in skirt and blouse. She was always smiling and spoke in a kind manner. We were asked to switch on the Apple computers on our table. The desktop looked entirely different to Microsoft Windows and unfamiliar to all. I looked at the student who was sitting next me. 

She looked at me and smiled. She said 'Hi, I am Shazmin what's your name?' I guessed that she was around my age who seemed very friendly and nice. I introduced myself and we became friends. She was my 'first' SAITM friend. 

The class was interesting but didn't understand a thing. Since it was common to everyone nobody was worried. Soon we were informed by the lecturers that we are to be separated into groups A,B,C and D. I fell into group B with 5 other girls and one boy. Shazmin was allocated to group C. Without my new friend I was again alone. I isolated myself in the library. 

Thus was the first day at SAITM. 

The Decision

It was in 2009 September. I just completed my London A/L examination. I managed to pass with three C's in the science stream in Biology, Chemistry and Physics in my first attempt. Since childhood I was fascinated by science especially the science of the human body. I always wondered why people fell ill what can be done about it. This inspired when mom fell ill complained about something wrong. The words 'gastic', 'migraine' became familiar household nouns which intrigued me. Hence I chose medicine for further studies. 

My parents never forced me to do anything. I had my free will since preschool to date. My father is an Electrical Engineer and mother is a business woman managing her own company. They probably wanted me to pursue engineering which was not to be. 

At school I was not well known my studies. I enjoyed playing football and assumed the role of senior prefect. I never highlighted in studies nor sports and was happy to be an 'average' Joe. 

The school did teach the science subjects that required to gain entry to state medical college. However I was not inclined to study for the GCE A/L examination to be in 2010. The A/L examination in Sri Lanka is highly competitive and gaining entry to medical college was considered the greatest achievement for an A/L student due to the very limited intake. This repelled me and I chose to do London A/L examination. I found the syllabus taught in was quite relevant and examination was more to test the knowledge rather than making competition. This decision was the beginning of an incredible journey which I never envisaged. 

After getting the A/L results in 2009 I realized that I was an year ahead compared to my peers in school who were sitting for Local A/L exam in 2010. Hence an the door was open to pursue university education. However I was not able to gain entry to state medical college which provided free education. The burden was suddenly upon my parents. 

I looked for opportunities abroad including Bangladesh, Nepal and Georgia to pursue medicine. I did happen to go for an interview to apply for Medicine course in Bangladesh. But fate had other ideas. 

In Malabe, a new building was under construction for a medical faculty. The opening intake to be scheduled in September 2009. The name was South Asian Institute of Technology and Management (SAITM). The brochure mentioned they offer medical degree MD Russia with the affiliation of a Russian university named Nizhny Novgorad State Medical Academy. It mentioned 4 years in Sri Lanka and the final year in Russia. My mother wanted to explore this option. I was excited to see the new medical faculty which happened to be a private medical college. 

I filled my application and waited outside. The building construction was ongoing and the sounds of the wheelbarrow and cement mixing was filled the background. Moments went by and I was called in for an interview. There were 3 people waiting in the board room whom I was formerly introduced as Prof. Shanti Goonewardene, Dr. Keerthi and Mrs. Hussain. I vaguely remember they asked if was ready to join. Without blinking I said 'Absolutely' not caring for what holds in the future or if it was affordable for my parents. The total fee was Rs. 5.5 million. Not understanding the gravity of the decision I just said I really want to join SAITM. It took my parents by surprise and there was no idea on how to find the money. My mother said 'if Shane wants it let's somehow find the money'. 

Such was the beginning of my future or an adventure of a lifetime.