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Sunday, April 9, 2017

My memories of the General Hospital Colombo and some of its personalities.

By Nihal D. Amerasekera


Kynsey Road entrance (from within GHC) with Koch Clock Tower and Medical Faculty in the background

Kynsey Road entrance from outside




Central Blood Bank - ND's  old workplace 


One of the long corridors, GHC in 2012

Lawn near Merchants Ward in 2012

My first encounter with the General Hospital Colombo was as a patient age 7. Having a tonsillectomy wasn’t a pleasant experience for a child. I have written about it in this blog calling it my ‘Tryst with Destiny’. (http://colombomedgrads1962.blogspot.co.uk/search?q=tryst)

My future experiences with the GHC were much more pleasant. Three of those years (1964-67) were as a student burning the midnight oil and a further 4 years (1970-74) as a doctor. It was much later I had the time to delve into its rich heritage, its glorious past and the colourful personalities that made the institution great.

As I look back I have tremendous affection for the GHC. It was my medical school, university and workshop where I learnt my trade. This note is not only a tribute to my former teachers but is also an appreciation of the efforts of the many who helped to plan and build this magnificent hospital. The General Hospital Colombo will always remain as a permanent monument to all those have worked in this institution since its early days. They all have done it proud.

Colombo’s first modern hospital was established in 1819 in Prince Street Pettah.  The 100 bed hospital soon became overcrowded and the decision was taken to build a new hospital away from the dust and grime of the fast expanding Pettah. In 1864 Governor Henry George Ward set aside a princely sum of £3000 and acquired the land around Longden Place. This area has been a cinnamon plantation since the Dutch occupation. Soon a hospital was built on this site for the people. The government recognised the need for doctors and a Colombo Medical School was established in 1870 in a female surgical ward. This moved to its present home in 1875 helped by the philanthropy of Mudaliyar Samson Rajapakse, who owned the land. De Soysa Lying-in Home was built in 1879 by the donations of a well known philanthropist Sir Charles Henry De Soysa. Lady Havelock Hospital was started in 1885 later named Lady Ridgeway Hospital. Victoria Memorial Eye hospital opened in 1903 with the money donated by Muhandiram N.S. Fernando and the OPD started in 1910. The ‘White House’ is the magnificent building that meets the eye when one enters the GHC through the Kynsey Road entrance. That was the old administration block which was commissioned in 1904. It also housed many wards in the upper floors. The present 5- storey administration complex was built by SWRD Bandaranaike in 1958 and has several wards, operating theatres and sterilisation units. A private home in Ward place was commissioned to become the Dental Institute. The Radiology Department began in the administration block in 1925. Dr. William R. Kynsey was the Principal Civil Medical Officer from 1875 to 1897.  He contributed much towards the Ceylon Medical College in its formative years. In 1900 The long road between the Colombo Cemetery and the GHC was named after Dr Kynsey.

Many of the private wards were built to serve the British. William Henry Figg donated the money to build the Merchants’ Ward which was opened by Governor Manning in 1918. It  was an impressive ornate building with an elegant porch, high ceilings and manually driven lift. This and the Seamens’ ward, Planters’ Ward, Skinner- Gnanasekeram ward and Matapan ward were for private patients. In later years at the east end of the main east-west corridor was the house officers quarters in the old  ‘White House’ and at the west end was the Ragama section of medical wards. Those wards were airy and basic with rattan slats to prevent rain beating in during the monsoon storms. To the north and south of the main corridor were the surgical wards. As I haven’t visited the hospital in nearly 40 years I have used the past tense in my descriptions not knowing how much has changed.

When the GHC had difficulty in recruiting nurses, the government requested the services of the nuns of the order of Franciscan Missionaries of Mary.  They began work in the wards in 1886 and lived in St Peter’s House in view of the ward later managed by Professor Rajasuriya.  The nuns served in the great tradition of Florence Nightingale showing tremendous compassion for the sick and the suffering. They provided excellent care to the patients.  I recall seeing them working all hours in the hospital. Their services were discontinued in 1964. Sadly they made a hurried exit from the island being caught up in the wave of nationalism that swept the country after independence. Since the Nurses Training College was established in 1939 we had our home-grown nurses who were excellent and filled the void with great skill and expertise.

