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Saturday, July 25, 2015

The Bad old days of Psychological Vandalism

By Nihal D Amerasekera 

My first introduction to the Medical Faculty was on registration day. It started with virtual ‘road blocks’ by seniors to round up the freshers. This was the beginning of the rag to usher in the new recruits and introduce them to a new brand of nastiness, a tradition that has prevailed since the very beginning of the institution. This infamous ritual has become more outrageous with time.  This kind of harassment went on for a further fortnight after we joined.  What an introduction to a supposed sanctuary of like minded scholars!!  As I look back this behavior was accepted by many of the staff in the Faculty and it was even encouraged by some of them.  It is the responsibility of the Vice Chancellor to stamp out ragging unless he too condoned it. Ragging has caused the death of students at Peradeniya University. I hope it is not a part of the faculty calendar anymore. I admire the stance taken by Buddhadasa Bhodinayake who stood up to those bullies and took no part in this pointless ritual. We should move to a system available in most British universities where there is a freshers week. During this time there is an organized period of induction by the management and the senior students help the newcomers to settle in.  

Although I loved the study of anatomy, life in the Block was a nightmare. There was this need to learn the subject in such great detail which when we look back now was totally and utterly pointless. Thankfully Dr Leicester Jayawardene was reasonable. The rest persisted in making the weekly signatures a stressful ordeal. Some tutors even enjoyed the humiliation they caused the hapless students who sat in a circle. They were  surrounded by their peers waiting to grab any pearls of wisdom or to laugh at their mistakes. There was much giggling at the  sarcastic comments by the tutors. That was indeed the circle of death. Physiology and Biochemistry were taught and administered well.  The only time I flinched was when ‘Prick’ Perera jabbed my finger for a full blood count. Prof Koch, Prof Hoover  and  Carlo Fonseka helped to bring some sanity onto an otherwise manic two years. 

As we moved on to the 3rd and 4th years we gained confidence.  The 3rd year without examinations was a shelter from the turmoil and strife around me.  During our holidays Nalin Nanayakkara and I went on a motor cycle journey to the central hills on his impressive red Moto Guzzi. It was a most memorable journey that will remain with me forever. 

After the Block the  subjects we studied seem more relevant. Prof GH Cooray, Prof HVJ Fernando, Prof Kottegoda, Prof.  Chapman, Prof Abhayaratne and Prof Dissanayake were great teachers who treated the students as human beings. I admire them greatly and remember them with much affection. 

In the 3rd year we started clinical work with the stethoscopes round our necks. Whether we needed them or not it never left our collar. My first clinical appointment was with Dr Thanabalasunderam. He was a superb teacher and one of the best. He made us work hard and taught us well. His fine approach to clinical problems and their solutions has remained with me ever since. I am ever so grateful to the Visiting Physicians of the Ragama section of the GHC for teaching me medicine. Dr Wijenaike, Dr Medonza, Dr DJ Attygalle, Dr Ernie Peiris were excellent teachers. Despite their busy schedule of ward rounds, clinics and private practice they found time to teach us clinical methods. They took great trouble to find interesting patients with multiple  clinical problems. Their efforts bore fruit as many of their students went on to be Consultants in various fields of medicine with great distinction, both at home and abroad. 

The surgeons who constantly deal with blood and guts had a macho image. Of the surgeons Dr Austin commanded and demanded respect. Once he was most annoyed I didn’t stand up when he walked passed me near the operating theatre. I really thought he would assault me as he raised me up by my shirt collar with my feet dangling in the air. Need I say more about such behaviour.  He was a good teacher. Dr Anthonis showed great kindness to his patients and taught his students well. Dr Niles had a volatile temper towards his patients but was kind to us all and was a fine tutor. His clinical classes were full of humor and always a good laugh. He had this great ability to see the funny side of day to day clinical problems. It was like being at a comedy show. Darrell Weinman, the neurosurgeon, was a superb teacher. He had a special room for his ward classes which was always full to capacity. He was a showman ‘par excellence’ and taught us the whole process from history taking to examination, diagnosis and treatment  with great aplomb. He was a kind man. I will not forget the concern he had for his patients. 

