Monday, February 1, 2021

Destiny of a Village Vedarala's Nephew

 DESTINY OF A VILLAGE VEDARALA’S NEPHEW.

By Appu Sumathipala 

At the end of five arduous years in the Colombo Medical Faculty, my Final year exam results were mediocre and were not to my expectations. ”Gods” were not on my side, perhaps, as I did not perform vows nor feared” GOD”! 

I opted for Ratnapura as my first choice for internship, although I could have stayed in Colombo. The beginning of my happy days dawned. After finishing the Intern period at Ratnapura, I was posted as MO OPD Anuradhapura. As time passed, the thought of doing higher exams appeared in my mind. I went to see Prof Raj, then DHS with the hope of getting a transfer to a station closer to Colombo. He was a bit sarcastic and promised nothing in the end. 

At the end of two and a half years and the arrival of coming-vacancies lists, I applied for one in Matara as it gave the appearance of being a MO post. The post given to me, however, turned out to be MO PU, Kaburupitiya. I was really upset and wanted to hit back hard at the Head Office and I wrote a letter of protest addressed to Prof Raj stating that I was a grade two Medical Officer and I should not be posted as MO PU. 

In the end, what I got was the post of DMO at Deniyaya. When I reported for duty, I found out that I was to replace Dr Dharmasekera (Ex-Anatomy demo). 

Life as a DMO was not rosy and was full of thorns such as the JVP Insurrection, a drunkard Apothecary-who consumed methylated spirit (stolen from the drug stores) like nectar. In addition, there were false petitions alleging that I accepted money and that I was a JVP supporter. The rumours had already spread like wildfire as far as Colombo. I heard about it when I attended High Courts in Kurunegala as a witness to a murder case, where I met Dr WDL Fernando. He offered me a lift back to Colombo in his Benz and related the story he heard, which I strongly denied. 

As things were getting worse following the aftermath of the Insurrection, I decided to drop in at the Head Office and interview the Permanent Secretary .He was an ex-GP and a friend of Mr Felix Dias Bandaranaike. He was kind-hearted and listened to my story. I was offered a transfer out of Deniyaya and the only two places vacant were Rakwana and Deraniyagala. I opted for Rakwana as it was the next DMO station to Deniyaya. I was sent to report on the situation in Deniyaya to Mr Dissanayake (Sriani’s Dad), who was the coordinating Officer. He was a kind-hearted Officer, who refused to take part in the failed Coup, where his own brother CC Dissanayake was involved. 

When I had finished about two years in Rakwana, a message arrived at the SHS Office Ratnapura requesting me to be released for MOH Training. I never asked for it, but knew that it was my imminent destiny. The SHS, initially, did not want to release me but within days another telegram arrived insisting on my release with immediate effect. When I reported for training at Nagoda, I was about a couple of days behind and had to do some catch-up work. At the end of the training, I was posted to Hambantota. 

A good friend of mine, two years senior, heard about my transfer and tried his best to get me in his place at Ambalangoda. He was finishing his term of office and planned to meet the local MP, Mr LC de Silva. He promised to do his best but failed as Ambalangoda was reserved for a Minister’s favourite. The Minister of Health was Mrs Siva Obeysekera. Hambantota at that time was a small town administered by a Town Council and there were no houses for rent. 

With the greatest difficulty, a house was found 28 miles away in Tangalle. I had to commute 6 days of the week by public transport and the work was tedious as paying and supervising anti-Malaria workers were a part of my duties. Handling of money is a risky job and one day I failed to lock the safe and my clerk had entered the office room and had stolen around Rs 500.00. I had to replace the money immediately as there was a risk of me being accused as the person responsible during a surprise audit check. That clerk was an alcohol addict and had French leave on several occasions, as a result of his drunkard state. 

At the end of two and a half years, the Anti-VD Campaign Superintendent paid a visit and asked me whether I was willing to start a part-time clinic in Hambantota. I was pleased to accept the offer and had a few days of training in Colombo. That opened the door for me to join the Campaign and come to Colombo. 

After a couple of months work in the clinic, I sensed that some of the doctors were not happy with my devotion to patients in need. I presumed that they were tired of the monotony of work and the fact that none of them had the MRCP. With DPH and MPH, they were only considered as Part-Specialists. Dr Ratnatunge had his MRCP and he was the only one in the Speciality to hold that Diploma. It was a dead-end and I was getting frustrated and decided to resign and migrate to the UK. Going anywhere else was hindered by the lack of ECFMG. 

