Wednesday, March 24, 1999

A hearty, healing touch
CARDIOLOGISTS in Central Mumbai were recently exposed to a unique technique of the now relatively common coronary bypass surgery. Surgery was elevated to the level of an intimate and gentle art form by a group of practitioners at the H. N. Hospital— a new technique even by global standards.

Skin care and cosmetics
By Dr Gurinderjit Singh

THE concept of skin care has undergone a significant change over the past few years with the introduction of various cosmetics and increased cosmetic awareness. Normal skin care, which once mainly consisted of just good personal hygiene, has today been transformed into the use of plenty of cosmetics. The selection of the cosmetics should be made depending upon the individual skin type — normal, dry, oily or combined.

Normal skin: This is an ideal skin type which has just sufficient oil to prevent it from dryness yet not so much as to give it a greasy shine. In addition, it holds just enough moisture necessary to keep it soft and supple.

Dry skin: The skin which looks dry and is improved by the application of emollients like cold creams or moisturiser is dry skin. It is seen in elderly people and those exposed to excessive wind, cold and detergents. When water loss is associated with dry skin it leads to irritation, redness, itching, fissures and cracks.

Oily skin: This has a greasy and shiny look as a result of excessive oil secretion from oil glands or the excessive use of greasy cosmetics. The complexion becomes muddy since the upper dead layer of the skin is not shed off routinely. The normal skin becomes oily in adolescence when enlarged pores and pimples also make their appearance.

Combination skin: It is rare to find normal skin all over the face since a greater number of sebaceous (oil) glands are present on the forehead, on and around the nose, above the upper lip and the chin. This area is oily and called the “T” zone of the face. In contrast, the lateral aspects of the cheek and the skin along and around the lower jaw has a smaller population of sebaceous glands. This area is dry and called the “V” zone of the face. Both these “T” and “V” zones constitute the combination skin.

Steps of routine skin care: The basic steps which should be routinely followed to keep the skin young, radiant and glowing are described below:

1. Cleansing: Most people use standard soap bars with water for washing away the dirt and grime. Other alternatives used for cleansing the facial skin consist of cleansing creams, milk, lotions, foams, oils, gels and liquid soaps. Some people use abrasive cleansers for the face. These cleansers have tiny particles of rough granulated material (walnut or apricot) with mild detergent in a cream base. They are to be scrubbed gently on the facial skin once a week for removing the superficial dead layers.

2. Toning: Toning is another essential part of skin care usually applicable for the facial skin following its cleansing. Toners, also called astringents, are available in varying concentrations of alcohol to suit skin types. The oily skin needs more alcohol whereas the dry skin needs less alcohol content.

3. Moisturising: The softness, suppleness, resilience and pliability of the skin is because of the water content of the upper layer of the skin. Various preparations of moisturisers are available like cold creams, nourishing creams, night creams and lotions. A moisturiser containing sunscreen agents protects a person against sunlight and the one containing glycolic acid is the best thing for its antiaging effect.

4. Facials: Facials are scientifically proven methods of keeping the skin youthful. The glow of the face can be maintained for years together if facials are attempted once a month or so. These have three main effects — physical, physiological and psychological. The physical effects comprise cleansing, exfoliating and increasing the local temperature through frictional rubbing (massage). The increase in the blood circulation and the activation of glands (oil and sweat) come as physiological benefits. Psychologically, a person feels relaxed and there is a sense of well-being after the facials.

The steps of a facial are described as under:

(i) Skin analysis: This is done by physical observation and judgement. It is essential for the selection of the correct skin product and the facial required.

(ii) Cleansing: The cleanser is spread over the face with a light circular movement of the fingertips starting from the base of the neck and finishing at the forehead. It removes dirt, cosmetics, pollutants, dust, grime and dead skin. In addition, the rubbing action itself loosens and exfoliates the superficial adherent dead layers of the skin. The cleanser is then wiped off by clean cottonwool.

(iii) Toning: A toner is then applied all over the face. It removes any trace of the leftover cleanser and causes cooling because of its high alcohol content.

(iv) Steaming: A steamer is used for about five minutes for locally heating the facial skin. It results in the redness of the face and the dilatation of the skin pores along with the stimulation of the sweat and oil glands.

(v) Comedone extraction: The face is wiped and open comedones are expressed out by the comedone extractor. The comedones, also called blackheads, come out easily as the opening is dilated due to steaming and the skin is soft and pliable due to moisture.

(vi) Massage: This is a major step in a facial. A generous amount of massage cream is applied all over the face and the neck. Massage is then conducted with four types of movements. The superficial movement is followed by a deep movement and after adequate relaxation brisk and vibratory movements are linked in between. Each type of movement lasts for about five minutes. The massage is concluded with a superficial movement. After completing the entire massage, the cream is removed with clean tissue and the skin is made grease-free.

