Revelion Soetomo Drahaman (Revo)

 Revelion Soetomo Drahaman (Revo)

This appeared in the Royal College 1953 Group Souvenir and was written by Revo himself and kindly sent to me by Nihal (ND) Amarasekera.

Revo 1959

I had my primary education at RPS, which I remember as a very happy period in my life, spending much of my time playing cricket and chess and participating in the annual concerts. I entered Royal College in 1953 joining the English stream, Form 1^S, and my class master was Mr. CP de A Abeysinghe (Cow Pox). I was interested in athletics and won some sprint events while in the lower school at RC. However, I did not do many sports after that.

Having obtained the Form IV to Upper V double promotion, I sat for and passed the SSC (the present GCE O Levels) in 1957. Passing the University Entrance examination in 1960, I was selected for a course in Medicine at Peradeniya but initially had to enter the Faculty of Science in 1961 in Colombo for a six-month course. I was able to get a transfer to do my medical degree in Colombo and qualified as a doctor in 1967. I did my internship in Badulla in 1967/1968 and was then transferred to Ragama. I got married to Gnei Larina, a graduate of the Peradeniya Dental Faculty later that year. We moved to Kandy where I trained under Dr Victor Benjamin. I passed my preliminary examination for the Fellowship of the Royal College of Surgeons (FRCS) and then moved to the General Hospital, Colombo, the present National Hospital of Sri Lanka (NHSL).

Revo 2018

In 1974, we left for London where I completed my postgraduate studies in ENT while being attached to the Whittington Hospital, Highgate, London. While there I obtained the Diploma in Laryngology and Otology (DLO) (London) in 1975. While in England I was able to complete my FRCS examinations and obtain my FRCS (Edinburgh) specializing in Otolaryngology in 1976. We had an enjoyable stay in England during the time we spent there, making several brief visits to the Continent.

I returned to Sri Lanka and worked as an ENT Surgeon at Lady Ridgeway Hospital in Colombo until I was transferred to the NHSL in 1980. I worked there as an ENT Surgeon until I retired in 2002. I also held a part-time appointment in the hospital of the Kuwait Oil Company which involved annual visits to Kuwait for six weeks each time. Most of the time I worked at NHSL, I provided channelled consultation and surgical services in private hospitals as well. The dog-eat-dog nature of private practice (PP) can be gauged by the fact that when I returned from my last visit to Kuwait, many of my patients were surprised to see me as they had been told that I had died and told to channel some other ENT specialist. Before I retired from the Ministry of Health, I became, in 2001, a Volunteer soldier as an ENT Surgeon working at the Army Hospital. I was able to continue in that capacity in the Sri Lankan Army Volunteer Force until 2013. I completed my MS degree after retiring from the Ministry in 2006.

I have been active in the College of ENT Surgeons, taking on its Presidency in 2003. I have also been involved in teaching for the MS examination in ENT conducted by the Postgraduate Institute of Medicine (PGIM), and have held the posts of Secretary and Chairman of its Board of Study in ENT.

I have a son, Akram who like me is an ENT surgeon and he too likes to work with the Army and has enlisted for full-time work as an Army Regular and a daughter, Asnita, who has been a General Practitioner in the UK for a long time, paying us visits from time to time. I have two lovely granddaughters who live close to us in Colombo and we are happy that we are able to spend many enjoyable moments with them in our retirement. 

My paintings of Fishes. Chirasri Jayaweera Bandara

MY PAINTINGS OF FISHES 

(please Left click on the painting with your mouse to see a large view)

Chirasri Jayaweera Bandara

1. FAMILY  CYPRINIDAE  includes 1) Gold Fish, 2) Skeleton Fish

 1)       GOLD FISH  below left

Phylum  Chordata    Genus   Carassius

Gold Fish Is one of the most popular aquarium fish. Gold fish released into the wild have become an invasive pest in parts of North America.

Size  30 cm long and 30 cm tall.    Weight  up to 500gm

Life span  10 – 15 years up to 30 years.

 2)       SKELETON FISH   below middle

Carassius auratus is a species of freshwater fish.

Native to Sri Lanka. 

