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Thursday, April 10, 2014

Memories  of internship at Kurunegala 1967/68

Dr. Nihal D Amerasekera

Entrance to the GH Kurunegala


With the publication of the results of the final MBBS the vast dispersal of graduates began. The euphoria of the MBBS with all its trappings of fame and fortune was only dampened by the stress of the internship. Interns were at the bottom of the pile overworked and underpaid (Rs 475.00 per month). Although this was an extension of our apprenticeship we were now to practice the trade we had learnt for five years. After a sheltered existence so far we had to learn to be streetwise dealing with the public. To retain ones’ good humour and common sense was vital. Ready or not we had to start practicing medicine in the real world.

For those of us whose local geography has been a casualty of the permissive sixties, Kurunegala is a sleepy town at the edge of the dry zone on the way to Anuradhapura. Most years the monsoons deserted the town and the clouds flew passed ignoring its parched landscape. The elephant rock stands majestically in the middle of town. During the day the sun beats on it mercilessly and in the night it dissipates its heat keeping the town oven hot 24 hours of the day. The 400-bed hospital is built in a coconut estate. In-patient numbers far exceeded the number of beds.

It was an oppressively hot day in July in 1967.  I remember as if it were yesterday walking up a narrow street by the hospital into the House Officer’s quarters. This typical government quarters painted a drab yellow was to be my home for a year. There were 4 shared rooms 2 in each. Armed only with a suitcase and a sagging confidence I took up my task seriously. The caretaker was an elderly man who had severe asthma. No one knew his real name but we called him Rhonchi Rajapakse. His cooking left a lot to be desired and reminded me of the chemistry book description of oxygen - tasteless, colourless and odourless. He had a young side kick who did the washing and cleaning. We took turns to be the “BUTH MASTER” taking charge of the finances for the month to provide delicious food at a reasonable price.

The hospital was managed by the Medical Superintendent Dr.Bertie Wijeratne, a kindly gentleman who had to serve the masses and balance the books. Interfering politicians and local unions were the bane of his life. He juggled his many impossible tasks admirably and with a smile. The Kurunegala hospital served a wide area extending from Galgamuwa and Dambulla in the north to Anamaduwa and Nikaweratiya in the west; Alawwa and Polgahawela in the south and Galagedera and Kandy in the east. The west and north being in the dry zone, the people’s lives depended much on the rainfall. They were mostly poor and humble but had vitriolic and volcanic tempers towards their own. This often resulted in stabbings and shootings for mundane trivial issues. They would kill for a dispute about a jak fruit. Those from the south and east were relatively affluent and knew their rights but were rather placid.

GH Kurunegala – A view from the south side

My first appointment was in paediatrics with Dr Chandra de S Wijesundera. I couldn’t have wished for a kinder boss. He was dignified, generous and occasionally  invited us for dinner at his house. (I had spoken with Dr Wijesundera on many occasions when he visited the UK but we never had the good fortune to meet.) I had H.N. Wickramasinghe, lovely Priya Guneratne and Adikaram as the co-workers. “Adi” emigrated to the UK and became a paediatrician working in the Middle East. He sadly passed away after a battle with myelofibrosis. H.N has always been a great comrade and colleague and is a successful GP in Hanwella. He was tremendous company and I have had many evenings drinking together in the privacy of the Kurunegala Rest House. Priya was a kind person and exceptionally helpful holding fort for us when we were oncall and drunk beyond repair. She remained in Sri Lanka to serve its people. (It was a great pleasure to see Priya in September 2012 at the Cinnamon Grand. She invited me for tea with “Pattas” but sadly I had a prior appointment to keep.)  Sanath de Tissera joined paediatrics when I was 3 months into my rotation. We continued our friendship which began in Medical College. In Paediatrics in Kurunegala, diphtheria and gastro-enteritis were the killers, both of which were so easily preventable. It is said a family never recovers from the death of a child. I still recall the deep distress and the wailing in the ward after a death.

Thanks to our teachers we have had a good all round training. The art of breaking bad news and counselling the bereaved were sadly lacking from our repertoire. We learnt these on the job. I recall one day when a seriously ill child of 2 years was brought to the children’s ward. I diagnosed diphtheria and gave the appropriate treatment. Within 30 minutes the child was in great distress with breathing difficulty. I called the surgeon who came promptly and when the child was taken to the theatre for emergency surgery went pale and died of asphyxia. It is a well known complication of the condition. This tragedy has remained in my memory ever since.

