Indra Anandasabapathy's comment on medical education

Some of you may have read this already because Indra wrote this as a comment on Speedy's piece on "Teaching Medical Students" posted on November 27th. Although Indra had made this comment on December 1st, it is unlikely that some may have missed it. As I have repeatedly pointed out before, it's the comments that make a blog post more interesting.

In the same way that I handled such a situation on an earlier occasion, I am re-posting Indra's comment as a new post. 
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AnonymousDecember 1, 2015 at 6:11 PM

Interesting topic you guys are in.I have often reflected on my experiences as a medical student & my experience as a teacher of both medical students,nurses & residents in the USA.

To start with I will add Prof. Lester Jayawardene to this list. This stems from my first meeting with him as part of a sig. group that was tested on their knowledge of the shoulder joint. It was our first sig. our first few weeks in the block, and our first meeting with the teacher from Peradeniya whose reputation for being strict preceded his arrival in Colombo. We did put in the effort for sure but without the right guidance.

He went right to the point with his first question. What are the movements of the shoulder joint. None of the eight in the sig.group knew it because it was in fine print in the dissecting manual- by Cunningham.
The eye brows went up, and he bellowed, I am sure you know thev rest of the stuff, but if you did not know the movements of the shoulder joint you really have missed the whole point.

I did learn from that day on the importance of applied anatomy ( by extension applications in other subjects too) which was also well thought by Drs. Panditharatne & Bandaranaike, who were good teachers too.I had only once listened to Prof. Kirthisinghe , when he held a post mortem on the failures in surgery after both he & Prof. Navaratne took over the teaching of surgery, but the little bit I heard was enough to realize here was another good teacher.

The point has been made that our teachers tried to belittle you if you attempted to question them or make a mistake in answering a question. teachers need to encourage students to ask questions , the attitude of several of our teachers was sad to say the opposite.What I found out quickly in the USA is that if you don't talk, the Attending staff (consultants) think you don't know & mark you down.

Several years ago one of my daughters & son in law, both med. students were in the professorial ward at LRH. Sanath was away on sabbatical. The acting consultant made remarks trying to ridicule the two kids from the US, even after they kept answering his questions.Well that culture has to change if one wants the kids to learn & develop into confident adults.

The forms to evaluate the teachers is there in most institutions in the US too.

To end this note in a humorous note, in one of his afternoon ( sleepy) lectures,
Prof. Sinnathamby mentioned about seeing a monkey with a blue scrotum- in the middle of his talk. It was unrelated to what he was trying to teach. Well I had never seen one in Sri Lanka though I remembered his odd remark. Well, more recently on a trip to Masai Mara in Kenya, I did come across the monkey & things clicked- he Siinathamby must have been there. Sorry this is unrelated to what we were discussing.

Indra Anandasabapathy

Brain Drain

By Sanath Lamabadusuriya

In the late 1950's or early 1960's, the government decided to establish a second medical school in Peradeniya so as to solve the problem of shortage of doctors in the country. We who sat the University Entrance examination (equivalent of today's "A" levels) in December 1960 were the beneficiaries, because the intake was increased. All those who passed in all 4 subjects were selected for direct admission to Peradeniya and others like us who failed in one subject, had to follow a 6 months course in the failed subject in Colombo's Science Faculty in 1961. Of the latter group, some entered the Colombo Medical Faculty and the others the Peradeniya Medical Faculty in June 1962. As the buildings at Peradeniya were not ready, its first batch entered late and eventually qualified in January 1967. We qualified in March 1967.

After the first Peradeniya batch completed their internship, they were  informed by the Ministry of Health (MOH) that employment was not available and were offered a monthly allowance and requested to attach themselves to a GP. Few months later, all of them were offered jobs in the MOH. It is rather ironical that the Government which created a second medical faculty to solve the problem of shortage of doctors in the country was unable to offer employment to its very first batch!