11.    FAMILY  SCORPAENIDAE

      LION FISH    below right       

Order Scorpaeni forms

Pteros is a genus of venomous marine fish commonly known as Lion Fish. Native to the Indo Pacific.

Also known as Fire fish, Turkey fish, it is characterized by conspicuous warning colouration with red, white, cream or black bands, showy pectoral fins and venomous spiky fin rays.

Lion fish sting result in changes in heart rate, abdominal pain, sweating and fainting.

Death from Lion fish stings are rare.

Female Lion Fish can lay 2 million eggs per year.

Size  1 – 18 inches, Life span  10 years

 

 Painting Gold fish                   Painting Skeleton fish                  Painting Lion fish

             111.  FAMILY  CICHLIDAE  includes  1) Angel fish  2) Disc fish

(1)    ANGEL FISH   below left

Pterophylum is a small genus of fresh water fish known to most aquarists as Angel fish.

These species originate from the Amazon Basin, Orinoco Basin and various rivers in the Guiana    

Shield in tropical South America.

       Body length 6 inches      height  8 inches with fins

        Life span  10 – 12 years.

  2)    DISC FISH   below middle

          Genus  Symphysodon

 Cichlids native to the Amazon river basin in South America.

Sometimes referred to as “King of the Aquarium because of their majestic beauty and regal colours.

          Size  10  inches

          Life span  10 years up to 15 years

           1V.  FAMILY SCARIDAE

                 PARROT FISH   below right         

Found around the coral reef coast of Kauai Hawaii.

They have large beaks which researchers have recently found, is formed by some of the strongest       teeth in the world.

 Found in the Indo Pacific. They are found in coral reefs, rocky coasts, and seagrass beds.

Inhabits coral reefs in the Caribbean, Bahamas and Florida.

          Size 30 – 60 cms can grow up to 1 m.

          Life span  10 – 15 year 

        

Painting Angel fish                              Painting Disc fish                               Painting Parrot fish

          V.  FAMILY  ACANTHURIDAE    includes  1)  Surgeon fish  2)  Yellow Tang

                                                                            3)  Blonde Naso Tang

       1)  SURGEON FISH  below left

Also called Tang, tropical marine fishes, found throughout the worlds temperate and tropical   Oceans, found in the Great Barrier Reef.

It is called Surgeon fish because of the very sharp, mobile spines on either sides of their tail that favours Surgeons Scalpel.

       Phylum Chordata

       Size  12.4  inches

       Life span  8 – 20 years   

        2)   YELLOW TANG  below middle

Phylum  Chordata

Habitat South Pacific Ocean, Hawaiian Islands, coasts of Florida in the Mediterranean sea.

Yellow tang is a salt water fish, is one of the most popular marine aquarium fish.

 It is bright yellow in colour and lives in reefs.

The yellow tang spawn around the full moon. It eats algae.

Size   7 - 8 inches

Life span  40 years

      3)   BLONDE NASO  TANG  below right

Genus naso

Found in Pacific Ocean, Indian Ocean, in Hawaii, Japan also Red Sea.

Length  18 inches

Life span 10 – 15 years     

Painting Surgeon fish                     Painting Yellow Tang              Painting Blonde naso tang

      VI.  FAMILY  CALLIONYMIDAE including  1) Mandarin fish  2) Spotted Mandarin fish 

        1)    MANDARIN FISH  below left    2) SPOTTED MANDARIN FISH  below middle

     Phylum Chordata   Genus Synchiropus

     Native to the Pacific ranging from Ryuku Island to Australia

     Popular in the salt water aquarium trade.

The vibrant colour of this species indicate to the other animals that it is dangerous to consume, to make up for the lack of protective scales. The Mandarin fish body  produces an odour foul tasting toxic mucus.

The Mandarin fish creates its magnificent hues by producing blue pigmented  “ cyanophone”. These light reflecting cells achieve that vibrant colour.

     This species is best known for its ritual reproduction mating dance which only occurs

     during sunset hours. Females will group together at the reef and seek a male mate.

     Length  3 – 4 inches

     Life span  10 – 15 years

      V11   FAMILY CHAETODONTIDAE

       COPPER BAND BUTTERFLY FISH   below right    

       Also called BEAKED BUTTERFLY FISH     

       Genus Chelmon  have long beaks

        Found in reefs in both the Western Pacific Indonesia and Philippines.