Sirima Subesinghe (wife of our immediate senior batch Disampathy Subesinghe) was in charge of the rota. She was firm but fair and provided great help to many young “green” doctors who arrived in Kurunegala. (Sirima sadly passed away in Leeds after cardiac surgery). We were on ‘call’ once every 3 days and once in 3 weekends. The calls were busy and a good night’s rest was a luxury we never knew.  The calls at night were brought to us by a labourer on a bike. He knocked on our door saying” Sir, Call ekak”  After the initial foul language we got dressed to attend to the problem. When not on call, the evenings were spent playing badminton with a drink before dinner. The H.O ‘s Quarters was a magnate for the young Government Servants like the dentists, Veterinary surgeons and Tax consultants who drifted in our direction for badminton and refreshments. We immersed ourselves fully in the pleasures of youth.

The Visiting Surgeons and Physicians kept their distance and rarely mixed with the junior doctors. I believe channelling, tunnelling and funnelling private patients kept them preoccupied. One who mixed with us regularly was Dr.Upali Ratnayake. He sadly died of a cerebral haemorrhage in his prime at the age of 48.

The doctors were the elite in town and were recognized and respected. The shops gave us special discounts and the local cinema flashed our names on the screen to say we were urgently needed in hospital ‘to save a life’. The doctors were automatically made members of the Upper Club. It was an exclusive social club in Kurunegala where the upper crust congregated. Every weekend was a party in the quarters or in town and the booze flowed freely. Sing-songs were an integral part of the fun. The general public and the local police waived off our youthful indiscretions.

All telephone calls to and from the hospital had to go through the hospital exchange. Some of the guys manning the exchange were arrogant and unhelpful. Calls to Colombo were trunk calls and we depended on the kindness and generosity of the operators. To my recollection even for the 1960’s the telephone service was poor.

It seemed the flushing toilets had not reached the dry zone yet. The quarters had bucket latrines and the daily ablutions were a tricky business. Those at the back of the queue in the morning had to endure the worst. Sirry Cassim now a senior Ophthalmic Surgeon in Colombo, had his own answer to the problem. He had a generous stock of Bulgarian cigars (Bulgarian bog punt) which produced acrid fumes to counteract the other nasty odours. The non-smokers had to make a quick exit cyanosed and blue poisoned by the fumes and driven by the stench.

There were many colourful characters living in the H.O’s Quarters. Pathology Registrar Rajasekeran alias Kapoor was an honourable senior who had been there for 6 years. He had a moustache like the  Hindi film idol of the 1950’s Raj Kapoor. He orchestrated the ‘misdemeanours’, arbitrated the disputes and collected the funds for the daily consumption of booze. Kapoor became a Consultant Chemical Pathologist at Bedford Hospital, UK. I met him from time to time until he retired. He was much subdued then. Our batchmate Rajasooriyar was our resident hermit. Being a teetotaller, he cared for the sick and suffering doctors (from recurrent hangovers) and provided the aspirin. Rajasooriyar  qualified as an anaesthetist and worked in the North of England where I tracked him down some years ago. He still effuses kindness and speaks softly and deliberately, just as he did all those years ago.

The young Kurunegala damsels as they went past the house were greeted cordially. After dusk the girls saw more of us. Many of the girls blushed and hurried past but a few retaliated with some choice language. We spent many happy evenings drinking and chatting putting the world to right. With our raging hormones many of the topics had a sexual connotation. There was a strong and healthy relationship with the nursing staff who were invited for our fun evenings. For some love blossomed. For others it was just a one night stand. The house officers quarters were a honey pot for marriage brokers who came from far and wide on fact-finding missions. Big bucks were mentioned and “fit-ons” were arranged. Deals were done in a backroom. Those who volunteered information (our servants) were on our payroll and the routine was well rehearsed.

