First Faltering Steps of a Future DoctorJuly 6, 2013, 7:32 pm
By Dr. Lakshman Abeyagunawardene
Every student in the Advanced Level classes (University Entrance of a bygone era) in the Biological Sciences stream of every secondary school has to go through the routine of dissecting a variety of dead creatures like toads, rats, cockroaches, earthworms and even small sharks. A few of them who do well in the competitive examination get selected to enter a medical school of which there are many in government universities today. Yet another lot, whose parents can afford the "luxury", find their way into private medical schools either in Sri Lanka or abroad.
Having gone through the process more than half a century ago when private medical schools were unheard of, I thought of sharing my own experiences with readers at a time of significance to medical education in Sri Lanka. The 100th anniversary of the Anatomy Block of Sri Lanka’s oldest Medical Faculty falls on November 3 this year. It is in the Anatomy Block that young medical students take their first faltering steps. I must hasten to add that what I write here applies mainly to the situation that existed during my time as a medical student. But apart from a few changes that I have mentioned below, a medical student’s career basically remains the same.
The First Two years
Just as the name of the institution has changed, the undergraduate medical curriculum too has undergone changes since I was a raw freshman in the Faculty of Medicine, University of Ceylon. That was in June, 1962 when all Faculties were under the single banner of the University of Ceylon. Anatomy, Physiology and Biochemistry were the core subjects that we had to offer for the 2nd MBBS examination which was due to be held 18 months later. We had already cleared the first hurdle (called the 1st MB) when we qualified to enter the Medical Faculty. Being an Executive Committee member of the Colombo Medical School Alumni Association (CoMSAA), I have been able to keep track of some of the changes that have taken place since 1962. I am told that the 2nd MBBS examination of yesteryear, no longer exists. Unlike many of the recent changes in other spheres, I must say that the changes effected to the undergraduate medical curriculum have been for the better. As true medical educationists, those responsible for the changes have done so with genuine intentions and great foresight.
Although changes in the undergraduate medical curriculum do not fall within the purview of this article, it is pertinent to touch on that aspect albeit very briefly. Even as early as 1962, the existing curriculum being direct copies of those that existed in British colonies, curriculum reforms were in the air and talked about. It was felt that the replicated curriculum did not represent an indigenous identity and failed to meet local needs in keeping with the rapid social changes that were taking place around us. Moreover, medical schools in other countries too were changing the curriculum to suit their own needs. The establishment of a Medical Education Unit in the Peradeniya Medical Faculty under the auspices of the WHO and its Programme to Reorient Medical Education (ROME) was a direct result. The Colombo Medical Faculty soon followed with the establishment of the Medical Education Development and Research Centre (MEDARC) thus paving the way for the development of a new curriculum towards the end of the last century. My own professional biases as a Community Medicine and Health Education Specialist aside, I am particularly in favour of the introduction of a Behavioural Sciences Stream which covers personal development, ethics and communication skills. Basic sciences referred to earlier are now included in this stream with early clinical exposure.
Francis Road and Vicinity
The Colombo Medical Faculty occupies a fair portion of the quadrangle of land bounded by Maradana Road, Norris Canal Road, Kynsey Road and Regent Street (some of them have since been renamed). A little known narrow road called Francis Road which runs parallel to Maradana Road and Kynsey Road, bisects the quadrangle. While the Anatomy Block lies on one side, a majority of the Medical Faculty buildings are on the other side with the main entrance facing Kynsey Road near the Koch Memorial Clock Tower. The Office of the Judicial Medical Officer and the Medico Legal Morgue are next to the Anatomy Block as one proceeds towards Regent Street on Francis Road.
The Anatomy Block
The Anatomy Block is one of the oldest buildings of the Colombo Medical Faculty. Built in 1913, it had obviously been designed to ensure privacy – an essential element considering what goes on within! As freshmen, we spent most of our time during the first two years within the grey walls of the Anatomy Block. We crossed Francis Road only to get to the nearby Physiology Block. We were allowed to visit the Common Room and canteen only after being "accepted" by the honourable seniors following the traditional rag in the first two weeks. Dressed in a very special "kit" as stipulated by the Block Seniors, I remember vividly the day I walked into the Anatomy Block for the first time in June 1962. White coat with a shoe flower in the button hole, a brinjal round the neck, a canvas shoe on one foot to go with a black leather shoe on the other were part of our dress code during rag time that year. This unusual attire added to our discomfiture in unusual surroundings.