(vii) Face masks and packs: These are special skin treatment preparations and their utility depends on the ingredients used. Setting masks are applied in liquid or gel form. They becomes dry and harden to get set on the face. Clay packs containing fuller’s earth absorb the excess oil and are useful in the oily skin. Non-setting masks do not dry after application and the ingredients remain as a thick or thin coat. They are useful when the skin is dry. After the removal of the mask, the face is wiped clean with the tissue soaked in water, followed by the application of a toner, which is followed by a moisturiser and then cosmetics, if desired.

5. Dusting: In a tropical country like ours, talcum powder is used as a dusting agent by a large number of people after bath. Body folds like groins and underarms are routinely dusted with powder which absorbs sweat, prevents friction and acts as a deodorant.

6. Care of hands and feet: The cumulative insults of repeated washing and the use of detergents result in the removal of protective oil barriers of the skin. This causes dryness, redness, the itching of skin and chapping of the nails. The regular use of moisturising lotions is a must after soaking the hands and the feet in luke-warm water for about seven minutes at night. Manicure and pedicure may also be adopted, depending upon individual preference.

7. Care of the ageing skin: The ageing of the skin is an inevitable process, but premature photoaging because of ozone depletion is becoming quite common. Sunscreens with the high sun protection factor (SPF, more than 15) should be routinely applied early in the morning on the exposed areas of the body. In addition, glycerine-based soaps and a lot of emollients should be used. A balanced diet, a lot of roughage, fruit juice and plenty of water intake help in keeping the skin healthy.

The writer is a senior consultant and the Head of the widely known Department of Dermatovenerology and Hair Transplantation at the Mohan Dai Oswal Cancer Treatment and Research Foundation, Ludhiana.

Piracy in Ayurvedic field
By Feizal Samath

COLOMBO: Long before the arrival of Western drugs, indigenous doctors pounded and prepared medicine from wild plants and flowers gathered from Sri Lanka’s thick tropical forests to treat a variety of illnesses.

The ancient formulations of the ayurveda system of medicine were zealously guarded and passed on from one generation to the next in families that could trace back their ancestry for many centuries.

In the north-central town of Polonnaruwa, an indigenous doctor treats patients with heart problems who would otherwise require bypass surgery for a fraction of the cost of surgery which is at least $ 4,500 in hospitals in the country.

Now giant pharmaceutical drug companies, aware of the therapeutical qualities of medicinal plants, are virtually stealing this ancient wisdom of extracting chemicals from local plants and patenting them abroad, particularly in the United States.

Upali Pilapitiya, Director of the Bandaranaike Memorial Ayurveda Research Institute, says that the tremendous interest in the West about natural ayurvedic remedies, has led to a growing interest in Asia’s indigenous plant life.

Studies have revealed that more than 40% of Western pharmaceutical products contain Asian plant extracts but these Asian countries including India have earned very little in return.

Export of medicinal plants or their extracts is banned in Sri Lanka. However, biopiracy is flourishing, quite often with the assistance of Sri Lankans who have no qualms about selling indigenous knowledge and innovation.

In September, 1998, a university professor and another wealthy Sri Lankan, whose wife is a social activist, were detained for biopiracy by security personnel.

“Loopholes in the existing laws and other legal snags are robbing the country of millions of dollars that is rightfully ours”, asserts Sirimal Premakumara, a scientist at the Ceylon Institute of Scientific and Industrial Research.

He said that the country does not have the hi-tech scientific equipment to analyse chemical components of indigenous plants or the capacity to pay the international patent fee of $ 60,000, and wealthy countries are taking advantage of this.

For instance, Salacil Reiticulata, the scientific name for the locally grown Kothalahimbutu plant, has been recognised abroad for its ability to control diabetes. Ayurvedic physicians in Sri Lanka have always advised patients to drink water left overnight in a hand-carved Kothalahimbutu mug or jug, whose production has become a cottage industry on the island.

Newspapers here report that a Japanese drug company patented a product based on this herb through the American Chemical Society in 1997.

Many other patents, like from the plant Weniwalgeta — used effectively as a herbal remedy for fever, coughs and colds — have been registered by Japanese, European and US pharmaceutical manufacturers.

Environmental lawyer Jagath Gunawardene says, “Although the law requires that a patent can be obtained only if it is an economically valuable invention created through a methodology, most multinationals have somehow obtained patents for products used in our country for thousands of years.”