On weekends we made trips to Kandy, Anuradhapura, Sigiriya, Dambulla and Puttalam which were a striking distance away. Once we went to Sigiriya and Sirry took his gun with him and shot a wild duck. Rhonchi Rajapakse cooked it for us. We still may have lead shots lodged in our appendices to remind us of those happy times of our internship.

The Law-Medical cricket match was the highlight of the year held in the Kurunegala Town Hall. It was similar to what we had in Medical College Colombo, a fun filled programme with a concert ending with a dinner and dance. The funds for the event were collected from the hospital Consultants and the Private Practitioners who, to our eyes, had tremendous wealth. The drinking began at midday and some of us forgot the lines being completely ‘stoned’ during the show. Those acting as angels could hardly stand. Few could remember how it all started but none could recall its end. Many had total amnesia for the whole event start to finish.

The second appointment was surgery with Dr. N. Rasiah.  He had a certain a magnetism and charm and took life and his work easy. (He is now living in retirement in Australia). Dynamic and mercurial  Tudor Wickramaratchie was my colleague. Tudor loved the good life and held his drinks well. His sense of humour and his interesting and provocative ideas made him a joy to work with. Tudor emigrated to the UK and became a Pathologist in Bristol. He passed away in the Golf Course playing the game he loved. The Surgical training was a strenuous six months with many knife injuries. During this period I had to deal with 4 murder cases which were committed to trial in the Supreme Court. Once a woman was brought with a vaginal prolapse bitten by a dog, while she was asleep. The husband had more sympathy for the dog than his dear wife.

Mist Sodi Sal and Carminative formed the bedrock of our treatment. Aspirin tablets were given out like Smarties. Once whilst returning for lunch there was an almighty commotion by the gynae ward. A man in national dress was shaking his fist unable to contain his anger and one of my doctor colleagues was calmly explaining to no avail. It transpired the man was accusing the houseman of stitching the episiotomy too tight. The doctor finally asked the man to mind his own business, which left him rather speechless.

Time moved on swiftly and relentlessly. The colleagues who shared our house had become a close knit family. Despite the hard toil it is the good times that often come to mind. At the end of internship I distinctly remember the sadness I felt saying goodbye, many of whom I never saw again.

Some of us took the advice of Rudyard Kipling “Go West young man”. As Sri Lankan politics was in turmoil and our coffers were empty life for the middle classes became intolerable. There was a mass exodus of doctors to the USA and UK in 1968. I was to remain in Sri Lanka for a further 7 years. My future was decided by politicians in head office and depended on whom I knew and not on my ability. My career development was at a standstill when I decided to join the rest of the herd for greener pastures abroad. Although I had agonised about it I never realised the enormity of that decision. My youthful exuberance protected me from the fear of reality.

I dedicate these memoirs firstly to the many doctors who have walked the long corridors of the General Hospital Kurunegala. Secondly to the simple, kind and generous rural folk of the Vanni who had implicit faith in our powers of healing. Thirdly to the nurses who taught us practical medicine and provided warmth and comfort during those difficult times. I must thank our teachers at Medical College and the Consultants at GHC who taught us the basics so well.

I remember with deep affection all those who shared our lives together and are no more. May they find Eternal Peace.

Senior Hospital Staff - 1967/68

SHS – Dr Kulasiri/Dr Oliver Fernando  MS- Dr Bertie Wijeratne  MO in Charge OPD – Dr Sabapathy

Blood Bank M.O – Dr Aloysius De Silva

Physicians- Dr Parakrama Weerasekera and Dr Miloo Visuvaratnam

Surgeons:  Dr Arumugam and Dr N Rasiah

Anaesthetists: Dr Dharmarajah and Dr Dexter ……

Obstericians: Dr Andrew Perera and Dr Upali Ratnayake

ENT Surgeon: Dr Ana de Soysa  Eye Surgeon Dr Miss Muthukumarana

Paediatrician: Dr C de S Wijesundera

Radiologist : Dr ‘Poosa’ Jayawardene

Medical Officer in Charge of TB Services: Dr John Douglas Seneviratne

I am now living far away from my beloved country and Kurunegala. All that is left is a storehouse of wonderful memories of times gone. Yet in an odd twist of homesickness, what I miss mostly are the people and places I knew in my youth.

 (This is a modified version of an article by the same author that was published in the Sunday Island many  years ago)

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