I was assigned to a cadaver (a dead human body or corpse intended for dissection) lying on a porcelain slab on my right as we entered the main dissecting room from the "T" shaped corridor leading from the main entrance. It was the still body of a dark skinned male whom I later learnt had been a homeless beggar. Although there was no one to claim his body when he died, there were eight young medical students to keep him company during the ensuing three months!
With Cunningham’s Dissecting Manual in hand, we sat down on stools placed around our "body" and awaited instructions from one of our teachers. We followed instructions and set about the task of identifying muscles, nerves, blood vessels and other structures through careful dissection. For dissection purposes, different parts of the cadaver were assigned to the eight students – head and neck, two upper limbs, thorax and abdomen and the two lower limbs. As the dissection process progressed, it was more convenient for the assigned students to detach the limbs from the main body and work on them separately at a quiet spot in the dissecting room. There was thus hardly anything left of the cadaver at the end of this period except for the skeletal remains. The budding doctors who were studying human anatomy had seen to that!
Life in the Block was not a walk in the park. We had to face bi-weekly oral tests referred to as "Signatures" in students’ jargon. They were conducted in small groups and based on the section of the body that had been dissected the previous fortnight. Successful students were signed up with comments such as "good", "fair" or "satisfactory", while the others had to repeat. Being new to the system, these "Sigs" were somewhat stressful. But they ensured that the students kept up with the study of human anatomy.
Familiar Smell of Formalin
An interesting book titled "The Colombo Medical Faculty: Evolution, Turbulence and Achievements" authored by Professor A.H. Sheriffdeen and Dr. Shalika Nagasinghe, was published in 2012 to coincide with the first Reunion of CoMSAA. In a section on the Department of Anatomy, it refers to the recent changes in the Anatomy Block which has been refurbished and modernised. The concluding remark is that "It has been air conditioned with hardly any smell of formalin in the premises which older alumni would recall with fond memories". As one of these "older alumni", on a recent visit to the Anatomy Block, I recalled with nostalgia the familiar smell of formalin but which was conspicuous by its absence that day. I am not sure what techniques are presently used for preservation of dead bodies that are meant for dissection. But at least during our time as block students, embalmed cadavers were immersed for about three months in a large tank filled with a formaldehyde based fluid that further preserved them.
In concluding this article, I wish to pay tribute to our teachers who helped us to take our first faltering steps. As mentioned before, we spent a great deal of time in the Anatomy Block during the first two years and it was here that the first steps were taken.
The Professor of Anatomy during my time was M.J. Waas who had followed a succession of illustrious academics namely Professors A. Gordon Smith, W.C. Osman Hill and P.K. Chanmugam. Since my own graduation in 1967, Professors F.L.W. (Lester) Jayawardene, P.S.S. Panditharatne and Rohan Jayasekara had ascended to the Chair. The last named Professor Rohan Jayasekara is the incumbent Dean of the Colombo Medical Faculty, who incidentally is the first Professor of Anatomy to be elected Dean of the Faculty of Medicine, Colombo. Professor Jayasekara who has been a close personal friend of mine since the time we both stayed at the popular Petra Guest House in Jakarta, Indonesia in 1982, has been instrumental in giving a much needed face lift not only to the Anatomy Block, but also to the other Faculty buildings.
In the early sixties, Professor Waas was assisted by seniors such as Professor Chanmugam who continued to teach as Professor Emeritus even after retirement. Dr. Lester Jayawardene who was a Senior Lecturer spent a brief period in Colombo before accepting the Chair in Peradeniya. He had later returned to Colombo in the same capacity. Dr. Panditharatne who succeeded Prof. Jayawardene was a Senior Lecturer. Raja Bandaranayake (Professor and well known medical educationist in Australia) and Shanthi Goonewardene (later to be Associate Professor in Anatomy), I believe had just joined the academic staff. The junior staff designated as demonstrators provided further teaching assistance. Their main function was to supervise the dissections and to conduct the bi-weekly oral examinations. Most of them were themselves preparing for the Primary FRCS examination while others were well on the way to specialise in other fields. The demonstrators included P.A. Wirasinghe (now a Consultant Ophthalmologist), the late L.A.G. Jayasekara who was a Consultant Anaesthesiologist in UK, S. Dharmasekara (Medical Administrator) and Phyllis Costa Fernando (Consultant Surgeon).
Unlike today, with only two medical schools in operation at the time (the second Medical Faculty in Peradeniya had just got off the ground), we were fortunate to have the best medical talent available in the country to teach us. This applied not only to the non clinical subjects, but more so to the teaching in clinical fields which followed later in a student’s career. Medical specialists in the government sector attached to teaching hospitals engaged in private practice even at that time. But teaching medical students was one of their priorities.