To all medical students of the Colombo faculty, crossing Kynsey road to start clinical work is happiness beyond belief. This brought an end to the ceaseless study of the theoretical basis of medicine, or so we thought. Now we were expected to be civilised as ladies and gentleman. This wasn’t an easy transformation for many. Armed with an Allan and Hanbury stethoscope and a knee hammer I had a spring in my step as I crossed the road to enter the hospital.  Although I hoped that traffic will stop for me to help me save a life I had no such luck!! All through my clinical years I may have covered a few hundred miles on the long corridors that crisscrossed the grounds of the hospital. Friendships were made and firmed during those ceaseless journeys. The images of the buildings, lawns and the hordes of students, doctors and nurses that thronged the corridors are still etched deep in my memory.

After the University of Ceylon was established in 1942 the GHC became its teaching hospital in 1946. We honour its original teaching staff, Professors Milroy Paul, PB Fernando and GAW Wickremasuriya in Surgery, Medicine and Obstetrics and Gynaecology respectively. We owe them a great debt of gratitude.

The 1960’s was the golden era of medical education in Sri Lanka. The visiting physicians and surgeons who served the hospital were clinically some of the best in the world. The orthopaedic surgeon Francis Silva was a Hunterian lecturer, a prestigious award conferred by the Royal College of Surgeons of England. Professor K. Rajasuriya was a Registrar at the Great Ormond Street Hospital in London when very few foreign doctors were allowed in its precincts. The physicians and surgeons took on the task of tutoring students seriously and gave of their best. We benefitted enormously from their clinical skills and teaching. 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.  I was mesmerised by their formidable powers of analysis, mastery of detail and ability to penetrate to the core of a complex problem.

Every medical student maintained a little yellow book of the lectures and appointments they had to complete. There were several 2 month medical and surgical appointments and numerous ward classes where we were taught clinical medical and surgical skills. They were committed to make certain we learnt our trade well before being released on the general public. Many of the clinical visiting staff gave us the impression they were invincible and wielded great power. Their wards were their kingdom which they ruled with an iron fist. It seemed to us they never got on well with each other perhaps due to professional rivalry or their enormous ego. Many never believed in 2nd opinions or took kindly to their diagnoses being questioned. Some of their teaching methods depended on creating an aura of fear. In the process they humiliated students and at times reduced them to tears. Having said all that It would not be fair to judge our former teachers with the attitudes and values of the 21st century. I still have a deep sense of gratitude to all of them.

Darrel 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. It was a sad loss to Sri Lanka and to medical education to see him give up neurosurgery to become a GP in Australia. In the same breath I recall the teaching of George Ratnavale. His teaching and tutorials were master-classes in clinical neurology. The surgeons who constantly deal with blood and guts had a macho image. 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. Dr Austin commanded and demanded respect as if it was his divine right. He took great trouble to teach us well. Dr Anthonis showed kindness to his patients and was such a fine teacher. He was well known for his interesting anecdotes supposedly from real life.  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 humour. He had this great ability to see the funny side of day to day clinical problems. Dr K.G Jayasekera had a fearsome exterior but taught us well. Dr DF De S Gunawardene was a kind man who spoke softly and was a great teacher. I am ever so grateful to the Visiting Physicians of the Ragama section of the GHC for teaching me medicine. Dr Wijenaike, Dr O.R Medonza, Dr D.J Attygalle, Dr Ernie Peiris  and Professors K Rajasuriya and R.P Jayawardene were excellent teachers. Dr Peiris had a subtle and sophisticated sense of humour. Once a pretty girl from my batch presented an interesting clinical case in a rather soft tone and people standing at the rear could hardly hear. Dr Peiris named her whispering pectoriloquy. Many of the clinicians called the students out for  dinner with drinks at the end of the appointments. Those were wonderful and memorable occasions. My first clinical appointment as a medical student was with Dr Thanabalasundrum. In that firmament of shining stars Dr. T  was the one that shone the brightest. In the De Soysa maternity hospital Professor Ranasinghe was a great teacher but had a quick temper. Dr Viswanathan was greatly loved by the students for his friendly manner and excellent tutorials. In the Lady Ridgeway Hospital Professors CC De Silva and Priyani Soysa were excellent teachers as was Dr Stella De Silva. I remember Dr W.J Gomes who took great care to teach us the basics of paediatrics.

The 2-month clinical appointments were invaluable tutorials. In those days the pathological investigations and radiology were pretty basic and much depended on the history taking, clinical observations and examination. Those basic clinical methods we learnt from our teachers. It makes me shudder when I see the 2 line histories on patient’s notes nowadays. Now so much depends on the scans and other investigations when they can get to the diagnosis faster without breaking into a sweat.

