RESEARCH IN TZCE FIELD OF MEDICAL SCIENCES

: Although Indigenous Medicine was practised in Sri Lanka as f w back as the 4th century UC, Western Medicine was introduced only in the beginning of the 14th century by the Portuguese. During British rule the practice of western medicine was rapidly developed. However an organized attempt at research in this field began only in 1900. Recognizing the need for co-ordinnted research and clevclopment activities, the state created the Nation a1 Science Council (NSC) in 1968. Since then the NSC and its successor the Natural Resources Energy and Science iiulhority (NAItESA) have been in the forefront of developing medical I-esearch in Sri LanIra. Upto 199'7 it has spansol-ecl over- 200 resc?arcli projecls in tlie ineclical sciences, of \vliicli 51 projects have yielded postgraduate clcgrees. In addition to NARESA, scuel-al local as well as foreign organisations are cul-rcntly involvecl in funding r~ieclical research in St-i Lanlta. Some issues concerning the ~.esea~-cIie~-s in meclicul sicences arc also tliscussecl in this papcr. as early as 4"' centul-y BC.'AncientAyurvedic text on ola leaves, ruins of' hospitals (e.g. in Mihintale, Medirigiriya,Polounaruwa), troughs for medicated immersion therapy, all indicate the existence of' hospital baseci care of'tbe sicli. Research during this era was probably limited to careful observation of' phenomena and interpretation of links bet~rcen events and disorders. Thus herbal drugs and other health related belief systems like astrology may have developed on a n empirical basis.


I-Iistory of Medical Sciences and Research in Sri Lanka
The Mahawamsa and several lithic inscriptions uneai-thed i n Anuradhapura and Poionnaru.vva indicate t h a t Sri Lankans have a rich tradition of medical practice. Thcne arc i.efcrcuces to hospitals as early as 4"' centul-y BC.'AncientAyurvedic text on ola leaves, ruins of' hospitals (e.g. in Mihintale, Medirigiriya,Polounaruwa), troughs for medicated immersion therapy, all indicate the existence of' hospital baseci care of'tbe sicli. Research d u r i n g t h i s e r a was probably limited to careful observation of' phenomena a n d i n t e r p r e t a t i o n of links b e t~r c e n e v e n t s and disorders. T h u s herbal d r u g s a n d o t h e r h e a l t h related belief s y s t e m s like astrology may h a v e developed on a n empirical basis.
Western medicine was introduced to Sri Lanka by the Portuguese i n 1505, and they built several hospitals. The Dutch extended the services by building a fcw more hospitals. Rapid development i n the health sector began aftcr 1802, when the ~naritime PI-ovince of' Ceylon became a British colony. Tbe early phase was characterised by concern for t h e health o f t h e troops, control or communicable d~seases llkc smallpox and cholera, and care of the estate laboul-/pcrsoni~el.~ :' Cor~.esporiding a u t h o r This article was originally writLen for tlie S u p p l e m e n t to marlc t h e 2 5 t h yeill-of publication of the Jourilal of t h e National Science Council.
Thus during the 191h century research was directed more towards the priorities of military medicine. Several studies were made of the high morbidity rates in white soldiers:' e.g. dysentery, enteric fever and iron deficiency anaemia. The services expanded rapidly after 1858 when a n independent Civi! Medical Department was established. Though one of the earliest proposals to set up a medical school was made in the late 1830s, the Colombo Medical School was opened only i n 1870. Ten ycars later i t was upgraded to a College. The diploma of Licenciate of Medicine and Surgery (LMS) which was granted by the College was given recognition by the Gencral Medical Council of Great Britain in 1887. In 1942, the Ceylon University Collcgc and the Ceylon Medical College were amalgamated to create the Universitynt of Science formed in 1944. Policy makers and politicians responded (somewhat belatedly) in 1968 with the creation of the National Science Council, (predecessor of NARESA).6 However, several initiatives to implement a comprehensive policy in science and technology (including research) have failed. However, NARESA has taken a lead role in giving direction for research by funding priority areas using a process of consensus and consultation between scientists and policy makers.