        The long snout is an adaptation for feeding on benthic invertebrates in crevices and holes

         Size 8 inches ( 20 cm ) in length.

         Life span 10 years    

 Painting Mandarin fish        Painting Spotted Mandarin fish       Painting Copper band butterfly fish

 V111       FAMILY  POMACANTHIDAE  includes  1) Royal or Regal angel fish

    2)   Queen angel fish  3) Blue ring angel fish  4)  Koran angel fish  5) Blue girdled angel fish

 1)  ROYAL OR REGAL ANGEL FISH  below left

Genus  lygoplites

Found in Indo Pacific Oceans

They have orange and white stripes with blue and black edging. They have yellow tails.

Grow as long as 25 cms

Life span 10 years

  2)    QUEEN ANGEL FISH    below right

    Phylum  Chordata        Genus Holocanthus

The Queen is limited to tropical Western Atlantic waters ranging from Bermuda to Brazil, from Panama to the Windwards Islands. The species most abundant throughout the Caribbean.

     Adult can reach lengths of 18 inches and  Weight  up to 56 ounces ( 1600 gm)

     Life span  15 years    

Painting Royal or Regal Angel fish                         Painting Queen Angel fish

   3)   BLUE RING ANGEL FISH   below left

   Also known as the ANNULARIS ANGEL FISH and the BLUE KING ANGEL FISH

   Genus  Pomacanthus

Found in the Indo- West Pacific Oceans from East Africa, throughout Indonesia and New Guinea to Calidonia  North to Southern Japan

               Species of large marine ray finned fish.

               Size 7.8 – 17.7  inches ( 20 – 48 cms )

               Life span 16 – 25 years

    4)  KOGAN ANGEL FISH  below middle

        Also referred to as SEMICIRCULAR ANGEL FISH also ZEBRA ANGEL FISH

        Found in the Indo – West Pacific Ocean.

        Species of marine ray finned fish.

        Size 14 inches,     Life span 21 years

    5)    BLUE GIRDLED ANGEL FISH  below right

           Also called MAJESTIC ANGEL FISH

           Is a marine Angel fish from the Indo- Pacific region.

           Size  10 inches.        Life span  21 years.   

Painting Blue ring angel               Painting Kogan angel fish             Blue girdled angel fish

1X.   FAMILY  OSPHRONEMIDAE

    SIAMESE FIGHTERS  ( Betta Splendens ) below left and middle                       

 Phylum  Chordata        Genus   Betta

 Native to South East Asia, namely Cambodia, Laos, Myanmar, Malasia, Indonesia, Thailand  and Vietnam.

 Commonly known as Betta is a fresh water fish.

 They come from what used to be Siam. They have been bred to fight for centuries.

  Size  6 – 8 cm.      Life span  2 – 5 years  

 X.  FAMILY  BALISTIDAE 

       CLOWN TRIGGER FISH   below right

      Phylum  Chordata

      Found in Indo Pacific Ocean.

   Clown trigger fish is highly prized aquarium fish because of its colouration.

   It has large white spots on its back belly and small black spots on the yellow back.                               

   Clown Trigger Fish has a thick white band under the eyes and bright yellow orange lips. 

   Its sharp teeth help to consume a diet of shelled animals.

   Length  19.7 inches.      Life span  over 10  years

 Painting Siamese fighter               Painting  Siamese fighter         Painting Clown Trigger Fish

 X1.  FAMILY SYNGNATHIDAE

   SEA HORSES   below left

   Phylum  Chordata     Genus  Hippocampus

   Hippocampus comes from Ancient Greek hippocampus, itself from hippos meaning ‘horse ‘ and  

   Kampos  meaning ‘Sea monster’

 Sea horses are small marine fish, are not just tropical creatures. They can be found in colder waters

 like those found off New Zealand, Argentina, Eastern Canada and the UK.

 Sea horses are truly unique and not just because of their unusual equine shape, unlike most other fish, they are monogamous and mate for life.