Interns, SHO’s and Registrars ran the hospital with the expert advice and supervision of the Visiting clinical staff. Doctors worked from 8am to 12 and 3pm to 5. Interns life was never easy clerking patients and doing the onerous on-call duties. The SHO’s supervised the interns and were 2nd on-call. The registrars were occasionally called in but the Visiting physicians and surgeons were never called after 5pm except perhaps in surgery. The registrars oversaw the work of the juniors and presented the patients to the Visiting physicians and surgeons on ward rounds. All this seemed to proceed seamlessly and like clockwork. The junior doctors lived in the hospital quarters within the GHC or in Violet Cottage or Regent House. It was such great fun living together and being an integral part of the GHC community. Life then was good despite the hard grind. We played cricket in the back garden. There was never a shortage of alcohol and chit chat in the evening and at weekends.

The GHC in those distant days had 3000 beds and at least 500 patients sleeping on corridors on mats and at the far end of the wards. As students we scoured the wards day after day in our endless search for ‘good case’ until we completed the final examination. Whenever there was a ‘good case’ that patient was questioned and prodded endlessly until they got weary and grumpy. The Patients too were a cross section of Sri Lankan society. Some understood our plight and complied. Others were annoyed and refused to take part in the ritual. The majority submitted without question. A few even saw the benefit of a thorough examination done by several would be ‘doctors’.

It is only when one works in the hospital one becomes aware of its soft underbelly. Most of its patients were poor and many were from far away villages. To them hospitals were unknown places synonymous with hopelessness, heartache and suffering. They were fearful of doctors and operations. There were unscrupulous and deceitful people who preyed on these gullible and vulnerable patients and their relatives promising accommodation, better treatment or even help to become private patients to get privileged care. Many were duped into parting with their cash. The undertakers too had their henchmen like vultures riding the thermals and descending on the terminally ill and the bereaved touting for business.

My final fling with the GHC was in 1973/74 when I was a Registrar to Dr U.S Jayawickreme. He took over the ward from Dr W Wijenaike. Dr USJ was a fine clinician and a dignified gentleman. Always immaculately dressed he showed tremendous kindness to his patients and to the staff. In turn he received great loyalty and enormous respect. He showed us how to conduct ourselves calmly and with dignity in the ward. His patients adored him. His work ethic and bedside manner had a tremendous impact on me. That was a fine finale for my clinical years at the GHC.

The General Hospital Colombo became the National Hospital of Sri Lanka in 1995. It now serves the people from cradle to grave. With a compassionate and caring staff and its fascinating history it will always remain at the forefront of healthcare in Sri Lanka and close to my heart for evermore.

27 comments:

  1. Lucky
    Thank you for those lovely photos, a reminder of times past. I haven't been to the GHC since 2012.
    Nihal

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  2. Those of you who have not been there since 2012 will not recognise the place now. So many high rise buildings have come up and every available space has been utilised. Some may say that it is a concrete jungle. But those long corridors and the Ragama Section row of wards didn't look that good either.

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  3. That was certainly a trip down memory lane! I learnt a lot about the history of hospitals and related Institutions in the process. ND covered so many areas and the written journey was illustrated without illustrations as memories were kindled as I moved on. I think my own very first memory of the GH was when I visited an uncle of mine. I still remember that particular smell that always reminded me of medicines and injections, and of course the nurses. On my recent visit to Sri Lanka I was again struck by the fact that the nurses uniform hasn’t changed. I may be old fashioned but I do think our nurses do look so elegant and professional in their uniforms. In these days of change, sometimes for the sake of change, it is quite a mystery as to why the uniform escaped change.

    ND has given a fairly comprehensive account of our teachers and there have been many previous articles in our Blog about them. They were a fine lot and the only “weakness” that they had when teaching us, and one has to view it in context as context is a vital ingredient we tend to ignore, is that they never spoke about the caring aspect of our profession, although some did so indirectly by example. For example, communication skills were unheard of and respecting individuals, empathising with patients and their families were just never discussed.

    The endless pursuit of “interesting cases” is also something I remember well. We used to hunt in gangs and although looking back, those poor souls must have suffered, we learnt such a lot. I doubt whether any modern day medical student would see so much rich clinical material.