Our Clinical Professors were good clinicians. They were committed to make certain we learnt our trade well before being released on the general public. Some of their teaching methods were archaic and depended on creating an aura of fear. In the process they humiliated students and at times reduced them to tears. This was totally and utterly repulsive and unacceptable.  The total of 4 months I clerked with The Professors of Medicine and Obstetrics may have reduced my life span by a good 4 years. The insults were relentless and damaging.  There are many anecdotes and sordid stories  which I will not relate as so many years have now passed and those culpable are not alive to defend themselves.  Some say they would never have studied without this strict regime – now that is what I call “Bull Shit”. Prof Navaratne, was a notable exception. He was a kind person and never showed anger to his students. We were never terrorized or intimidated by him or his department.  Didn’t we study surgery to pass the exams?? 

All through the 5 years in medical school  there was this aura of fear that pervaded the corridors, wards and lecture theatres. Such an atmosphere of terror  was created by a small minority of teaching staff. It amounts to bullying and psychological vandalism. This should not be tolerated in any institution. I am reliably informed this still goes on in the faculty in Colombo.  It is sad this  culture of bullying is not abating despite the passage of years. This is the responsibility of the Dean of the faculty to stamp out unacceptable behavior by his/her staff. Bullying was not recognized as a problem in the Faculty during my time.  Those who were bullied had no one to turn to hence  were unable to speak of their ordeal. We felt nothing would be done about it even if we complained.  There was always the distinct possibility of victimisation. In their fields, both professors were extremely clever and able doctors. But they needed to be taught how to teach and influence students. Bullying in Universities is a recognised problem worldwide and it requires the Institution to take necessary action.  Mostly it is the hierarchical nature of the environment to blame. Both the staff and the students have to be educated how to prevent and how to bring it to the attention of the authorities. 

To me personally the stress that prevailed was unbearable and took its toll. Bullying destroys morale. I was at my wits end not knowing how to cope with this constant battering on a daily basis.  I seldom spoke about my inner feelings. It wasn’t something I could discuss with my friends or even my parents. The result was  anxiety, distress and the loss of confidence in my own ability which lasted all through my years in medical school. I was reticent while presenting cases in the ward and at examinations where I performed poorly. It was when I emigrated to the UK that I regained my confidence as my bosses treated me with kindness and respect. They appreciated my hard work. Thankfully I was able to have a rewarding career in Radiology. 

The nightmare that began as I started in the Block ended the day I passed the finals in June 1967. The relief was almost palpable. I still look back on those years with trepidation but harbor no grudges. I sincerely hope things would change for the better.  

I lament that in real life, unlike fairytales, stories do not always have happy endings. Thankfully, I have not been scarred for life for those traumatic five years in medical school.  We were all in it together. Some withstood the pressures much better than others. What stood me in good stead was the camaraderie that existed and the friendships that I made during those grueling years. So much time has passed that I can now maintain an emotional distance from the turmoil of the past.

11 comments:

  1. A thoroughly honest recount of some unpleasant aspects of the life of a Medical student mingled with some positive and pleasant experiences. I share ND's views on ragging which I too described as torture in one of my posts. It has no place in a civilised society. I must admit that although I relate to the uncomfortable atmosphere that ND describes, my recollection of that period is not that bad. The hierarchical attitudes that prevailed were not just limited to the Faculty but to Sri Lankan Society in general and I am told that it is still far from absent, or to put it more simply, is still present, although thankfully, to a lesser degree. When I visit SL, I am reminded by friends and relatives of how patients are actively discouraged from asking questions from the Consultants although I have to be careful what I say as I run the risk of being ostracised as a "ungrateful deserter finding fault"! Parents did not encourage questioning their views by children either and this attitude just "went up the ladder". I am sure things must have changed with more liberal view, not just in Sri Lanka but the whole World.