Getting my resignation was a nightmare as a quota system was in force at the time. The minimum requirement was five years’ service. I had almost 10 yrs service and the letter of release was issued sometime in January 1977. At that time I was a Part-time GP for Dr Ranjith Attapattu at Tangalle. He was busy with politics and wanted a helping hand to one partner already in place. My clinical attachment was to begin in April 1977. 

I landed in London on 1st April 1977 and to my surprise, the friend who was supposed to meet me was missing. I started to panic and had no coins to dial him. A fellow traveller came to my rescue and used his own coins to contact my friend. But as his telephone was out of order I tried the other friend. I was lucky as he answered my call but his car was in the garage. He promised to see me as soon as the car was ready. I had only £5.00 in hand and there was no way of getting to Sheffield for my attachment. As promised, my friend turned up a couple of hours later and took me home. The next day, my first friend was available on the phone and I travelled by train and met him at his quarters. He was a batchmate and was helpful in lending me pocket money to survive until I received the allowance from the hospital, during the period of attachment. 

Finding a hospital job was not easy without experience in the UK and this applied to a lot of foreign doctors unless they have come on Fellowships. 

I had experience in VD and this made it easier to get jobs. But that did not help in the pursuit of General Medical jobs. I also obtained training in Dermatology and Family Planning, which helped me to earn a decent living. 

Working as a locum GP helped me to gain the necessary requirements to be registered as a GP (Primary Care Physician). 

I thoroughly enjoyed the work which involved providing Dermatology Services to a local GP during the Fund holding era. As a part of a GP’s work, I was entrusted with minor surgical procedures, such as excision of “lumps and bumps” and administering intra-articular injections. 

After retirement, I enjoy gardening, doing long walks and reading books. During winter my gardening and the usual walks became restricted. 

I do hope that this saga is not going to be boring for our readers   

25 comments:

  1. Hi Sumathi, your Saga was not boring at all! It was interesting to read and I can relate to some of your experiences. I'm sorry that your post-internship professional life in Sri Lanka was so traumatic, especially during the JVP uprising. I am not surprised that you were groundlessly accused of supporting the JVP. That sort of thing was prevalent in the outstation hospitals. I have similar stories during our time in Karawanella. We had a corrupt DMO (very much senior to us) who had a cozy relationship with the UNP MP in the area. His opponent was a prominent LSSP politician. We had a red Austin Mini and there were rumors flying that we were leftists! Someone said that Dr. Dias (the other Dr. Dias!) was seen tearing a UNP poster off a wall! All because we didn't obediently follow all the corrupt DMO's directives! It is a long story, and that was the backdrop which led to our decision to leave Sri Lanka. If we had remained in Karawanella during the JVP uprising we would undoubtedly have been labeled 'JVP supporters.'
    All this is behind us now and I hope that you are enjoying your retirement.

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  2. Thanks.Srianee,for your comments.We were the victims of that bad old corrupt and inherent cultures of your beloved Motherland.
    I must mention that Dr Ratnatunge was no longer at the VD clinic during my time.He was a great techer who taught us the basic principles of inspect and palpate.We were made to inspect and palpate the chancres,barehand.That helped us to get the feel of the chancre-firm,non tender and was able to lift off the base like a button.Those chancres were non tender,unless secondarily infected.

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  3. Far from being uninteresting, I must say that I am very interested in this type of writing.

    I regret very much that I did not get to know Sumathi more closely during our student days, mainly due to alphabetical reasons! More so because he was in neighbouring Deniyaya when I was in Matara in the early seventies. Since I received a long handwritten letter from him more recently, I have got to know him better. But being so far away has prevented us from getting closer to each other.

    All what I can say right now is that he deserved a better deal in life. That I think is the best way to sum up in a nutshell.

