SPEEDY DIALOGUE SERIES- EPISODE 10.(Instlament V)

SPEEDY DIALOGUE SERIES- EPISODE 10. WITH CHIRASRI JAYAWEERA BANDARA  (Instalment V)

Episode 10 (V) : Chirasri  Jayaweera Bandara (nee Mallawaratchi)

“My achievements in Ophthalmology”

 Speedy: Good to see you again Chira. As agreed, let us talk about your special achievements in Ophthalmology

 Chira: Thank you again Mahendra for giving me this opportunity to talk about some of my achievements.

Speedy: Chira, we all know a lot about you after the previous episodes and how you became such an eminent Ophthalmologist in Sri Lanka. We are all very proud of you. 

Chira: Thank you, Mahendra for your kind words.

.Speedy: OK Chira, after obtaining your qualifications, you came back to Sri Lanka in May 1979 and was appointed   Consultant Eye Surgeon, Kegalle Hospital. When our good friend Cassim got transferred to Eye Hospital from Kandy Hospital, you got a transfer to Kandy Hospital in Oct 1979.

 Chira: That is correct. 

Speedy: And you worked in Kandy for 5 years and came to Eye Hospital Colombo as Consultant Eye Surgeon in Oct 1984 and retired in Feb 2001.             

Chira:  Yes, those were my Consultant posts in Sri Lanka. 

Speedy;  Good. We know that you developed special expertise within Ophthalmology. Tell us more. 

Chira: I went with other Consultants to Hyderabad and Madras to follow workshops on Cataract Phaco emulsification Surgery in 1999. This is the latest technique to remove a cataract by emulsifying the cataract and aspirating it with the Phaco machine. 

Speedy: You also gained more expertise when you had several spells in the UK after you became a Consultant. What is the background to this and when and where did you work?   

Chira: While working in Govt.  Service  we  were  entitled  to  take  6  months overseas  leave  every  5 years. I made use of this and  worked   in  the U.K in the  latter  halves  of  1986,  1992  and  1998.

Going to the U.K helped me to get special experience. For example, in 1986, I learnt the use of the LASER and obtained experience in Laser treatment. At that time Sri Lanka did not have a single Laser machine. When I was the President of the Ophthalmological Society of Ceylon in 1987, I started a Laser fund and organised several fundraising programmes. 

And also working in UK in 1992 and 1998 as a Locum Consultant I gained experience with more modern and advanced instruments and techniques which helped me to purchase certain items and improve my techniques in Sri Lanka. 

Speedy: I can see how you made good use of these overseas opportunities to gain specialist experience in Ophthalmology.

You indicated to me that the late Dr Sivasubramanium was a special influence in your career. Can you tell us about him and how he helped you?

Chira:  He was a truly great man Mahendra. He was the first Sri Lankan to obtain the FRCS England in 1950 and he is rightly considered the Father of Ophthalmology in Sri Lanka.

Speedy:  I wasn’t aware of that. That is certainly a milestone in your speciality. Did he also think highly of you?

Chira: Yes he did. Dr. Sivasubramaniam used to attend every single meeting and every single Annual Congress of the Ophthalmological Society earlier, and later the College of Ophthalmologists of Sri Lanka after it was formed in 1992. He was the founder President of the College. He was a keen participant and observed the happenings carefully and formed his own opinion.

I received a letter from Dr Sivasubramanium in 1992 when I was in UK. 

Actually it was a very long letter; I have combined the beginning and end. Here it is.                                                

Speedy:   I note he says in this letter that you have impressed him as a dedicated Eye Surgeon and a teacher. That was high praise! No wonder you treasure it.

Chira:  Yes Speedy. I was so thrilled when I received it. 

Speedy: He has also said that you have done miracles and marvels.  Why do you think that he said that?

Chira: I think it was because I have done corneal surgery where others haven’t.

Speedy: You dared to venture into uncharted territory so to speak. So you were a pioneer in that field in Sri Lanka?

Chira:  Yes, I was.

Speedy: Dr Sivasubramanium showed his appreciation by giving you something with, a label pasted on top saying “to a gifted colleague who excels in surgical handicrafts”.                                          

Chira:  Yes, he did. . He gave me his Keratoplasty instruments box with my name written on top and also all his published papers in the British Journal of Ophthalmology, with the note you mentioned pasted outside.                             

Speedy:  You must have been so happy.