    Yes, the vast majority of our clinical teachers were brilliant and I would pick Dr Wickrema Wijenaike, Dr Ernie Pieris , Dr George Ratnavale, Dr Darell Weinman and Dr Rienzie Pieris as special examples, in my book at least.

    Just a little anecdote about Dr PR Anthonis living upto his name. During a ward class, he was teaching us on the technique of PR examination for an enlarged prostate on a hapless patient who had to endure at least 10 fingers "up his.." as each was asked to do a PR while Dr Anthonis told the hapless patient, "Lokko, may dostorala akin eke, poddak tel ganawa amaruwa thiyana thanata".

    A word about Dr Lester Jayawardena. I am fairly certain he was Lester and not "Leicester" as ND says, but I may be wrong.


    On the whole, I mostly enjoyed my period at the Faculty with the exception being the time of the rag which still brings all the negative emotions that ND describes. But like ND, my confidence in myself and ability to speak up without fear developed fully only after I came to the UK, where I was fortunate enough to have enjoyed a good career prior to retirement.

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  2. How I wish some of our colleagues would also contribute with their experiences. Come on now!!..... come on!!!!........

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  3. Mahen
    You are without doubt one of the finest products of our time in the Faculty. There are others who got more distinctions but as an overall person and human being you are streets ahead of everyone I know. I accept your take on the issues I raised. Some coped far better than others. We are also talking about the ethos in the faculty 50+ years ago. So I too have to be careful not to judge our teachers too harshly. But from where I sit now this is exactly how I feel.
    ND

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  4. My career blossomed in the UK where people are treated on merit and with respect. Hence I had the privilege to work in 2 of the best teaching hospitals in London as Registrar and Senior Registrar. I could never have dreamed of the successful career I have had as a hospital Consultant in the UK if I remained back at home. I still feel deep gratitude for my life in Sri Lanka and the happy childhood amidst my own people. As for my career my loyalties lie with my adopted country. They gave me back my confidence which I had all through my years at school which was sadly taken away from me in the Faculty. All is well that ends well!!
    ND

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  5. "Tout est bien qui finit bien" !
    I like happy endings although happily, this is not the NDing!

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  6. ND,
    Thank you for a forthright view to which I too can relate to as well & empathise with you to the goings on during our stint at Med School.
    My feelings and sentiments are mutual.
    Shall elaborate a tad further in a day or two!!!
    Razaque.

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  7. Razaque
    Thank you for your honesty and courage. Your words say it all. The bullying was done openly for all to see. It was disgraceful behaviour by people who should have known better.
    ND

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  8. In the 20th century and before priests and teachers were respected unconditionally. That is not the case anymore and quite rightly so. They have to earn their respect. The same applies to the teaching staff in the Faculty of medicine. Many of them earned and received tremendous respect and deservedly so. A few fell well short. Although I was greatly tempted to name and shame them I have resisted so far. It suffices to say I have nothing but contempt for them. For several decades they made life hell for many students and many suffered in silence. Some may feel It is far easier to get on with life without 'rattling the cage'. But I find it cathartic to get it off my chest.
    ND

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  9. Have to agree with you . You hit the nail right on the head. There is no place for such behaviour on the part of the teaching staff. Stuff gets into ones head a lot better & quickly without the threat of verbal abuse. Luckily no one was driven to suicide.
    Interestingly years ago one of my daughters and son in law did a few weeks of clinicals in LRH. They hailed from one of the prestigious undergraduate & later med. schools in the USA . The consultant tried his best to bait them- you Amercan med. students see if you know the answer ... well they did answer most of his questions. Totally unnecessary.
    Some students end up not faring well because of the abuse likely to be heaped- fear to open their mouths & talk.

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  10. This last post is from Indra Anandasabapathy, I forgot to add my name. Will get used to it.

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  11. Indra
    Thank you for your comment and support for my point of view. The verbal abuse, acerbic comments and the aura of fear was totally and utterly unnecessary
    ND

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