Sunday Times E-Paper

College of Surgeons looks back and into the future with pride as they mark a 50-year journey

Centre to relieve agony of patients with kidney stones, strengthening of trauma care and more on the cards

By Kumudini Hettiarachchi

They care, they have cared in the past and they will care in the future – times may be doubly arduous due to the pandemic, but it has not stymied the efforts of the College of Surgeons of Sri Lanka (CSSL) from going beyond the call of duty to its patients.

This is what uplifts the spirits of those gathered at College House, the beautifully re-furbished legacy of legendary Dr. Noel Bartholomeusz and his wife Nora, off Independent Avenue, Cinnamon Gardens, on the rainy evening of Wednesday (November 24).

Surgeons old and young have downed their scalpels and laparoscopes to witness the making of history at the hybrid inauguration ceremony celebrating the college’s golden jubilee as well as the Sri Lanka Surgical Congress 2021.

The ceremony, steered by CSSL President Prof. Srinath Chandrasekera and his council, was the epitome of elegant simplicity and was held in the charming auditorium with a rich red backdrop and muted decor.

On the stage to cheer and support the local surgeons were representatives from the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Surgeons of Edinburgh, United Kingdom ( UK), and also colleagues from India, Pakistan and Malaysia. The SAARC Surgical Care Society was represented by its President Prof. M.D. Lamawansa.

The Sri Lanka Surgical Congress was co-hosted by the Royal College of Surgeons of Edinburgh for the 10th consecutive year and the SAARC Surgical Society since 2005.

The chief guest at the inauguration was Senior Surgeon Prof. A. H. Sheriffdeen, while the book ‘The History of Surgery in Sri Lanka’ by another Senior Surgeon Prof. Channa Ratnatunga was also launched.

The good news for patients came from Prof. Chandrasekera – for all those in any corner of the country doubled up in agony due to kidney stones, on the cards is a model free-care referral centre to be established at the Vijaya Kumaratunga Memorial Hospital, Seeduwa.

“To be built through philanthropic contributions, people can undergo kidney stone surgery here in the near future without suffering in silence on long waiting lists. Initial funding, approvals and plans have been confirmed. This project will provide the infrastructure and state-of-the-art technology for surgeons from different parts of the country to treat kidney stone patients,” promised Prof. Chandrasekera to whom this is a disease very close to his heart, being a Consultant Urological Surgeon.

Taking into account the large number of people who are either succumbing or getting maimed due to accidents and trauma, the CSSL has embarked on a 10-year plan to assist the state in the further development of trauma-care services.

“Significant progress has been made with this initiative and numerous improvements in policy and governance proposed by the CSSL have been accepted by the Health Ministry for implementation,” said Prof. Chandrasekera, appreciating the support and collaboration of the DirectorGeneral of Health Services, Dr. Asela Gunawardena and the World Health Organization (WHO).

It was with much pride that he declared that the CSSL has grown to a membership of over 600 in five decades and contributed to the development of all internationally recognized specialties and sub-specialties. “We have been able to retain the vast majority of the specialists over the last 3-4 decades which is reflective of the healthy working culture in the national health system.”

These surgeons are from all 10 main branches of urology; orthopaedics; neurosurgery; paediatric surgery; cardiothoracic surgery; plastic surgery; onco-surgery ( cancer surgery); vascular surgery; gastro-enterology; and general surgery.

Casting his eye around the CSSL’s home, he says that they have restored College House to its past glory, refurbished the auditorium to serve as a top-class conferencing and educational hub and constructed a new building to commemorate the Golden Jubilee. This will house the surgical museum and library.

“The CSSL embarked on a digitization programme which includes high fidelity virtual conferencing facilities, upgrading of the website and commissioning of all new ‘ CSSL apps’ which will enable our members to interact more effectively,” he said.

Pointing out that an accreditation and exit examination process for different specialties within surgery has been a long-felt need for Sri Lanka’s surgical fraternity, he said that the CSSL took on a new challenge and initiated an ‘ Exit Certification’ programme this year which is compatible with international standards and quality. The pilot examination will be conducted in December 2021, with plans for expansion across all specialties.

Saluting the efforts of surgeons across the country who continue to provide the best possible service under challenging circumstances, ensuring the safety of patients and health workers, as with the rest of the world, Sri Lanka suffers severely due to the pandemic, Pro f. Chandrasekera looks to the future.

“The CSSL will continue to strive to maintain a culture of quality and standards and compassionate services to the needy,” he added.