 

That is the time we all started sitting for the *ECFMG because of the uncertainty of employment in Sri Lanka's MOH. Nearly all of us who sat the ECFMG passed it at the first attempt and applied for jobs in the US. As the US had a shortage of doctors at that time, all who applied for jobs were successful. By this time, the MOH was able to offer jobs to all of us. However, some of our batchmates decided to emigrate. After a few months, they wrote back saying how wonderful it is to work in the US. Most of them started in Coney Island hospital in New York. As the 'brain drain" gathered momentum in the next few years, the government introduced in 1972, a 5 year period of compulsory service.

So dear friends, that is how the "brain drain" started and is still continuing, although to a lesser extent.

PS: *ECFMG" was an examination conducted by the Educational Council for Foreign Medical Graduates. At that time, it was the sole qualifying exam to select foreign qualified medical graduates to practice as doctors in the United States.

Congratulations!

Before I publish this latest post, let me offer my own heartiest congratulations to Speedy. I am doing so at a time when our own batch blog is closing in on that magical figure of one million "hits".

As I have stated before, Speedy is my adviser and it was his idea to introduce the "Creative Spot" category on this blog. He has also been the most regular contributor to that category, and together with ND, among the most prolific contributors to the blog in general. It was just the other day, that I posted his version of "Yesterday, Today and Tomorrow". But it has been on You Tube for a while longer. This is how I heard the good news.

Lucky

Mahendra Gonsalkorale	5 Dec (2 days ago)
to .......

I am really chuffed and I hope you don't mind me wanting to shout out and say "Yippee"! This is the first time any of my songs topped 1000, the nearest to  this being "Oh how I miss you tonight with 302 hits and "Nalavee Sanasenney" with 262.

The range of countries is amazing. I am sending these to you because  I had no idea that Youtube songs are being accessed by so many countries.. I won't bore you with all the countries but the top ones are 

Sri Lanka -369,UK-115, US 120, Aus-35, Phillipines-34, Quatar-29,UAE - 19, Japan- 16, Canada-16, Polean 15, South Africa -11, France-10, India -10, Taiwan-10, NZ-10.

Mind you 1000 hits is nothing! Deborrah Allen's version of "Oh how I miss you tonight" had 17.100 views! --- Just to put matters in perspective.

https://www.youtube.com/watch?v=a3TyDwvfmqU

Creative Spot - By Mahendra (Speedy) Gonsalkorale

Intro by Speedy:

This song was composed and sung by me with lyrics provided by Shanta. Shanta's son and swiss wife had a baby boy and Shanta is yearning to see the baby their first grandson. She wrote the lyrics and asked me to compose a suitable song and here it is - the eagerness and happiness and yearning she is experiencing for an event that is going to happen soon.

Speedy

Moving House

By Dr Nihal D Amerasekera

It is often said moving house is as traumatic as a divorce.  Having done both I wouldn’t disagree. We moved into our present house 33 years ago from busy London. I recall the day with such great clarity it seems just like yesterday. It was a warm sunny autumn afternoon with hardly a breeze. A couple of chirping  robin redbreasts perched in a window sill welcomed us to our new home.

With a stable job and a happy family it seemed like the beginning of paradise. The hard grind of training and exams was over. I created a little “Walauwwa” in a leafy suburb in rural Hertfordshire far from the madding crowd as I could manage.

My professional career and the boys education took precedence. My wife gave up her career to care for the kids. Ferrying them to school and back and for the myriad of their activities usurped our time and energy. Their success was our joy which we recall with great delight.

As I look back what amazes me most is how rapidly time has gone. The children have now flown the nest leaving empty rooms , empty chairs and a void that cannot be filled. Every corner of every room brings back a store of memories of times past.

Wherever we went on holiday it was our ritual to bring back a momento. A collection of those adorn the mantelpiece and the windowsills. Reading has been my joy since I was a kid, a habit which has been passed on to my sons. The resultant collection is a fine library. Computers have been my hobby and Apple Macs whirr away deep into the night. Their detritus and wires fill every corner of my study.

A “Walauwwa” ,  however magical it may sound is not the place for an aging couple in their retirement. Keeping such a place in good shape even with help is tiring and time consuming. We have now taken the hard decision to move to a small flat just enough for the two of us.