The female Sea horse produce eggs for reproduction that are then fertilized by the male. Unlike  almost all other animals the male Sea horse then gestates the young in a pouch until birth.

 They are among the only animal species on earth in which the male bears the unborn young.           Males become pregnant and undergo painful contractions.    

 Male Sea horses can deliver 5 to 1000 babies at a time.    

Sea horses have two-chambered heart but no stomach and teeth. Food passes through their digestive tract so rapidly, they need to eat almost constantly to live and grow.

      Sea horses change colour to mimic their surroundings when hiding from predators or prey.

      Size   0.6 – 14 inches     Weight   7 ounces  to 1 pound  

     Life span  5 – 9 years

 X11.  FAMILY  DELPHINIDAE

     DOLPHINS   below right

       Class Mammalia

 Dolphins are found all over the world. Found in Sri Lanka.

  Dolphins are not fish but aquatic mammals.

  They stick to their mothers for a long time

 Dolphins have 2 stomachs. Dive up to 1000 feet. They are extremely intelligent animals.

They have large brains with 2 hemispheres that are able to sleep at different times. Dolphins are small toothed Cetaceans recognizable by their curved mouths which give them a permanent ‘smile’.

       Dolphins are Carnivores.  They can swim more than 20 MPH

       They can hear well beyond the range of Human hearing.

        Size  2 – 4 m      Weight  Av -  50 kilogm

         Life span  10 – 45 years  

Painting Sea Horses                                                            Painting  Dolphins

Mini-reunion at Lucky's - 18th March 2022 Sri Lanka

Mini-reunion at Lucky’s home in Sri Lanka on Friday 18^th March 2022

From Srianee Dias

It was a beautiful, sunny and warm (no surprise there!) afternoon in Colombo when I joined Indra and Rani Anandasabapathy in a Kangaroo Cab and made our way through dense midday traffic to Lucky and Mangala Abeyagunawardene’s beautiful home.  We joined Senarat and Hemantha Jayatilake, Sanath Lamabadasuriya and Sura Fernando, and enjoyed a sumptuous lunch as is the usual case at Lucky and Mangala’s home.  It was a lovely intimate setting with the flowering wisteria just outside the door.  The conversation was lively and interesting as usual.  It was lovely to meet even a handful of my batch mates after two long years.

Indra Anandasabapthy who sent the photographs adds: - Thanks Sura Fernando for more photos

A great meal as is usual and company followed by a tour of their beautiful garden.

Left to right facing camera , Dr Senerath Jayatilleke, wife Hemantha, Dr Srianee Dias Fernando, host Mangala Abeyagunewardene , back to camera right to left Prof Sanath Lamabadusuriya, Devarani Anandasabapathy, Dr Surangani Fernando

  "Permission to speak Sir!"

The Muscicians of my youth- Nihal D Amarasekera

The Musicians of my youth

Nihal D Amarasekera 

I cannot sing to save my life, hence I’ve become an inveterate fan of the magical music produced by so many talented musicians. The sheer talent and the variety of music available out there is simply staggering. 

I spent my early childhood in a large family house in Nugegoda owned by my grandparents. Several of my uncles, aunts and many cousins we all lived together which was a wonderful start to life. Music then was ever-present on the radio, in church or at school. In the evenings my aunt played the guitar and we were encouraged to sing and we did. I remember singing several old arias including “Santa Lucia” into the stillness of the night. 

During our Teenage years, music had a very special appeal. 1955 saw the emergence of Rock 'N Roll music. The first rock 'n' roll record to achieve national popularity was "Rock Around the Clock by Bill Haley and the Comets. I queued for hours in the heat of the day to see the film at the Savoy. Bill Haley succeeded in creating a music that appealed to youth because of its exciting backbeat, its urgent call to dance, and the action of its lyrics. The booming base and the twang of electric guitars produced a foot-tapping sound. Haley abruptly ended the ascendancy of the bland and sentimental ballads of the crooners popular in the 1940s and early 50s. I was then in the boarding, singing, clicking my fingers and gyrating to the music coming through the Rediffusion set in the common room of the school boarding house. The music of Elvis Presley and Cliff Richard and the Shadows was all-consuming to us teenagers. The Colgate Hit-parade on Tuesdays was as good as watching cricket on a Saturday.