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  4. Thank you,Lucky.It was certainly true that you came to know me better in later life.
    I remember meeting you after graduation and you told me that you opted for a less popular Speciaslity-Public health.You were attached to the Family Planning Dept,as far as I remember.You took the correct decision.
    There were so many lost opportunities in entering a career post,during my time in SriLanka.The opportunity was to become a SHO in Obs&Gyn.During my internship with Dr John Karunaratne,I introduced the technique of administering IV instead of IM "Inferon" to anaemic mothers.The results were amazing and John Karu was immpressed.I quote his own words.Sumathipala,"I know that you want to do medicine,but we would like to make you a HO after your internship and train you to be a Obstetrcian&Gyenecologist".The other Consultant was BA Jayaweera,who became the Proffessor at Peradeniya Faculty.He too was keen and gave me his BMJs for me to read.Indra Ananda was my co-HO at the time.I really donot know whether he too was aware of that proposal.I was not in favour of the proposal,purely because,I did not want to get up in the middle of the night.Our own Cassa too felt the same way and rejected General Surgery.On one occasion,I had a mother with a ruptured uterus,in the middle of night.When I rang John Karu,he wanted me to hold on until,morning.I did not to see a death of unborn baby and its mother.I had no other alternative,but to call Dr Jayaweera,who turned up in minutes and performed an emergency Caesarean and save baby and the mother.His remark was that John Karu was a lazy man.With respect to John Karu,I accept fully that he was a lazy man in that sense,However,he was a very influential man,having been a son of EX-Professor of Bacteriology.His wife and WAS's wives were MOHs at Ratnapura.Next opportunity that I missed was to become a SHO to Kira de Silva at Anuradhapura General.MS at that time was Dr.Herat,who was undecided in creating a post without permission from Head Office.Kira was happy have me in helping his interns.That was the second opportunity.Lucky,I met Mr Earnest Perera at Matara,during the turbulent period.He came later on to see me and inspect the situation in Deniyaya,I heard that he rose to the rank of IGP.I am sure,you knew him well.My school friend,ASP Iddamalgoda was based at matara at the same time.He was surprised and shocked to see me at Matara police station.
    I am sure his thought were that I was taken to custody as a JVP supporter.

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    1. Ernest Perera (he was SP at that time) and his wife Enid were very good friends of ours. He resided close to Battaramulla at the time he passed away.

      Like you, he too had set backs in life. He had just gone to Malaysia as the High Commissioner but was recalled by the new SLFP Govt (Government had changed while he was away) even before his bags were unpacked.

      On another topic, you probably knew ADT Maithripala (Medical Laboratory Technologist) who was doing part time work at Dr. Kasturiratne's clinic at Maharagama where I used to be Dr. K's regular Locum when I was attached to the Health Education Bureau. I used to give Maithri a lift in my car to Kohuwela junction on most days. He used to talk about Iddamalgoda of the Police whom he had known from his Sri Palee College days. I knew Maithri from the time I was at the Central VD Clinic, but lost touch with him when I went to the US for the first time in 1974.

      Iddalmalgoda's doctor daughter was working with JC F'do at Asiri Central Hospital, but didn't like her very much.

      I got to know Prof. Bennet Jayaweera in New Delhi where he was with the WHO. Those days, I used to visit Delhi quite often. Bennet's wife Sumitra was living in Battaramulla after retirement and passed away a few years ago.

      Kira must be Dr. KS de Silva who gave us a few lectures as RP (when we were 2nd MB students), GHC before he was posted to A'pura. His nephew Kingsley Kurukulasuriya was a classmate of mine at Ananda in the UE class.

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    2. Hi,Lucky,poor Ernest Perera lost the High Commissioner's post as a result of been a Christian.
      Mr.SA Mairipala,was known to all Sivalians as Maitri-shortened version.When I took up the post in the VD Clinic,I did not have a descent place to live and he provided food and logings until I left the clinic.He was the first cousin of Prof K Dharmadasa.He told me about his spare-time work at Kasturi's surgery.He was in London on short-term Fellowships and on one occasion,he visited us.I knew about his demise,a few years ago.
      Iddamalgoda was popular among the Ratnapura crowd and he was senior to me and several yrs junior at Sivali(Gaga laga Iskole)We had the Primary and the Secondary about a mile apart at the bank of Kaluganga.There had been lack of Science teachers all throughout,when compared with Colleges by the sea.Children from "Rich&Famous"families ended at famous schools in and around Colombo.By the way,Iddamalgoda visited us at Birmingham,during a short-term Fellowship in Birmingham.He was DIG Traffic,during that time.He went into gem business,after his retirement.
      Bennet sacrificed his Professorship in order to join WHO.I presume WHO posts are hightly recognised throught the world.It was Dr KS de Silva,well known as Kira among the Medical fraternity.He was appointed during halfway in my post at Anuradhapura.I followed his ward rounds during my spare-time.

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  5. Hi Sumathi
    I read with great interest your post which was very honest and certainly not boring.I was very impressed with your pioneering work in introducing total dose iron infusion in Ratnapura,very convenient and more effective for the patient,convenient for the staff too.I remember at the start there was concern about nasty side effects to the infusions and reluctance to use this regimen.I think John Karu's father was Prof of Pathology,I maybe wrong.
    Sorry to hear of your missed opportunities, the rub of the green did not go your way.Judging by some of the comments you have posted on the Blog,of clinical relevance, you had the capability and dedication to have been a good,caring Visiting Physician.