Resources for research and Cladosporridium wernecki.
During the 1940s to 1960s several researcllers documented descriptions of disease/ disorders (e.g. PI-ofessor Rajasuriya on lept.ospirosis, Professor Karunaratne's monograph on rhin~sporidiosis).~ The recent clinical research interests include occupational lung diseases, l~acmoglo~inopathies, organophosphate poisoning, molecular biology and clinical features of parasitic diseases (malaria and filariasis), aflatoxins, epidemiology and aetiology of non-communicable diseases, amoebic liver diseases, nutrition, diabetes rnellitus, intestinal infections, specific antidotes for viper bites etc. These were conducted mainly by clinicians and scientists in the state sector, sometimes with foreign collaboration. There is a co~~spicuous absence ofresearch in the private sector, except those conducted by a few general practitioners. Pharmaceutical industry sponsors a few projects while they "donate" considerable sums of money for conferences, seminars and meetings. Research i n the ayurvedic sector is done in the Bandaranayake Memorial Murvedic Research Institute at Nawinna.
Basic scientific research hss been based mainly within the Universities (e.g. Malaria Research Unit) with a few exceptions (e.g. Institute of fundamental Studies, Medical Research Institute). Notable advances have been made in immunology of malaria, DNA probes for filariasis, organophosphate poisoning, peripheral neuropathies, cytokines i n diarrhoea1 disease, entomology and risk factors i n cardiovascular disorders.

ROLE OF NARESA
From its inception, the National Science Council and its successor NARESA have played a n active role in co-ordinating medical research in Sri Lanka. Their role has been to give direction, facilitate, fund, train researchers and disseminate findings related to basic and applied research.

Direction f o r research:
A country requires directed research a n d development for its advancement.
Researchers agitated for such a policy for science through the Ceylon Association for the Advancement of Science formed in 1944. Policy makers and politicians resp~nded (somewhat belatedly) in 1968 with the creation of the National Science Council, (predecessor of NARESA).6 However, several initiatives to implement a comprehensive policy in science and technology (including research) have faild. However, NARESA has taken a lead role in giving direction for research by funding priority areas using a process of consensus and consultation between scientists and policy makers.

Resources f o r research:
Funds : Since its inception 203 research projects in the Medical Sciences have been funded by NARESA accounting to 12.8% of its resource allocation. From 1992-1997 the grants for Medical Sciences were approximately Rs. 12.6 million (or US$240,000 using a conversion rate of Rs 50 = lUS$), a comparatively small quantum if about Rs. 2.1 million or US$40,000 per year by international standards. This compares favourablj~ with the amount allocated for research by the Universities, (which amount to about Rs. 300,000 fo; a Faculty of Medicine), and the annual vote of Rs. 3-5 million (U.S.$60,000) for research by t h e Ministry of Health.7 However, t h e contribution by NARESA is small in comparison to the funds being made available to the Ministry of Health via grants from the World Health Organistion (US$ 2.? million), the World Bank (US$3.9 million) and UNICEF (US$0.77 million) for the year 1995."owever, the percentage of these utilised for research is not available, except that the WHO has committed US$ 17,500 in 1995 for Research Promotion and Development. Most of the funds allocated by foreign aid agencies are for service oriented work though a proportion is used far commissioning reports (which are unfortunately not widely distributed). Data is not available on the number of projects funded by these Agencies.
The funds allocated by NARESA are well utilised and 15 PhDs and 36 other degrees have been completed during the past 25 years (MSc, MOhil and MD). This is a total of 51 projects to fulfill degrees (an average of 2.04 per year). This is a significant contribution in basic research for a local non-university institution. Several contemporary research projects (e.g. molecular biology of parasitic diseases, epidemiology of non-communicable diseases, nutrition, etc.) have received financial assistance from NARESA. Furthermore NARESA h a s provided a much needed impetus to researchers who are required to complete a dissertation as a prerequisite for a degree. During the period 1992 to 1996 alone, 57 such projects received funding and 36 of them were completed. Several of these prajects were community based or clinical studies of relevance to Sri Lanka.
The total budget for health sector research is not available. However, the Research and Development budget for Srl Lanka is reported to be only 0.18% of GDP and yet there are not enough taker^".^ This is a sad indictment on the scicntific community.
Physical resources: NARESA does not provide infrastructure facilities (e-g. laboratory space). T h e financial support is used by reseai-chers t o obtain physical resources, personnel and expenditure for travel.
The following major settings are used by researchers for their projects. Together with other professional organisations, NARESA has taken a n active role in training researchers i n methbdology and scientific presentations. Seminars and workshops on research methodology and Getting Research into Practice (GRIPS) have been held with the participation of the Sri Lanka Medical Association and Professional Colleges. Furthermore, there are grants available from NARESA for researchers to travel abroad i n order to present t h e i r work a t i n t e r~l a t i o n a l seminars a n d workshops.