Chira:  I couldn’t believe my eyes when I saw it, coming from a great person as Dr Sivasubramaniam.

I treasure it.

Speedy: Leaves us in no doubt on what he thought of you. 

Let us discuss some of your special work in the field of eye surgery. I am not very good on technical terms in your field but you mentioned Keratoplasty. I hope that I got that right.

Chira:  Keratoplasty, Mahendra, is a corneal transplant. It is a surgical procedure to replace part of your cornea with corneal tissue from a cadaveric donor. I have done Penetrating (full thickness) keratoplasties (PKP) on  Hypopyon (pus in the anterior chamber) ulcers.

Speedy: Sounds very complicated Chira!

Chira:   Not really, once you get trained and acquire the necessary skills.

At that time no one dared to do a P.K.P. on a Corneal Ulcer with pus in the anterior chamber. I took up the challenge and did 35 PKP on such eyes and read a paper in 1989 at the Ophthalmological Society Congress. Dr Sivasubramaniam who was present said it was very good and fit for an oration. I managed to save all these eyes with good vision; otherwise, they would have lost their eyes.

Left side: Before surgery. Corneal Ulcer with Pus in Anterior Chamber,

Right side After Keratoplasty

Speedy: Most impressive Chira. What are the other types of grafts you did?

Chira: I did Freehand Keratoplasty. 

I read  papers in 1982,  1993,  1994,  1996  at our Annual Congresses and also at the  S.A.A.R.C.  Eye Surgeons Congress in 2000.

I did  freehand  lamellar  (partial  thickness),  freehand   penetrating (full  thickness) and freehand combined  keratoplasties .

Speedy: Not sure what you mean by “freehand”. Could you please clarify?

Chira: Sure. Freehand keratoplasty is where the Surgeon cuts the donor cornea and the patient’s cornea freehand without using the usual circular trephine.

Speedy: I understand now.

Chira: When the lesion is in the periphery of the cornea near the limbus the usual circular trephine cannot be used.  Freehand keratoplasty is then required and is very difficult to do. It is time-consuming and a lot of patience is needed.  I devised this on my own and tried with success as no one had done this before. I have saved these eyes by doing freehand grafting.

For your interest, I will let you know that I used sterilized paper first and later on cotton material to fashion out the patient’s cut and also the donor eye cut. The donor corneal strip may be bean-shaped, crescentic, horse-shoe or oval-shaped depending on the lesion. This is sutured to the patient’s eye.

These are seen in the Freehand grafts I did below.. 

(For each set, pre-op on the L and post-op on the R)

 

 

Speedy: All those eyes looking at me! Yes, Chira do carry on!

Chira: I read 3 papers at the S.A.A.R.C. Eye Surgeons Congress in 2000.

The first was on Keratoplasty on Keratoconus (Conical cornea where usually teenagers present with very poor vision).

I did   102   PKP over a period of 5 ½ years with   excellent results. I followed  them  for  more  than  5  years  and  I had  to  repeat  only  one,  with  very  good  results.   No  one has done  102  PKP  on  keratoconus  in  5 ½   years  in  Sri  Lanka  and  I  don’t  think  even  abroad.

Speedy; That is simply amazing!

Chira: Yes, I am quite proud of it. While on the subject Mahendra, this reminds me of a special case. There was a medical student (now a doctor) I did. His other eye was done by a graft surgeon in the UK. The keratoconus eye I did was much better with a perfect graft with 6/6 vision. This patient’s uncle is Kariyawasam our batchmate. He had got him to the U.K to get the graft done.

Photo below shows a Bank Manager’s bilateral PKP done on Keratoconus.

This Photo taken 10 years later, shows perfect grafts (the surgical trephine cut is hardly seen) with 6/6 vision.                                                                                           

 

The second was on the usefulness of Freehand Lamellar Keratoplasty in Marginal Ulcers.

This marginal ulcer patient had a horse-shoe shaped donor corneal strip.

The third was on Keratoplasty in complicated eyes.

This was an only eyed acid burns patient who was blind for 21 years. Was refused treatment by many eye surgeons. I took up the challenge and did a total lamellar keratoplasty. Patient was thrilled, he was able to see his own 9 year old son for the first time, after he was born. This appeared in the Lakbima newspaper on10.12.2000. 

Speedy: That was great. What about your papers presented at congresses?

