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Sri Lanka Health
Sri Lanka has one of the most effective health systems among
developing nations. The crude death rate in the early 1980s was 6
per 1,000, down from 13 per 1,000 in 1948 and an estimated 19 per
1,000 in 1871. The infant mortality rate registered a similar
decline, from 50 deaths per 1,000 births in 1970 to 34 deaths per
1,000 births in the early 1980s. These figures placed Sri Lanka
statistically among the top five Asian countries. Improvements in
health were largely responsible for raising the average life span
in the 1980s to sixty-eight years.
Traditional medicine
(
ayurveda--see Glossary)
is an
important part of the health system in Sri Lanka. The basis of
traditional medicine is the theory of "three humors"
(tridhatu), corresponding to elements of the universe that
make up the human body: air appears as wind, fire as bile, and
water as phlegm. Imbalances among the humors (the "three ills,"
or tridosha) cause various diseases. The chief causes of
the imbalances are excesses of heat or cold. Treatment of disease
requires an infusion of hot or cold substances in order to
reestablish a balance in the body. The definition of "hot" or
"cold" rests on culturally defined norms and lists in ancient
textbooks. For example, milk products and rice cooked in milk are
cool substances, while certain meats are hot, regardless of
temperature. Treatment may also involve a variety of herbal
remedies made according to lore handed down from ancient times.
Archaeological work at ancient monastic sites has revealed the
antiquity of the traditional medical system; for example,
excavations have revealed large tubs used to immerse the bodies
of sick persons in healing solutions. Literate monks, skilled in
ayurveda, were important sources of medical knowledge in
former times. Village-level traditional physicians also remained
active until the mid-twentieth century. In the late 1980s, as
part of a free state medical system, government agencies operated
health clinics specializing in ayurveda, employed over
12,000 ayurvedic physicians, and supported several
training and research institutes in traditional medicine.
Western-style medical practices have been responsible for
most of the improvements in health in Sri Lanka during the
twentieth century. Health care facilities and staff and public
health programs geared to combat infectious disease are the most
crucial areas where development has taken place. The state
maintains a system of free hospitals, dispensaries, and maternity
services. In 1985 there were more than 3,000 doctors trained in
Western medicine, about 8,600 nurses, 490 hospitals, and 338
central dispensaries. Maternity services were especially
effective in reaching into rural areas; less than 3 percent of
deliveries took place without the assistance of at least a
paramedic or a trained midwife, and 63 percent of deliveries
occurred in health institutions--higher rates than in any other
South Asian nation. As is the case for all services in Sri Lanka,
the most complete hospital facilities and highest concentration
of physicians were in urban areas, while many rural and estate
areas were served by dispensaries and paramedics. The emergency
transport of patients, especially in the countryside, was still
at a rudimentary level. Some progress has been made in
controlling infectious diseases. Smallpox has been eliminated,
and the state has been cooperating with United Nations agencies
in programs to eradicate malaria. In 1985 Sri Lanka spent 258
rupees (for value of
rupee--see Glossary)
per person to fight the
disease. Although the number of malaria cases and fatalities has
declined, in 1985 more than 100,000 persons contracted the
disease.
Sri Lanka had little exposure to Acquired Immuno Deficiency
Syndrome (AIDS) during the 1980s. As late as 1986, no Sri Lankan
citizens had contracted the disease at home, but by early 1988
six cases had been diagnosed, including those of foreigners and
of Sri Lankan citizens who had traveled abroad. Government
regulations in the late 1980s required immediate expulsion of any
foreigner diagnosed as an AIDS carrier, and by 1988 the
government had deported at least one foreign AIDS victim.
Government ministers have participated in international forums
dealing with the problem, and the government formed a National
Committee on AIDS Prevention in 1988.
Mortality rates in the late 1980s highlighted the gap that
remained between the urban and rural sectors and the long way
good medical care still had to go to reach the whole population.
Over 40 percent of the deaths in urban areas were traced to heart
or circulatory diseases, a trend that resembled the pattern in
developed nations. Cancer, on the other hand, accounted for only
about 6 percent of deaths, a pattern that did not resemble that
of developed nations. Instead, intestinal infections,
tuberculosis, and parasitic diseases accounted for 20 percent of
urban deaths and over 12 percent of rural deaths annually. The
leading causes of death in rural environments were listed as
"ill-defined conditions" or "senility," reflecting the rather
poor diagnostic capabilities of rural health personnel. Observers
agreed that considerable work needed to be done to reduce
infectious diseases throughout the country and to improve skilled
medical outreach to rural communities.
Data as of October 1988
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