    One more phenomenon we never saw when we came to the UK, were “floor cases”. There was a definite social order here and a labourer (as we called them) would readily exchange his bed for a mat, with a “mahattaya”. Sometimes the exchange was made worthwhile by the intermediary “Attendant”, usually dressed in a kind of white pinafore, sarong and very likely with the red gums and teeth of a habitual betel chewer.

    I fully agree with ND that we owe an eternal debt of gratitude to the GHC, all our Teachers, our patients, our nurses and other health care colleagues and to the system of Free Education started by the great C W W Kanangara, our First Minister of Education in the State Council, rightly called the Father of Free Education. I am not a Patriot as I don’t believe in any kind of boundaries between human beings, be they sexuality, ethnicity, religion, social status or country of birth. I am a proud citizen of the World but also very grateful to my Motherland for all the opportunities she have me and I do what I can in recognition… but, I will never kill for my Country

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    1. Mahendra
      Thank you for the contribution. Yes there wasn't any direct teaching about the psycho social aspects and about how the patients will cope at home.

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    2. Unusually brief comment ND.Hope you were not put off by my provcative statements!

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    3. They were not provacative at all but facts which I accept. There are so many facets to every story. My story is more than 2000 words and didn't want to expand it further. Just allowed others to embellish it.

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  4. We all feel a deep gratitude to our motherland. I have now lived longer in the UK than in Sri Lanka and UK is my home. It has given me a rewarding professional career and a peaceful retirement. The land of my birth and of my forefathers will always have a special place in my heart.

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  5. I say "Amen" to thayt. I was quoting Horace ( I am pretty sure) who said "I would not kill for my Country, but will will die for it".("Pro patria mea non interficiam, sed pro ea moriar.").I was mischievous and omitted the second part!

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  6. Dear Nihal, sorry I am a few days late, as always, but here I am at last to say thanks for sharing your golden memories with us. I admire your phenomenal memory, your writing brings back pictures in our minds of our own corresponding experiences and your vocabulary adds colour. Thanks again and GIVE US MORE! Zita

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  7. Thank you Zita. Always a kind and generous comment from you to boost our morale. Your input is indispensable on this blog

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  8. Nihal, Thankyou for this fine treatise on the GHC and its personalities.
    Packed with the history of an an institution which was so much a part of what we are today, with reminiscences of the factual eccentricities and accomplishments of our mentors,
    written with empathy, appreciation,and humour-it is a great read.
    The photos add to the nostalgia !
    Thank you

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  9. Rohini
    Thank you for the comment. Glad you like it. There are so many memories which are slowly disappearing. We look forward to your contributions

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  10. Thank you ND for the well researched article about GHC/ NHSL.
    Prof GAW Wickramasuriya was the first Ceylonese Professor of Gyn & Obs but he died in his early forties due to renal failure before he assumed duties. He was the father of Dr. Kamalika Abeyratne and the father-in-law of Dr. Michael Abeyratne. Tissa Wicramasuriya is a nephew of his.. He was a cousin of my mother and he delivered me in Ward 3 of DMH on the 30th of December 1942.. In 1975 Prof GAWW's family offered a prize for research in Paediatrics and Gyn.&Obs. and I shared the prize with Professor Ratnam, a Sri Lankan expat working in Singapore. We were the first winners of that prize.
    Sanath

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  11. Sanath
    Thank you for those real life additions to the history of the GHC and the interesting anecdotes. I do appreciate your time and effort in keeping this blog alive.
    I am reliably informed that many in our batch read the blog and don't interact for various reasons. I do respect their choice. But I would urge that 'Silent Majority' to please help keep this forum alive. This is our own Forum. We have this narrow window of opportunity to keep in touch before into the dust we depart. Whenever possible do acknowledge our efforts and share your views and much valued opinion. Writing to this forum sometimes is like whistling in the wind when it is lost in the vastness of space and time. It certainly makes me sad that so few use this most remarkable forum maintained with such great expertise by Lucky. Thank you is not a big enough word to express my gratitude.

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  12. Thank you ND for that trip down memory lane. Very interesting indeed.As medical students we respected our teachers, most of whom were wonderful teachers & good people as well as good clinicians. Come to think of it they were teaching us free of charge. I have kept that in mind always in teaching medical students as well as physician residents as they are called in the USA, be kind to them, inspire and inform . They are after all human beings in the learning stream.

    Thanks for the effort in recalling all those historical facts.