Dissemination of information and r e s e a r c h work:
NARESA also has a n excellent library, multimedia facilities and Internet facilities to assist researchers. The newsletter provides regular information on fellowship programmes, conferences and workshops of interest. The Journal is a forum for publication of research work subject to peer review. Workshops are held for researchers to exchange views and information. Merit awards are given in appreciation of high quality research work.

OTHER ORGANISATIONS IN THE ARENA OF SCIENTIFIC RESEARCH
More recently policy related research has received a n impetus with the Health Systems Research  Individual contributions by well-wishers or personal funds of the researchers.

FU'I'URE ISSUES IN RESEARCH
Several issues confront the research community. Three priority areas are: lack of a coordinated plan to develop research; problems related to prioritising research; inadequate resources for research.
Lack of a coordinated p l a n t o develop research : The need to have a coordiaated plan for development of research in the health sector has emerged ' as a priority and is being addressed in the National Workshop on Research Management (April 1998). Focal points are to be identified in the Centre and Provinces and research management capabilities would be strengthened. NARESA is a n active participant i n this activity.
Future research priorities : The general direction of research should take cognisance of the developmc~lt strategy adopted by the country. An obligation of tlie research community should be to focus on identifying and prioritising existing and emerging health problems facingthe country, based on the strategic plan for the country. The role of organisations like NARESA in this activity would be pivotal in impressing upon policy makers the need to articulate the direction being taken by the country. For example, if a clear strategy of industrialisation is stated, it would highlight the importance of appropriate occupational health related applied research and issues related to environmental pollution.
Once the crucial development goals and challenges are identified, institutions like NARFlSA should continue the process of identifying priority research areas, preferably by consensus with wide participation of institutions and individual researchers and funding organisations. A workshop methodology or a consensus conference is likely to yield satisfactory results. Prioritisation of research does not mean individual researchers should be restricted from pursuing their interests. Such freedom, which is vital for an inquiring mind, should be encouraged. However funds from a national budget should be directed more towards resolving national problems and issues rather than the intellectual curiosity of researchers.
Inadequate resources for research: The current expenditure on research in the health sector invested by the Ministry of Health is less than 1% of the health budget. This is comparatively low when compared to other countries. With the current growth rate of the economy, it seems unlikely that there would be a substantial increase in the resources made available unless researchers lobbied for more. One option would be to utilise funds made available by foreign donors to develop research in our country. However, there exists a potential danger of 1 concentrating our resources on research questions, which are a priority for the donor, rather than us! Institutions like NARESA, Universities and IFS should have a resource base to counter this tendancy and give leadership a t this juncture. Pooling of resources (equipment, human resources and infrastructure) available to different institutions, avoidance of duplicate funding, lobbying for funds, collaborating with private sector for research initiatives and diverting funds for research (for example from the sponsorship of medical conferences to research) are some options available to us. It would be wise to thrust; such issues on the policy agenda i11 order to meet these challenges facing our country.