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  6. Thank you,Bora
    Prof Karuaratne had done reaserch and I have read a joint paper by Cameraon&Karunaratne.a very long time ago.I am certain that Bacteriology was under the realm of Pathology,until a seperate Chair was created for Bacteriology.Similarly Biochemistry&Pharmacology was under one Department.
    I would like to hear from Prof Lama about the history of the ramification of the different Faculties in our beloved Almar Mater

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  7. Sumathy
    What a story of battles won and lost. How elegantly written without rancour or real bitterness. From the many stories I have heard this indeed has been the experience of many doctors of our era of transfers and jobs being a part of the Health Dept lottery and also whom you know. Perhaps things are better now.
    What matters now above all else is that you have had a successful career as a respected GP in the posh part of the 2nd largest city in UK, Birmingham. Your children have grown up to be useful citizens of this wonderful world and you have grandchildren whom you can love and spoil them to bits.
    Enjoy your retirement. Hopefully when the Covid saga ends we can meet up in Birmingham or at our London Reunions. Take care and stay safe. My best wishes to Latha
    Please write about life and experiences which I'm sure you have many. We would love to hear from you.

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  8. Thanks, Nihal, you are one of my motivators.

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  9. Sumathi, I must echo what Nihal has said. By any yardstick, your life has been a success, both personally and professionally. If we look at our careers, we have all come to cross-roads and either by choice or circumstance, gone one way or another. What you have achieved is something you should be proud of. If I may say so, I do detect just a touch of sadness on further heights you could have reached but I implore you to cast those thoughts and think of the present. You are great son, a father, a husband, a doctor and above all a good human being. What more could one ask for! All the best and I wish you well.

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  10. Sumathi and others,I fully endorse what others have mentioned about Sumathi's saga. It was not boring at all.My regret is that I did not serve in a rural area at all!The Permanent Secretary referred to was Weeratunga, who was a GP in Kandy and a strong SLFP supporter. I taught his daughter in Colombo in the 1970s. Later she emigrated to Australia and passed away after developing SLE? Prof Raj was DHS and was not happy to work under a GP!
    John Karunaratne was the son on of Prof K who was the first Ceylonese Professor of Pathology and a former Dean. When we were students, we used to see him coming to the faculty in a huge American sedan car, dressed in a three piece suit, wearing a top hat. He had a beautiful secretary as well! His son-in-law, Jayasundera was the radiologist at the LRH .
    Bennet Jayaweera's brother Chandra was with me at RC;he is an engineer domiciled in Canada. I taught Bennets youngest brothein the Colombo Medical Faculty in the 1970s.Bennet's wife Sumithra was a paediatrician at the LRH.
    When I embarked on an Alaskan cruise few years ago, Hasanthi Iddamalgoda and her daughter Kavya were fellow passengers. Her fist husband was an Ariyaratne, a Sri Lanka airline pilot and a son of AT Ariyaratne of Sarvodaya fame.Hasanthi Iddamalgoda is now the Medical Director at Asiri Medical Hospital.
    When Peradeniya was created the junior professor from Colombo was sent to Peradeniya, as each department had two professors except in paediatrics(CC functioned as the professor for both faculties) Only senior professor to go to Peradeniya was Senaka Bibile and Kottegoda remained in Colombo.Others were;Anatomy-Waas-Colombo and Lester J.-Peradeniya, Biochemistry-Hoole-Colombo and Tommy Wickramanayake-Peradeniya,Physiology-Koch-Colombo and Jansz-Peradeniya. Pathology-Cooray-Colombo and Tennekoon-Peradeniya,Microbiology-Chapman-Colombo and Chubby Arseckkkkkkularatne-Peradeniya,Forensic Medicine-HVJ Fernando-Colombo and Ranasinghe-Peradeniya, Public Health-OER Abhayaratne-Colombo and Malcolm Fernando-Peradeniya, Parasitology-Sivalingam-Colombo and?-Peradeniya,Medicine Rajasuriya-Colombo and Macan Markar-Peradeniya (RP Jayewardene refused to go to Peradeniya and resigned).Gynaecology and Obstetrics-Ranasinghe -Colombo and Sinnethamby-Peradeniya, Surgery-Navaratne-Colombo and Keerthisighe-Peradeniya.
    Sumathi,in the 1970s at the LRH, a patient of mine developed anaphylaxis after an IV infusion of iron and with the greatest difficulty, I saved her. That was the last time I gave iron IV.
    Srianee, when I was the President of the SLMA, I visited Karawanella Hospital for a clinical meeting and was informed that it is the second oldest hospital in Sri Lanka, the oldest being the NHSL.At the Karawanella Hospital, the hospital records were computerised with the help of the local politician. When I visited the Trincomalee Hospital few years earlier ,to deliver a lecture, it's computer records were computerised with the help of a NGO.