    Great write up as always.

    ia

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  13. Indra
    Thank you for taking the trouble to comment
    Teaching students is a privilege and a pleasure. Teachers must know learning isn't always easy. For us Asians respect and gratitude for teachers is in our DNA but for westerners that is something that has to be earned. There is much to be said for the latter. In my writing I have been critical of those who created that aura of fear but in my humble opinion feel all of my teachers had our welfare in mind. There have been times when that has been called into question but I will give them the benefit of the doubt with the wisdom of having lived much of my life.
    It will be interesting to get further views from our wise and well informed readers on teaching and learning.

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  14. Methods of teaching are variable. I like to relate appropriate anecdotes during teaching so as to capture the attention of the students,. That helps to avoid boredom. I also actively encourage students to be inter-active during teaching.
    Sanath

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  15. Sanath
    I have listened to a couple of your lectures/talks online. You made them interesting and informative. The anecdotes and the humour made them lively. The delivery was a masterclass. I wonder if it is a requirement that University staff get training on how to teach or to have a diploma in education.

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  16. Nihal,
    I am self taught regarding this matter. Most Faculties of Medicine have Departments of Medical Education and there are specialists in this field. The University of Colombo has a staff development centre and all members of the University have a training at this centre,which is mandatory.
    Sanath

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  17. Thank you Sanath for that information. Our University has always been rated highly and its graduates have been competent and have competed well abroad. It is great to know medical education is in good hands.

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  18. With an in-house Dept of Medical Education I take it that the aura of fear doesn't exist anymore and there is better rapport between teachers and students. I presume the climate in the wards too have changed for the better. We certainly had some big egos in our time but it was the golden era of medical education. That was 50+ years ago when the culture, attitudes and ethos were different. Fear that was ever present was upsetting at times but left no permanent scars.

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  19. Nihal, Thank you for your excellent article, full of historical facts and tributes to those who taught us very valuable skills in taking histories, making observations and eliciting clinical signs. I think our clinical training was exemplary. I don't think that one can complete one's medical knowledge and training in five or six years. It is a lifelong process, keeping up with new information and technology. I think a good teacher should be able to instill that love of learning in a student. One of the main criticisms I have of our teachers is that some of them expected us to memorize and regurgitate their lectures. I still remember learning Ob Gyn one way for "Ranaya" and another way for "Sinna" which gave me a major headache! And yes, there were the over-inflated egos to contend with, but thankfully not everyone was like that. I also remember how "Viswa" assigned separate assignments for each student in his group, during our clinical rotation in his ward. We had to research a topic and present it to the group. That was a far more interesting way to learn. To this day I have not forgotten the risks of an "Elderly Primigravida." As for the General Hospital, or National Hospital as it is now known, there is a brand new Neurosurgical Unit with a helipad on the roof. I've walked past the Dental Institute, which has been rebuilt and looks quite grand. I suppose some of the old buildings are still the same. Thank you again, Nihal, for this trip down memory lane. You are good at that!

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    1. Sriani
      Thank you for your kind comments. Five years when one is 20 is a long time. Although inevitable I am saddened by the physical changes to the buildings and not being able to see it as it was. I suppose living abroad and not seeing it happen gradually the suddenness of the change is upsetting but that's progress. Sriani, do write your memories too when you can.

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  20. Very astute observations by Srianee. The statement about Life long learning is so true. Regarding instilling enthusiasm, I consider Oliver Pieris, Viswa, Wijenaike, George Ratnavale and I am sure many others if I think about it more, as outstanding. To me, the main weakness was the neglect of the psycho-social elements of Medicine which are so important. We were so fortunate to have had such great inspirational teachers and to be exposed to such rich clinical material (euphemism for patients!) and of course not forgetting the wonderful colleagues with whom we shared "the Good,Bad and the Ugly"! Good to see you back on the blog Srianee!

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    1. Thank you ND and Mahen. Hope to keep contributing my "two cents" from time to time. See you around!

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  21. Add to the list of GREAT CLINICAL TEACHERS, Stella de Silva, Darrel Weinman,R.S. Thanabalasunderam ( I never was with him, but those who were lucky rave about his teaching). Then there was J.R. Wilson , who was much more recent in his thinking- something I saw when I came to NYC.. I was already out of med. school, but I met him several times & realized he was current in his treatment outlook.

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  22. Don,t you all think we had too much of the0ry and less of practical knowledge.Some of our colleagues passed in Gyn&Obs
    without having done a single PV.How many of us were thought to suture a wound during our clinical work.Mostly clerking&taking bullshit histories.Sam

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