Scientists say that the moral ruse adopted by drug transnationals is to befriend an indigenous doctor, learn the curative properties of plants and sometimes offer him a trip abroad. The process of extraction of the chemical and export of the product which is often in the form of a powder, chemical solvent or the bark of trees, follows.

The two recent cases of biopiracy involving a university botanist and a wealthy Sri Lankan got wide publicity and led to a sudden interest in the issue by environmentalists and scientists here.

The botanist was intercepted by customs at Colombo airport trying to smuggle out some plant extracts in his suitcase. In the same month customs officials discovered a container-load of Kothalahimbutu — 1,512 cups weighing some four tonnes — being shipped to Japan through a firm owned by the wealthy Sri Lankan.

Gunawardene feels that the laws should be strengthened to prevent the smuggling of Sri Lanka’s indigenous plants and ayurvedic knowledge.

Normally, product patents are given only if they fulfil the criterion of being new, specify the process and must necessarily have commercial value. If there are discrepancies in this process, the patent can be contested in court, as in the case of the US patent for turmeric, which was successfully challenged by India on the ground that its medicinal properties have been well-known since ancient times.

However, because India has no worthwhile law to protect its rich biodiversity of intellectual property rights, another US company earlier in 1998 took out patents on long-grain basmati rice, grown for centuries by farmers in India and Pakistan.

Developing countries, rich in indigenous resources, need to tighten biodiversity laws to stop the usurpation of the resources and knowledge of their people, Sri Lankan scientists say. — IPS

A hearty, healing touch

CARDIOLOGISTS in Central Mumbai were recently exposed to a unique technique of the now relatively common coronary bypass surgery. Surgery was elevated to the level of an intimate and gentle art form by a group of practitioners at the H. N. Hospital— a new technique even by global standards. The live interactive workshop was organised by a young dextrous surgeon, Dr Rajendra Patil, who is steadily earning accolades and blessings from middle class as well as lower middle-class patients. People are approaching him for medical succour in what is otherwise a very difficult and expensive situation for the suffering multitudes in our country. Affordable world-class medical treatment has been Dr Patil's dream for his fellow citizens. He is being ably assisted in this endeavour by Dr Vinod Haneria.

A workshop featured the pioneer of this alternative bypass technique, Dr V. A. Subramaniam. Dr Subramaniam, who hails from the Lanox Hill Hospital in New York, operated on three patients successfully with assistance from Dr Patil. The fourth case was operated on by Dr Patil independently.

The workshop was attended by eminent cardiologists and cardiac surgeons from Mumbai and was followed by a lively discussion on effective methods of heart treatment.

What is this technique of surgery all about?

One meets the very reticent Dr Patil, who qualifies as a karma yogi interested in doing his best with his providence-bestowed skills "every moment" for the suffering humanity. A man of very few words, he strikes a chord in you with his spontaneous empathy and sensitivity. It is like a sculptor at work with his most cherished creation. And what happens if every creation becomes cherished?

A magical quality of quiet harmony flows out in the action, which emanates from the depths of the human mind. Have you ever seen the fullness of a river in flow? This fullness comes from the pace of the flow, a pace characterised by mysterious silence. That is Dr Patil for you—intense, mysterious and an artist on the operating table. He is among the handful of surgeons in India who operates coronary bypass patients with what has come to be known as the MIDCAB technique. The expanded form of this technique pioneered by Dr Subramaniam is "Minimally invasive direct coronary bypass".

But does it really achieve what the name proudly proclaims? Dr Patil is quick to point out that even though the mortality rate in conventional coronary artery bypass surgery has been reduced to significantly low levels due to improved safety standards of cardio-pulmonary bypass, there still are certain classes of patients like those with multiple disorders, especially, multi-vessel disease with associated morbid conditions like cancer, renal failure, prior coronary artery bypass grafting with failed vein grafts, resteriosis after angioplasty and so on.

Indications like these have given an impetus to the development of new techniques such as MIDCAB which are performed through extremely small cosmetic incisions in the duct or the abdomen. The coronary bypass grafting is performed on a beating heart with the help of various external stabilisers. Needless to add, it is a technique that requires a very high degree of dexterity on the part of the performing surgeon. In view of the deletion of the cardio-pulmonary bypass, these MIDCAB operations are safer, cosmetic and less painful.

The technique requires a post-operative recovery period of only four days. The cost of the basic surgery itself is not prohibitive and the minimal post-operative period of recovery facilitates the technique to become available to a wide cross-section of our people.

In Dr Patil's work we see a true implementation of the Hippocratic pledge of healing.

The service of the anatomically disturbed needs a million Rajendra Patils. But where are they?
— (Dr) N.R.P.