The music fashions changed when we were in the Medical faculty. Music of the Beatles, Rolling Stones and others became popular.  Dancing caught on and the beat music was ideal for swinging and jiving. 

The music scene is so very different now. Compact disks took over from vinyls. The new amplifiers and speakers provided music much closer to a live performance. Now there are more musicians producing good music. The distribution of the music with streaming and YouTube is much better and faster. Hence the turnaround is so much quicker. Many of the songs are here today and gone tomorrow. With the pieces being so evanescent I wonder if the songs of today will have the same lasting impact like the music of our era. 

I still remember most fondly the singers and the songs that appealed to me in my youth and made me see the world in such vivid technicolour. 

Elvis Presley (1935-77)

He was our cultural icon growing up and was the King of Rock and Roll. Elvis energised the songs he sang and his performances had a certain sexual content which appealed to the youth of the day. Much of his music fizzes with life and passion. His films like “Love me tender” became box office hits. Elvis conquered the charts well into the 1970s. Despite his hell-raising image and fast living and equally fast music, the song that I love and remember most of all is the tenderness and emotion with which he sang “Are you lonesome tonight”.

Fame and fortune brought into his life ‘drugs’ which compromised his health. He led a colourful life in the spotlight. Elvis’ untimely death brought great sadness to many of his fans. His house and estate called ‘Graceland’ is a mausoleum, monument and a museum to a legend fondly remembered by many.

When my mood takes me, I still listen to some of his songs. They do remind me of places and people who were in my life all those years ago. 

Pandith W.D Amaradeva (1927-2016)

Often referred to as the maestro, he was a well-known Sinhala vocalist, violinist and composer. He had his early training in India and he has included South Indian and Tamil music into his compositions. His work invoked what could be called traditional folk music including into them many outside influences making the compositions unique and well-liked by many. Amaradeva was a regular and found steady work at the Radio Ceylon. He has composed music for ballet, TV and films and has won many national and international awards. There was a calming Zen air and a mystique about his songs and his music. Wherever he performed WD Amaradeva received a rapturous reception and he enjoyed critical and popular acclaim.

He composed the music for the Maldivian National Anthem.

Out of the many beautiful songs he has sung in his life time my special favourite is “Sasara Wasana Thuru”. It is intriguing that the year it was composed and the name of the composer and lyricist remains unknown. The way it is sung by W.D Amaradeva shows how much he has mastered his craft. The song conveys a deeply philosophical message. The expressive way it is sung, the poignant lyrics and the soulfulness of the melody enhances this message and transports the listener into a different realm. 

The Beatles

In the 1960’s the British rock band from Liverpool took the world by storm. John Lennon, Paul McCartney, George Harrison and Ringo Starr each of them were fine musicians in their own right. They oozed talent and charisma. They revolutionised music of the time. The Beatles attained cult status becoming leaders of the youth of the time. They thrilled us with their swagger, confidence and audacity. The fan frenzy was called Beatlemania. Psychedelic drugs entered the music scene at this time. Their music enhanced interest in Indian spirituality like the Hari Krishna movement. Delirious ragas, incense and sitars joined the cult with tantalising fusions of East and West.

I was a medical student during their early years and became mesmerised by their musical culture, fine vocals, superb lyrics and the rich twang of the electric guitars. The very thought of the Beatles brings back nostalgic memories of those youthful years dancing unashamedly to the Harold Seneviratne Combo playing Beatles music at the Colours Night Dances at King George’s Hall. Accompanied by a glamorous partner and up to the eyeballs in amber nectar, those events brought us closer to heaven. Where have all those years gone?? My favourite since all those years remains “A hard days night” made famous in 1964. 

Cliff Richard

He was born Harry Rodger Webb in Lucknow, India to British parents. They moved to England after Indian Independence in 1948. When his talent was recognised, he was on a fast track to fame, fortune. With a huge fan following, he was a teenage heartthrob when we were growing up. I’m certain at least some of us will know the words of the popular Cliff Richard hits like Living Doll, Young Ones and Summer Holiday. In the late 1950’s and early 60’s he dominated the British pop music scene with the backing of the shadows. He had a prosperous film career with the “Young Ones” and “Summer Holiday”. Cliff Richard's popularity was mostly in Britain and the Commonwealth countries. He was less known in the USA. He continued to sing well into the new millennium with much popularity and affection. He was the voice of my generation growing up in Sri Lanka. Despite a battery of important examinations that was indeed a magical time in my life. Still, when I hear his old songs, which I play occasionally, it takes me back to the happy times of my 6^th form years at school when his songs hogged the charts and our lives. 