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    1. Thanks,Lama for your comprehensive account of the Medical fraternity.I knew you are the only person who has access to medical records in SriLanka.
      I did not elaborate about how I continued to administer IV Inferon.Inferon was added to either added to normal saline or 5% dextrose and infused at at a very slow rate under my supervision.I followed the accepted guidelines of observing first 15 minutes of transfusion.I had two patients with broncho-spasm within minutes and was able to terminate the trasfusion and administer IM 1:1000 adrenaline and IV chlorpheniramine.These drugs were ready in hand and made sure realiable nurses were available to have a close vigil,until the drip was over.I used htis technique in Rakwana as well.We had very severe iron deficient anaemic pregnant mothers who needed to be transferred for blood transfusions.I save the hassal of transfers out of my hospital unless it was beyond my management.
      I am sure parenteral iron is still availabe for IV infusion.

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    2. Sumathi, I remember giving IV Inferon at Ratnapura as well, and I do not remember any adverse outcomes. Allergic reactions are difficult to predict and as you described it was important to be prepared.
      Sanath, my experiences at Karawanella opened my eyes to what was going on in the rural areas. The villagers were lovely and appreciative of our efforts. I'm sorry that you didn't get to work in the 'front lines' that way! Perhaps I will write about my experiences for the blog one of these days.

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    3. Srianne, did you infuse inferon to pregnant mothers & anaemic patients in medical wards?

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  11. Dr.Ratnatunga the VD specialist, taught us at the OPD at GHC.Idrani Williams (Lester Jayewardene's wife) was the other consultant.I remember seeing all types of VDs,chancres, Huthinson's teeth, Moon's molars etc.Channa Ratnatunga is a nephew of his.
    Lester J. spent his sabbatical leave at the Mantivu Isand, in the Eastern Province, looking after a leprosy colony.

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    1. Lama,I remembered a remark that was aimed at Mrs.RP Jayawardene by Prof Raj. Mrs.RP Jayawardene,Parasitologist at MRI.I remember the very words that he uttered."Who is interested in material passed from the back passage of insects".His superiority complex was always displayed.We had a nice gentleman,as Permanent Secretary bt the name Dissanayake,who wore the so called National dress from his days as ACLG(assistant commissoner Local Government) at Ratnapura.(His younger brother was senior to me at Sivali.)
      I interviewed him with regard to a transfer of my wife from Polonnaruwa to Anuradhapura,where I was stationed.Without any hesitation,he told me that her name would appear in the next list of transfers.It happened as promised.

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  12. Thanks for your comments, You were a close friend of mine and had jokes as well.

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  13. Dear Sumathi, I read with interest, sometimes shock but all the time great admiration, your account of your serving the first ten years of your life as a doctor in Sri Lanka and the harrowing details of some of your ordeals makes for grim reading. One reads it with admiration, shock, condolence and a mixture of these as you take us through your sufferings and achievements until you finally left the country to work in the UK. This too was not a bed of roses, as we all know what the first few years are like, until one gets the postgraduate qualifications to go up to more satisfying but nevertheless ‘back-breaking’ but in the end satisfying jobs as this is what we all signed up to when we embarked on our medical studies and careers. Some tread a much harder road and you did that, but no one gets out of it unscathed. Thankyou, for this account. It’s never too late for batchmates to share their experiences now when we can sit back at look at it sometimes with horror but most of the time with a glint of satisfaction. Zita

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    1. Couldn't have put it better Zita. Well said. Well crafted.

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  14. Thanks,Zita,I consider you as a female Mensch.

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  15. Sumathi and everyone,
    Winston Churchill said it well, "Success is not final, failure is not fatal; it is the courage to continue that counts."
    I think we can all pat ourselves on the back a bit, don't you think?

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    1. Spot on! Only death is fatal......or is it? some may say!

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  16. Nice to see you back with a quote from a great man,who defeated the Nazis, Srianne.

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