31 January 2020 11:15 am Views - 1296
Following are excerpts of the interview done with Prof. Seneviratne.
This particular subject is quite new in Sri Lanka. Could you shed some light on it?
Clinical Immunology looks at how the immune system works in a person. Like any defence system found in a country, the human body also has a defence system. The immune system is composed of proteins and immune cells. When the body receives a danger signal, the protective immune system gets activated so as to defend us effectively. If the different parts of the immune system are not working well, one would get an ‘immuno-deficiency disorder’. Then, people would get lots of infections- chest infections, sinus infections, ear and eye infections etc. If the immune system is not behaving itself and if it attacks one’s body, one would develop an autoimmune disease or if it reacts abnormally to things found in the environment or to items of food, one would get an allergic reaction. Even in the United Kingdom, there are only small numbers of clinical immunologists. In Sri Lanka too, only a few are found. When a person coming to see me at the clinic, complains of many infections, the workings of the immune system would be checked. If the functioning of the immune system is found to be low, specific action could be taken to boost it.
There is a false belief, even among some doctors, that Immunodeficiency diseases only affect children and that adults do not suffer from them. If a child develops three or four infections during a year, it should be a pointer to having its immune system checked. Even in the UK, there is a big delay in patients with possible immunodeficiency disorders being identified and investigated. This is a pity as so much could be done if the problem is diagnosed early and managed appropriately.
Have you done any research or study in this area in Sri Lanka?
I have a visiting Professor position at the Department of Surgery, Colombo Medical Faculty. For the past four years, I have been having many good research collaborations with several research teams and groups in Sri Lanka. Our research has studied patients whose immune systems are not working appropriately. Secondly, we have focused on diseases where the immune system has been acting in a harmful manner - inflammatory bowel diseases, food/drug/environmental allergies and cancers and thirdly we are looking at the immune aspects of common infectious diseases (dengue, leptospirosis) in Sri Lanka. These conditions are studied with excellent researchers such as Dr Roshan Niloofa from the Colombo Science Faculty, Prof Ishan De Zoysa from the Colombo Medical Faculty and Dr Sanjay De Mel and Dr Visula Abeysuriya from the Nawaloka Hospital Research and Education Foundation. Over two hundred and twenty research publications have appeared in International and national Medical and Scientific Journals.
According to your observation, how prevalent is this problem in Sri Lanka?
I see a number of patients in my Immunology/Allergy/Immunogenetics clinics in Sri Lanka. Many of these patients are referred to me to obtain a specialist opinion about their diagnosis and treatment. Over the past four years, many patients in Sri Lanka have been diagnosed with recognised immunodeficiency disorders. This process is made much easier, as the tests for making such diagnoses are now available in Sri Lanka. The long delays seen in doctors suspecting there may be an immune related problem and then making the correct diagnosis would need to be reduced. Increasing the awareness of immune disorders among doctors and the general public would definitely be helpful. Sri Lanka is also seeing a major increase in the number of patients with allergic and autoimmune diseases and this is a troubling development when considered in the context of the large increases in non-communicable diseases and the high burden from infectious diseases.
In the development of health sector of a country, how important is it to look at this area?
It is like this. In Sri Lanka our lifestyles have been changing so much during the past two decades. When I first went to the UK about 20 years ago, not many persons in Sri Lanka had any interest in allergic or immune related diseases. At the time, these were conditions that affected those in the western world and Sri Lankan’s did not get many Immune, autoimmune or allergic conditions. We then, experienced big changes in lifestyles among those living in Sri Lanka. Children and adults began spending many hours indoors, sitting in front of their TV sets or computers. Playing outdoors and taking adequate exercise became less of a priority. For some strange reason so many expect antibiotics to be given for managing even a viral infection they may suffer from. In addition, to causing issues with an increase in antibiotic resistance, the incorrect use of antibiotics would destroy the millions of ‘good-bacteria’ one has within their gut.
We could also do basic things to maintain a healthy immune system. One should have adequate sleep. Often one hears stories of children taking their phones and other electronic equipment when they go to sleep and thus end up spending hours using them, rather than getting adequate sleep. Mealtimes should be as regular as is practically possible. Adequate amounts of time should be spent outdoors and every opportunity should be taken to get the recommended amounts of exercise. Whenever possible, people should consider walking or going up stairs rather than always taking a lift or hitching a vehicle right up to ones planned next location. Antibiotics should not be taken for every cold or cough the person develops and should only be considered when a bacterial infection is likely. Vitamin D levels should be maintained towards the middle of the reference range. The continuous consumption of processed food should be avoided and the intake of freshly prepared food needs to be prioritised. I have been told that people have outsourced their kitchens and that people hardly cook any food at home and in turn tend to eat from fast food outlets on most days of the week.
What are the other lifestyle aspects which are important to improve our immune system?
During times when a person is supposed to be off work, one should try his or her best to follow this. Partaking in continuous work related activities on their computers or phones, when one is expected to be relaxing would be counter-productive to the immune systems and overall health. Meeting targets appears to be the current buzz word. Thus, even when someone is supposedly having a little leisure time, meeting work targets may often be foremost in their minds. Smoking and the intake of excess amounts of alcohol would adversely affect immune functions.
Message to the people
For many years, Sri Lanka has had wonderful primary care health related statistics and has been the country to follow in this respect. However, whilst massive development has occurred within the country from an economic perspective, many persons have been moving away from a traditional lifestyle and embracing one that’s fast-moving, very stressful and targets a driven lifestyle. One needs to take into account the mistakes made in the west over the past years and learn the appropriate lessons, so as to prevent the ill effects of poor lifestyles leading to adverse health effects.