Nat King Cole (1919-65)

He started his musical life as a classical pianist but soon moved over to jazz. The Nat King Cole Trio where he played the piano and also sang became popular and they began to tour the country. It was in the 1950’s that he launched a successful solo career scoring numerous hits like ‘Mona Lisa’, ‘Smile’, ’Rambling Rose’, ‘Pretend’ and ‘Too young’. Sadly, despite his popularity as a singer his life was tormented by racism, a sign of the times.  A life-long smoker he died age 45 of lung cancer. There is no music that brings me closer to my youth than the music of Nat King Cole. There’s a charmingly relaxed quality to his songs. His husky, velvet voice generated a certain magic that reached deep into my soul. I still listen to a lot of his indelible songs on quiet evenings when I’m in a mood for nostalgia. Listening to the best of his tracks, I can quite easily imagine Nat wandering into our lounge. There was an album I owned where the great man sang with his daughter, Natalie Cole. This brilliant collection of duets included a version of unforgettable that will indeed remain what it says on the cover -- “Unforgettable”.

 

C.T Fernando (1921-77)

Cyril Tudor Fernando was a legendary singer and composer and an icon of our time. He had a vast repertory of superb songs which were his own creations and well known to many of our generation. His recordings also featured lyrics by the famous Lalith S. Maithripala, Karunaratna Abeysekara, Sarath Wimalaweera and Wimaladasa Perera. C.T Fernando music was on the radio many times a day and at important functions including weddings. No music or musicians can bring me closer to Sri Lanka of my youth and those halcyon days than C.T Fernando. I grew up singing his songs, badly, enjoying it nevertheless. I had the good fortune to see him perform live on Sunday evenings in a small hall by the sea in Kollupitiya in 1966/67 while I was at the Jeewaka medical hostel. Even now when I hear his music I’m transported back to Ambaruk Sevana, the H.O’s residence in Kurunegala where his songs were played in the evenings and at weekends at our regular booze-ups. Those memories remind me of my friends at the time, H.N Wickramasinghe, Tudor Wickramatchi, A.P Gunetilleke and Derryck De Silva among many others none of whom are alive today. My favourite C.T Fernando classics are “Suwanda Rosa mal” and “Pin Suduwannay” which I try to sing in the shower just hoping no one will hear. His songs will live on.

A Drop of Ink- A poem by Mahendra Gonsalkorale

A drop of ink

Mahendra “Speedy” Gonsalkorale 

I am a drop of ink
one of many
trapped in a cylindrical barrel, a pen
my escape is manipulated
by a dextrous Sapiens hand
which guides my liberation
in successive dots to a parchment
merging into a meandering trail
that confers a meaning
a message
an edict
a story
an instruction
to the eye-equipped beholder
trained to transform visual images
to information and meaning

I spend a lot of my life
inseparable from my fellow drops
on that dot laden paper
drying,
dying
in our manuscript tomb
hidden and mostly forgotten
in a library of dead scrolls

And then a glimmer of hope
when the room is lit
by solar power during day time
and harnessed stored power at night
by a curious information seeker,
eyes lit with hope and anticipation
visiting my abode, my grave
and locates my parchment, the book

Satisfied with knowledge gained
through a visuo-cerebral transaction
whereby the meaning conferred
by the trail of our collective dots
on the parchment, is understood,
he leaves,

and I am alone again
bound within a book
trapped forever,

or so I think
Or, maybe not
for The Curious never die
and where there is curiosity
there is hope

which hopefully is not hopeless
and I can still live in hope

for another day, another time
lying still

Until….

