• Morning Spice by Ginger
  A different type of driver

• Is child abuse a problem?
• Sacrifice - does it serve the purpose?
• Annoying 'G'

I chanced on a rather interesting three wheeler driver. A man with rather drastic methods of solving problems. He asked me what I was doing in Kotahena shortly after I got into his three wheeler. I replied that I had come to hand in some copy to The Island. He then turned round and snapped at me saying that we scribes were not doing enough to contain the drug menace and why I won't write more on the subject. I replied rather hotly that we as a tribe had written more than our share and were sick of doing it as it did not help the cause very much and asked him whether he had a scheme that would stop the rot.

He replied in the affirmative and said you had to attack it from two ends. First you had to get at the addict. The first thing was to set a date and from that day start rounding up all those who took drugs like how they rounded up stray dogs. They should be then taken to a rehabilitation centre and from there sent to the battle front. I told him that there would be rather hilarious situations with the addicthrowing both our troops and the LTTE into a total state of confusion. Their conduct like singing baila and waving to the LTTE to move in their direction would make them feel it was a delibelrate, trap. Our troops in the mean time would look on in utter dismay not knowing whether to shoot the enemy or the addicts. He then said the real villains were the drug dealers and if he was given the weapons he would form a group like Edgar Wallace's Four Just Men. He would eliminate every single one of them if they did not respond to his letter asking them to stop. At this I got down and I was in a bath of sweat. I told him to put it to the Ministry.

More on his experience with kassipu and cops.

Digital X-ray
You may not have to wait in pain quite as long for your X-ray film to be developed as the X-ray unit has gone digital. General Electric Medical Systems has produced a machine that does away with the normal X-ray film as it produces instant computerized images. The patient will not notice anything different from the normal X-ray when the picture is taken.

In fact the invisible rays are, still beamed through the body. The difference is that it hits a flat glass panel that stores the information at once as a digital image. The new machine has four million pixels and has a higher resolution than the normal machine gives more and detail with less errors. In the long run it is expected to be more economical though it costs more to buy.

ASEAN and sports
Are Asean countries of the opinion that they are having a little too much sports for them and the sooner they concentrate a little more on other things the better it would be for them? There seem to be hosting problems for the coming Asian Games in 1999 and it may be for good reason too.

Originally Malaysia's Selangor state government stepped in and promised to do a rescue act when Kodak got cold feet feeling it lacked the funds and facilities. Now even Selangor may back out and Brunei also has failed to respond to the call for similar reasons. Will they have to postpone the '99 games. We hope not, as our athletes would be more than a little disappointed.

I recently attended a seminar at the Ruhunu Medical Faculty, Galle on child abuse organised by the Sri Lanka College of Community Physicians and sponsored by UNICEF. Original research on the subject is being done chiefly by Dr. Harendra de Silva, Professor of Paediatrics and Dr. Chandrasiri Niriella, Professor of Forensic Medicine. They presented a study of about 250 cases from the Galle-Matara area collected in one, to two. This was the first exposure to 'child abuse' for several of us from the college and it was very interesting. The study is done in order to make policy recommendations to the government and as such, all persons interested should encourage it and as far as possible, participate. This article is written in that spirit.

We hear a great deal about child abuse in the west, particularly in the UK, USA and Belgium. Most readers will know about the sensational Mathew case in the USA and the paedophile ring in Belgium. Newspapers frequently publish macabre stories of cruelty to children in the west by psychopaths, some of whom are single parents and even hospital nurses. So far, we have not heard or read similar news items about our children. There are allegations of children being used by tourists and others for homosexual pursuits and video perversities. For some unknown reasons psychopaths of this kind do not appear to breed in our parts of the world - at least in number that demand public attention.

Instances of child abuse coming to the attention of doctors are rare. I can recall only one case during 30 years of health service in almost all parts of the country when I was called to perform a post mortem examination of a new born child that had been smothered by her mother, a young homeless mentally retarded woman at the rural hospital, Hurulu-wewa in the early 60s. The subject has never been discussed by paediatricians as a 'problem' and many have not seen more than two to three cases in their careers. It was a great surprise, therefore, to note the large number in the Galle-Matara area, as if to suggest that such perversity was southern phenomena not found elsewhere! This cannot be. The reason is very common. For example, when Dr. Lamabadu-suriya, the then professor of paediatries at Ruhuna Medical College took a special interest in hare lip and cleft palate, some years ago, there was an avalanche of cases coming for the surgical attention he had organised with foreign doctors. Special interest activates a dormant problem or need and give misleading information about its overall prevalence. It is an axiom in epidemiology - the study of the causation and distribution of disease or 'problem' - that hospital statistics do not give a true account of the actual situation.