Chira: I have read many papers at our annual congresses.  PKP in Fungal Suppurative Keratitis, PKP and Scleral fixation IOL (Intra Ocular Lens or Implant is sutured to the sclera), are a couple of them

Speedy: I see. Keratoplasty was something you were very good at. Any statistics on that?

Chira: in  my  unit  at  eye  hospital,  on  an  average,  180  grafts  were  done  per  year.  In  my  study  the highest  number  of  grafts  were  done  on  corneal  ulcers  -  28%

I  have  done  about  30  grafts  on  Pakistani  patients  and  about  the  same  number  of   grafts   on   local patients at  Nawaloka hospital.                                            

Patients have been referred to me for grafting   by   consultants from Colombo and from all   over   Sri Lanka. 

Speedy. Shall we now talk about some of your achievements in Ophthalmology?

Chira:    Sure. I shall start with my post-graduate qualifications. Firstly, the Diploma in ophthalmology D.O. (Lond) which I obtained in 1977. Next, I got the Fellowship of the Royal College of Surgeons F.R.C.S. (Eng) in1978. I obtained my F.R.C.S. Ophthalmology Eng. in 1978.  It was conducted by the Royal College of Surgeons England

Speedy: What was the status in Sri Lanka, were there any specialist programmes conducted? 

Chira: Only later. The College of Ophthalmologists England was formed and they started conducting Ophthalmology exam. Those who obtained F.R.C.S. Ophthalmology England were awarded the F.C.Ophth.U.K. Certificate. I was awarded F.C Ophth. U.K. certificate in 1989.

Speedy: With the commencement of the PGIM (Post Graduate Institute of Medicine, Colombo), were you recruited to help?                            

Chira: I was quite involved with the PGIM) and was very happy to help.

Speedy: What were your duties there?                                        

Chira: My duties are best summed up as, Member Board of Studies From 1985 to 2001, Examiner for D.O. Ophthalmology From 1983 to 2001, Examiner for M.S Ophthalmology From  1985 to 2001, Tutor in Ophthalmology From 1989 TO 2001, Undergraduate Trainer in Ophthalmology From  1979 to 2001 and Postgraduate Trainer in Ophthalmology from 1983 to 2001.

I was in the MCQ core group and we used to meet once a week to form MCQ for the MCQ bank.

May I add that I was  President of the  Ophthalmological Society  of  Ceylon  in  1987 and of the      College of  Ophthalmologists  of  Sri Lanka  in  1999 and  2000.

 

Photo taken after  the  Induction  in  1999 (Cassim and  Late J.G.Wijetunge are in the Photo)

Speedy: Those were singular honours Chira. It is tremendous to see a Batchmate achieve so much.

Chira: Glad you think so. I was always keen to help Medical Education in Sri Lanka.

Speedy: You have set a very good example, no doubt. Moving on, corneal grafting was clearly your main interest.        

Chira: Yes Mahendra. I  do  not  think  that  anyone  has  done  so  many  grafts  as  myself  at  that  time. That  may  be  the reason I  received  two  awards  on  grafting.

The first  From The  Lions club in  1995/96  An appreciation award for services rendered to the “sight  for thousand programme” and the second from The  Sri  Lanka  Eye  Donation  Society  in  2004,  an award in recognition of the  invaluable services  rendered to the society for grafting human corneas for patients in Sri Lanka.  

Speedy: I am aware that you won many other awards. Would you mind listing them?

Chira: Sure. I am proud to say that I received a President’s Research award from Mrs Chandrika Kumaratunge in 2000. And In 2002, I was awarded Honorary Fellowship of the College of Ophthalmologists of Sri Lanka.

Another proud achievement was being invited to deliver the Prestigious Dr P. Sivasubramaniam Memorial Oration on 3. 9.  2011.

Memorial Oration at the Galadari  Hotel,  Colombo.                                                                      

 

                                       With my family after the oration including my daughter in Law                                                              

College of Ophthalmology  President’s  Medals  1999 and  2000

Dr Sivasubramaniam Memorial Oration  Medal  In front           

                                                                                    

 

I also received an Outstanding Health Professional Award  from the Sri  Lanka  Medical  Association  on the International Women’s day   8. 3. 2012.

                                                                         

 

Group Photo        Prof. Priyani Soysa,  Suri  are  also  there.