Our Health, Our Security, Our Choice | Sharmila Anandasabapathy, M.D

Our Health, Our Security, Our Choice | Sharmila Anandasabapathy, M.D. TEDx BaylorCollege of Medicine

It gives me great pleasure to post this. Sharmila is our much-loved Batch colleague Indra and his wife Rani Anandasabapathy's most distinguished daughter. She is a Physician and researcher in the field of gastrointestinal cancer. She is a professor of medicine in gastroenterology and serves as director of Baylor Global Health and vice president at the Baylor College of Medicine.

 “What if we approached health security the way we now approach national security? What if we approached health threats the way the military prepares for potential conflict? Dr. Anandasabapathy outlines four actions that will prepare us for the next health threat and the next after that, and, in doing so, save lives, save money and insure a safer future. Sharmila Anandasabapathy, M.D. is a Professor of Medicine in Gastroenterology and Vice President of Global Health at Baylor College of Medicine. In her current role, she oversees Baylor’s global programs and affiliations and seeks to develop novel, environmentally appropriate technologies and approaches to addressing global disease burden. This includes the development and validation of innovative mobile-applications for clinical care, point-of care diagnostic technologies, and portable, low-cost devices for the diagnosis and management of chronic, non-communicable diseases worldwide. As an advanced gastrointestinal endoscopist by training, Dr. Anandasabapathy’s research focus involves the development and validation of novel technologies for diagnosis of early gastrointestinal cancer. This talk was given at a TEDx event using the TED conference format but independently organized by a local community”.

All's well! No need to yell! -Zita Perera Subasinghe

All's well! No need to yell!

A welcome contribution from Zita Perera Subasinghe

(written I'm  National Poetry Day (09 10 2015)      

I'm just walking along the street

In Marseille, that famous town

Children laugh, people greet

Happy faces, not a single frown

 

Suddenly, a crowd, in the street

Red flags of strike, people chant!

Police throng, while drums beat

'Go away'! 'Stop'! 'No, I shan't'!

 

Some in cafés, drink in hand

Others punch the air and loudly shout

Some enjoy Sun, Sea and Sand

Others have grave needs no doubt

 

Some, to work, are more than willing

While some need to scream and chant

There's no need for guns and killing

No one is in, that much want

 

Attacks by nature, we can't fight

When she sends Storm and Deluge

But personal greed, we can fight

And to the homeless, give refuge

 

A bed of roses, life is not

Dire hardship's there for all

Be thankful for what you've got

Stand up! Hold head high! Walk tall! 

The Future of Medicine - Srianee Dias

 THE FUTURE OF MEDICINE

 By Srianee Dias

When I first began practising pathology our diagnoses were made pretty much on morphology alone. The history, the location of the lesion, the gross and microscopic appearance also contributed to the final diagnosis which was made using basic hematoxylin and eosin stains, as well as a few other special stains.  The treatment decisions depended on the pathologist’s diagnosis.  In those days (late 1970s) when the diagnosis was malignant, the treatment options were few. 

      As time went on, various techniques became available to identify the unique properties of the malignant cells, which assisted the oncologists in choosing the most appropriate treatments for their patients.  This is especially true in the case of haematological malignancies.  Surgical pathologists began to sub-specialize as gastro-intestinal pathologists, breast pathologists, gynaecological pathologists, cytopathologists, hematopathologists etc. 

    Nowadays when a surgical pathologist encounters a malignant tumour it is deemed inadequate to simply diagnose the tumor based on only routine hematoxylin and eosin stains. A myriad of molecular studies need to be done and hormone receptors need to be assayed before the final diagnosis is made, because all these tests will definitely influence the treatment.  As an example in 2004, we began performing a test called Oncotype DX on breast cancer tissue samples, where the tumours were given a certain score.  But, it was 2015 before it was determined that patients with a certain score do just as well with hormone therapy alone, as with the more toxic chemotherapy.  Women had been unnecessarily exposed to the more harmful chemotherapy. 

   There are more and more technologies looming on the horizon.  Perhaps the H&E slides that we studied as medical students will become obsolete in diagnostic pathology. 

  The genetic make-up of the tumour is also important.  It is increasingly apparent that our own individual genetic combinations will also influence therapy, and not just in oncology. In the future, our genomes will be sequenced, stored, and the information saved for treatments that have been demonstrated to have had good results on similar gene types and combinations that we have. 