Downsizing is a heart rending business. Losing personal possessions specially those attached to important events in our lives is not easy. Throughout our lives we took photos which are a priceless reminder of times past. They were real paper photos that need space and care. It is impossible to retain them all. Discarding them broke our hearts. Much of the books, clothing and furniture have been given away to charity.

Downsizing helps to concentrate ones mind to what is important in life. We come into this world with nothing and we leave with nothing. What happens in between is a journey and its memory evaporates into thin air as it ends. After all the next move will be our final rest.

Although I will be moving just 50 miles down south it will be harder to keep friendships with my close pals and former colleagues of 33 years.  As adults we grew up together and have much in common. Meeting them now will need planning and effort. The all important ingredient and social lubricant called alcohol will not be at the table as they must drive back.

Getting used to a new apartment takes time. Living in a new environment with brand new neighbours will be a challenge. But it will not be harder than what I have done in the past to move 5000 miles to a new life in England.

Buying and selling a house is fraught with problems. Estate Agents are in a cutthroat business as are the solicitors who like scavengers live on other people’s misery.

Moving house is not the end of life but the beginning of a new phase in my lifes journey. I look forward to the peaks and dread the troughs as I have always done. London is a place of fun, which we can still enjoy. The museums, galleries, concerts and the theatre will fill our time with joy. It is the culinary capital of the world and a gourmets’ paradise. I will drink a toast in anticipation - no more moving house again.

More on the Meththa Foundation

I think our viewers have got enough and more. This correspondence is now closed.

Lucky

Mahendra Gonsalkorale	02:23 (5 hours ago)
to me

Dear Lucky,

I am very pleased that Sanath has given more details of the Meththa Foundation.

Could you please do this post from me also.

Dear Friends and Colleagues,

You have seen a lot of the Meththa Foundation and I make no apologies for doing my best to help them. Actually seeing the Amputees and the dedicated work force was very moving and powerful. 

Santath has very kindly posted more information on the Meththa Rehabilitation Project.

I want to emphasise the relevant links to Websites and the Bank details for donations or standing orders.

There are two websites worth looking at  

http://www.meththafoundation.org.uk/  and http://mannar.com/category/meththa-foundation/

The Bank details are

Hatton National Bank, 

Cinnamon Gardens Branch, Account number 07601009438

The Meththa UK account details are:-  ( A standing order could be arranged)

HSBC
sort code: 40-11-18
Ac Name: Meththa Foundation UK
Ac no;  04456173

I have attached a copy of the Guest Lecture he gave at the 2015 Anuradhapura Clinical Society held jointly with the SLMA and the SLMDA of the UK in October which I attended.

Just to give some idea of scale.

Maho managed  729 users  in 2014 and 463 users from 1.1.2015 to 31st July 2015

Mankulam had 552 from May to July 2015.

Pana himself has arranged to collect unwanted prostheses from UK (they have plenty of discarded ones which can be used for spare parts and adaptations) and ship to Sri Lnaka.

The limbs he turns out with his ingenuity are actually more functional and of the highest quality. The cost of a Below Knee prosthesis to be made in Sri Lanka is about £140 (in the UK it is about £750) and an Above Knee is about £152 (£1500 in the UK). As you can see he makes maximum use of resources and the limbs are provided free of cahrge. Up to May 2014, about 1800 prostheses were provided.

(Lucky, I have attached the AMS report as a pdf and as a JPEG and you can choose the most appropriate.

I have also attached a few pictures of his Team and 2 with patients, one a delightful little girl who was the victim of a landmine. I do hope you will be able to post it.)

Dr. Panagamuwa writes about THE METHTHA FOUNDATION

I have thus far refrained from using our batch blog for fund raising. But this request comes from none other than our own batchmate Sanath Lamabadusuriya. After all, it is for a worthy cause.