 

Awards   On left side Award  from Eye Donation Society,  Centre  Award From Lions club,   

right side Outstanding Health Professional  Award  from S.L.M.A.   Circular award  from Methodist College, felicitation by O.G.A.                                                                                                        Speedy: Very impressive! Very impressive!

Chira: Not  only  did  I  have  achievements  in  the  field  of  ophthalmology    but  also for other Achievements at  the  Eye  Hospital.

Speedy: These I presume were of a more broad nature?

Chira: That is correct. For example, I arranged to refurbish Wards 7 and 8. We collected  about  Rs  300,000  from  donations  from  patients  for  floor tiles. These wards were the first to get floor tiles in the whole hospital. Further improvements such as colour  washing  the  walls,  new  fluorescent  lights,  new  curtains,  pictures  on  the  walls, providing the Nurses  duty  rooms  with  illuminated  Snellen charts.

Speedy: All very useful and much appreciated I am sure.

Chira: Yes, you can say that. Furthermore, when I was President of the college, I arranged the refurbishment of the lecture hall at Eye Hospital Colombo. Meetings of the  College of  Ophthalmologists of  Sri   Lanka are held at this lecture hall. A public address system with 4 speakers was also installed. New fluorescent lights and  3  dimmer lights were fixed, a podium and  2  additional stools were provided. A Magiboard was fixed at the centre and 2 screens 5’ x 5’ were fixed for double projection. Colour washing was done and new curtains were fixed.    

Speedy: What about all these photographs of famous people you showed me?

Chira: They are to do with another innovation I made. I  started  a gallery of photographs of the  Past  Presidents  of  the  College  in  the  College  room, (which I opened before),  in the Eye Hospital, Colombo.

College Room Photographs  hung                        

Late  Dr.  Sivasubramaniam, Dr. Wirasinha, Dr. Mendis and Dr.(Mrs).Stephen are seen in the photo. Cassim’s and my photos are  seen hanging on the wall.

Then I  got the idea of having the photographs of retired  Consultants,  Eye  Hospital, Colombo,  hung   according  to  seniority  in  the  lobby  outside the  lecture  hall, Eye  Hospital,  Colombo.

 

This Photo  is in the lobby outside  The Lecture hall,  Eye  Hospital, Colombo.

Speedy: This is quite a common practice in the Royal Colleges in the UK and it is a good way of honouring them and recognising the service they gave. I am so glad that you did this. 

There is another important duty for Consultants and that is to be Trainers. As a consultant, you must have had responsibilities as a Trainer. Why don’t you tell us a little bit about that? 

Chira I have trained a large number of Ophthalmologists who are consultants now in Government service and in the Private sector. They are doing well.  Three of them invited me as  Chief Guest at our College Banquet when they became Presidents of the College. The third one invited me one year ahead as he became Vice President.  I  said  I  have been  Chief  Guest twice and to think of inviting someone else,  but he insisted, and so I was Chief Guest thrice!

Speedy: Isn’t it nice to be wanted! I am sure they were honoured to have you. And how good to know that your daughter is following in your footsteps

Chira: Yes, I am very proud of Anjali. She will be a consultant eye surgeon like her mother when she is board-certified after her post-M. D. training one year in Sri Lanka and one year overseas. 

Anjali and myself at college congress 2019                         

 .

Speedy: That’s great! Chira, we are all very proud of you, our Batchmate who has achieved so much and done so much for improving the speciality of Ophthalmology in Sri Lanka. It was good to know that your efforts were appreciated. I had no idea on the scope and extent of work you have done and it was a great pleasure to hear of your achievements. 

Well done Chirasri  Jayaweera Bandara. Consultant Ophthalmologist,  proud daughter, wife and mother, a true servant of Sri Lanka. 

Chira: Thanks very much Mahendra for your kind words of appreciation. Do I deserve all that praise!

Speedy: Of course you do Chira! You were a bit bashful to talk about yourself but I am so happy that you put that aside and shared your happiness with us. I enjoyed this session a lot and I am glad to have given you the opportunity. 

Chira: Thanks Mahendra, I really enjoyed it too. You have taken a lot of trouble and I appreciate very much your effort.  I am ever so thankful to you for being so patient, so caring and spending a lot of time preparing this difficult interview. Thank you for giving me this opportunity and I hope that the Blog will continue to flourish. All the best!

Speedy: It has been my pleasure and thanks again for sharing.  Your tea was lovely too but then there is nothing to beat Ceylon Tea!