It is opportune to review Sri Lanka’s progress of surgical services since Independence in 1948. Seven decades and three years have elapsed and where do we rate in terms of similar services in advanced economies? Have we achieved equity of access to the island’s population of such services both from a geographic and affordability point of view?

Is access to sophisticated surgical care, in situations where complex surgical problems pose a threat to life, as in those patients with multiple co-morbidities, available? Is the availability of supportive care services that make survival dependent on, like ICUs, available in areas away from Colombo? These are metrics that we as surgeons should reflect critically on the occasion of the golden jubilee of the College of Surgeons of Sri Lanka.

To be frank, the kudos for life expectancy, which has reached almost 77 years, close upon that of the west ( UK 80-83 years), must go to the Ministry of Health. Due to successful public health programmes, specifically those of immunization, we do not see malaria, cholera, dysentery, polio, tetanus and diphtheria. These rampant killers have become a thing of the past. This is a major achievement. Yet, viral disorders such as tuberculosis remain to be tamed. It is a reality that we see non- communicable diseases -- the major cause of morbidity and mortality -- in the forefront of health related issues, as is seen in the west.

To those of us seniors, we see the sharp contrast from our childhood experience of almost not seeing unattended cleft lips and palates, club feet in children and adults. If at all a set of birth defects exist, they are mostly those related to the heart.

As for injury ( trauma), road traffic accidents remain a massive issue draining both the health purse and leaving often young adults maimed for life, if they manage to survive. The ambulance facility, ‘Suwasariya-1990’, has been a real boon in this context, bringing those injured early to hospital. Speaking from almost five decades of personal experience, even though this problem requires many stakeholders, it is possible to start whittling on it.

Based on evidence of priority issues, I would recommend a far stricter surveillance of drunk driving and driving under the influence of narcotics. Vigilance of licensing authorities, a probationary period of two years for new licencees to see if they behave according to road rules with punitive deterrents and a greater check on driver’s eligibility to drive are some of the measures required to be implemented. Many accidents involving long distance bus/lorry drivers are a result of tight schedules and lack of proper rest. Well furbished rest rooms at depots for drivers will go a long way in rectifying this imminently correctable issue. These are starters in dealing with the problem. Road quality, lighting, vehicle fitness and many others measures should follow.

In terms of care for the injured, accident and emergency facilities are now available in most teaching hospitals. But here again some, such as the one in Kandy, are ye t embroiled in litigation related to construction. Care is now well triaged, with sub- specialised surgical services for orthopaedic trauma, neuro- trauma, vascular and plastic surgery reinforcing the general surgical care. However prevention is less costly in terms of life and rupees.

Infective surgical disorders which were rampant once upon a time -- such as polio, tetanus, diphtheria and gas gangrene requiring surgical intervention -- are now rare or absent, thanks mostly to immunisation programmes. Defects, as in mal-united fractures and delays in seeking surgical attention due to beliefs in alternative medicine have also dwindled, giving an opportunity to effectively combat infective disorders early with better results.

What we now see are disorders related to wear and tear. Much like in the West, the longer lifespan has necessitated support for organs due to the effects of age-related change in their joints requiring artificial replacement. Weight bearing joints, like the hip and the knee, are common problems: Likewise, in the blood supply of the organs. For which we offer bypass surgery, stents and even replacement if indicated, by the transplant for the organ concerned. Routine kidney transplants, less often liver transplants with a beginning for heart transplants are now made available.

Ageing also affects the immune defence system, hence cancer cells which arise in us, are not effectively removed by these defences. However, they are well handled by the Oncosurgical fraternity. We fall short only on, not instituting islandwide screening programmes for certain cancers like that of the breast and the cervix. Unfortunately the dominant cancer which can be largely prevented -- i. e. oral and possibly food- pipe cancer -requires the ‘ bulath habit’ to be removed for good.

Surgical training that confers such advances has improved by leaps and bounds. The Post-Graduate Institute of Medicine of the University of Colombo has been in the forefront, keeping pace with advances in the international arena. Our exit qualification, MD Surgery, is recognised for entry to the Royal College of Surgeons UK post- graduate surgical programmes at an equivalent level. The College of Surgeons of Sri Lanka plays a great role in this respect, offering a multiplicity of facilities for hands- on training as well as lectures, workshops and master-class

es in the spectrum of surgical specialities. These programmes have been sustained for the past several decades. They have benefitted the community that we live in without much ado, making quality surgery available and accessible to all Sri Lankans.

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2021-11-28T08:00:00.0000000Z

2021-11-28T08:00:00.0000000Z

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