Hospital data should be complemented with other findings such as field studies, from samples of persons at the risk of having the problem. In the case of 'child abuse' it would be very difficult and patronising to decide the 'population at risk' - that is, who are the parents likely to be cruel to their children or conversely, children of what social class and of what sort of parents of that class are atrisk of being abused? I shall leave that to sociologists and other experts. It is perhaps fair to assert that children of educated parents of all classes do not abuse their children. I have been caned by my parents but that sort of thing is not child abuse. Yet hyper awareness and propensity to the problem has become dangerous in the west. Children inform the police when parents punish them and get arrested for child abuse! We must beware and keep the discussion and debate at realistic level.

Most of the cases in the Galle-Matara study were about children as small as seven months and around 12 years being caned, injured by pouring boiling water, burnt with firebrands, limbs fractured or ligaments torn from twisting or pulling either by a drunken father or an irascible mother. As I recollect, the majority were from the lower social class - the poor, unemployed, uneducated segment in urban, rural and remote areas. They are notified to the police by citizens and doctors get involved in the proceedings from the outset. The children are invariably admitted to hospital and are looked after with love. They appear to generally go back to a close relative such as grandmother or are placed in institutional care. In the case of ill-treatment of child servants, police prosecution becomes mandatory.

I was amazed to learn from another lecturer at this seminar, the local magistrate, about the array of ordinances, laws and procedures that cover the offence of child abuse and the definition of a child. There are more than a dozen. The authorities such as the police or probation officer can act under one or more of them. Educating the police not only about the law but as regards technique of taking down statements from the injured child was discussed by the magistrate and two professors. Some police officers attended the seminar.

More information should be researched and collected to represent fairly the distribution of child abuse in the country and among the different ethnic groups. It is unfair and tendentious to predict or expect children to be abused by a particular social class or preponderantly by one of the other ethnic group or segment of society, in space and time. Sociologists should be consulted to handle the sampling of populations at risk. Taking the whole of the population will give very low rates and the findings will suffer from appearing trivial.

The most important aspect of this type of study or pursuit is what to do after discovering or uncovering the 'problem'. What are we to do with these unfortunate children, many of them who may be girls due to lower 'value' of the girl-child in our parts of the world? It is clear that the government will never have the resources for their long-term care, upbringing, education, employment, marriage etc. That is, attuned to our culture and mores, unlike in the west, we should from the outset plan and design to return the children to their former homes or environment, as the majority of cases would justify. It will be rare for both parents to have abused the child and we can surmise, whatever was the physical and psychological trauma, the child would prefer to go back to a mother or father or relative or sibling it is fond and able to trust. The child should not have a lurking guilt of 'telling' against a parent. There can be difficulties as in the case of children kidnapped and brought up as domestic slaves. Nevertheless government policy should never be oriented to institutional custodial long-term care.

I gathered that the two researchers intend to recommend that proceedings in cases of child abuse be handled exclusively by paediatricians, as in the west. This would be a disastrous if not impractical insistence for two main reasons: there is a grave shortage of qualified paediatricians in the country and secondly, our DMOs are eminently qualified to examine these children because they do serious medico-legal work, and the majority of child abuse cases fall into the category of statutory simple hurt. In the case of rare serious instances such as the shaking baby syndrome (the Mathew case in the USA) even paediatricians are not qualified to attend alone!

It is said that the emerging problems of the next century are to do with old age. Will child abuse in our country add to it from the other extreme? I do not think it will.

Kingsley Heendeniya,
Nugegoda.

The letter "A death in Kilinochchi" by Dr. Dias in The Island of 5/6/98 rouses some pertinent thoughts. While the service of this lady certainly deserves applause, I am doubtful whether her death deserves approval.

Once I had a patient who came to me for reading glasses. She had diabetes. I advised her to get controlled before obtaining the glasses. She said, like this lady, that she does not believe in taking medicine, since all diseases will be healed by God directly. Then I pointed out to her that reading glasses is the medication for her presbyopia, the food she eats is the medication (in prophylaxis) for malnutrition; the slippers she was wearing is the medication against many diseases. I asked her who decided which is disease and which is not? Did God indicate this in His book? Or is it man made? If so who made it?

While respecting the belief of another religion, I also wish to point out that this lady if she lived longer certainly could have served the refugees much better. One helping hand at these times of trial is never too many.

If one wants to serve the people, one must look after his own health to the best — this is why Islam preaches to improve ourselves, physically and spiritually, to the best in order to serve others. Not, of course, by stealing from others but by honest means. Islam insists on seeking, long, healthy life; and forbids asking Allah for an early death. All diseases had been sent by Allah Himself as a test; He Himself has taught the medicines for the ailments too.

If one believes that He will cure the physical ailments directly, why should we bother about the social ailments? Doesn’t He know that they are more important to be solved directly by Him? Why did Jesus cure the lepers, the blind and the sick?

We must understand the Allah expects us to do service after every body created — including ourselves. This body of ours is also a trust given to us by Him. We have an obligation to look after them too. When it becomes sick, we have to find ways to cure it, in the way He had shown us.

Dr. Mareena Thaha Reffai,
Dehiwela.