    In 1990 when the Human Genome Project was launched it took 10 years to be completed and cost a few billion dollars.  Today it is possible to study an entire genome of about 25,000 genes in a few days on a portable DNA sequencer called a MinION.  It costs about $1000.00 and connects to a laptop.  The Oxford Nanopore, a portable device is capable of sequencing DNA in humans, plants and microbes.  In the present stage of its development, the DNA has to be extracted from blood or tissue involving a multistep process. This will have to be simplified before this technology is widely available. 

    Ethical and privacy issues arise with all this information gathering.  People will have to be willing to share their data, and privacy ground rules will have to be established before this kind of technology is able to reap any benefits. 

    Knowing a person’s genome will allow effective targeted therapy against diseases.  Knowing a pathogen’s genome will also lead to effective targeted therapy against the pathogen.  (Think of all the damage we’ve inflicted on society with the irresponsible use of broad-spectrum antibiotics resulting in resistant organisms).  We’ve known for years that if a person is a carrier for G6PD deficiency the ingestion of fava beans could be fatal.  Certain medications can also cause hemolysis in these people.  We all know patients and family members who develop serious side effects after beginning treatment with a particular medication.  In the future there will be tests to identify one’s genetic predisposition to such reactions so that doctors can make the correct choice in treating their patients. 

    Targeted therapy is being used in oncology today and the range of medications is ever-expanding.  Targeting the malignant cells specifically helps to avoid the toxic side effects of standard chemotherapeutic drugs. 

   One of the therapies in current use is Chimeric Antigen Receptor T cells (aka CAR T cells)  These are T lymphocytes that have been genetically engineered to produce an artificial T-cell receptor for use in immunotherapy.  It gives these T-cells the new ability to target a specific protein.  It works this way:

        a) The T lymphocytes are separated from the patient’s blood.

        b) These cells are genetically altered in the lab so that they will specifically attack an antigen on the patient’s malignant tumour, but not the patient’s healthy cells.

        c) These altered T-cells are then re-infused into the patient where they will seek out and attack the patient’s malignant cells.

CAR T cells can be autologous (patient’s own cells) or allogeneic (donor cells).  These were first approved by the FDA in 2017 and now about five such therapies have been approved, mainly for the treatment of leukaemias, lymphomas and multiple myeloma. 

  In the future, it will be possible to scan a blood sample for circulating cell-free DNA (cf DNA).  It will identify the type of cancer a patient has and what type of therapy will work.  That is a far cry from what we had to do many years ago when a patient’s chest had to opened to obtain a tissue sample from a lung tumour.  With genomic information, we won’t even have to wait for a patient to develop symptoms. 

   We already have smartphones and devices strapped to our wrists (I refuse to call them watches!) that monitor our movements, heart rate, heart rhythm and breathing.  If we stumble and fall they automatically dial for help!  (911 in the US) Skin patches and under the skin implants will evolve to monitor additional information.  These devices may monitor your activities and in the future, when something is amiss, even make an appointment with your physician on your behalf. 

   Modified ink-jet printers are being used to print layers of living cells such as skin cells which have great potential for skin grafting.  These are still in the stage of animal research but have great promise.  It is possible that a person’s stem cells could be harvested and used for this purpose as well. 

   The future of medicine is exciting and vastly different from what it looked like when we started on our journey.  I have listed only a few advances which are relevant to my speciality of pathology.  There is much more happening in other specialities as well. 

   The only concern I have is that with all these advanced technologies available to them, physicians will lose their human touch.  They still need to look the patients in the eye, answer their questions, reassure and comfort them when needed.  I hope those qualities will not be pushed aside. 

NOTE:  I got the idea for this article while I was in the middle of reading a book entitled “Lifespan: Why We Age and Why We Don’t Have To” by David Sinclair, PhD with Matthew D. LaPlant.  It is about longevity, and the author predicts that people will be living much longer in the years to come.  He gets into a lot of scientific details, some of which I skimmed, but he made me think about the changes we have gone through when he started discussing some of these technological advances which I have listed.  I am only halfway through the book!   It is an interesting book crammed with information.