I don't know Dr. Panagamuwa personally, but I do remember meeting him once at Karapitiya in the company of Chandrasiri (Niriella) when "Johnny" (as we used to call Chandre) was living and I had to visit the Ruhuna Medical Faculty on official work over three decades ago. Chandrasiri was the VC at the time and Dr. Panagamuwa I believe, was a Senior Lecturer in Surgery at the Ruhuna Medical Faculty. If I am not mistaken, it was during that same trip that I, accompanied by my late work colleague Dr. Marcus Fernando (brother of former Health Ministry Secretary Dr. Joe Fernando) visited Lama at his Karapitiya Quarters.

I have reproduced below, Sanath's correspondence with Dr. Panagamuwa. I shall try to upload another document as a separate post.
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Professor Sanath P. Lamabadusuriya	22:04 (1 hour ago)
to me

Dear Lucky,

This e-mail from Pana is self explanatory. As you can see he wishes it to be circulated. Could you please post it on our blog site giving Pana's e-mail address as well.?

Kind regards,

Sanath

---------- Forwarded message ----------
From: B Panagamuwa <bpanagamuwa@blueyonder.co.uk>
Date: 2 December 2015 at 21:32
Subject: Raising funds for charity
To: ushacsam@yahoo.com, "Professor Sanath P. Lamabadusuriya" <sanathp.lama@gmail.com>


Dear Usha, Dear Neville

I hope you both and child (?ren) are well.

I am sitting at my desk in Birmingham this cold and miserable winter afternoon thinking of ways to raise funds for our charity, the Meththa Foundation.  I am trying to recruit a few people who may be able help me now and carry the Foundation further when I am no longer there.  I have been wanting to ask for your help since I met you all briefly at the Water's edge 2 years ago but have not had the time to put my thoughts to paper.

Prof Lamabadusuriya has just joined our organisation and I got your email address from him.

Our work has grown exponentially and we now treat more than one amputee every working day.  We have a case load of more than 3000 amputees who seek our services regularly.  More recently, a number of neuro disabled children and adults have begun to come to our Centre at Mahawa seeking help from me.

We need approximately SLR 900,000-1,000,000 per month for our work. Until now, we depended entirely on donations from the Tamil diaspora and a few friends in the UK for our routine output and grants from agencies like the International Rorary Foundation for a few special projects.  Even though an European mobile telecom company named Lebara Foundation owned by a team of young people of a Sri Lankan Tamil origin supported us from 2011 and pledged GBP 45,000 for our services to the war injured Tamil people this year, there was a delay in getting this money and we faced a severe crisis in February.  I managed to keep things under control using our family savings of about 4.2 million rupees this year alone.  I will not have the resources to do this again.

There is an urgent need to find a regular funding stream to continue this valuable work because there is no other reliable service for amputee and other disabled people in Sri Lanka.  Everything is private, expensive and the quality, as far as I have seen is far from ideal

This is what I have in mind.  I taught three batches of students at Galle into their final year and I was very close to them.  Many of them are senior consultants now and all of them are no doubt affluent in their own ways.  I want to ask them if they would give up a small amount of money monthly by standing order for an indefinite time.  If I can recruit about 200 doctors, I can build up capital and eventually, bring our organisation to a stable level.  I have in mind about Rs 5000 every month but that is not a fixed amount.  I guess consultants like Neville, Ananda Perera, Sunil Perera, Kanishka etc to name a few can afford to give this amount and some others may not.

I shall be extremely grateful for your views on this proposal.  You and a few other girls showed leadership in arranging batch get togethers etc which were really enjoyable and I hope that you will agree to carry the same spirit to this venture.  I will be extremely delighted if you agree to support and advise us and in fact, join the Meththa Foundation (we are desperately looking for a Secretary to our Sri Lankan Board).  I will be disappointed if you decline but I will not be angry with you at all.  Please do not feel pressured in any way

I have attached a writeup about our latest work which we hope to take to the President of Sri Lanka and seek his support but I am not very hopeful of a long term solution through a political route. Personal contact and commitment of benevolent people will be more valuable for us and their support will be more solid.  Feel free to circulate the document if you wish to.  It should download through networks with a reasonable bandwidth  You may want to remove the highlighted section about reconciliation because of its sensitivity.  You have first hand knowledge about how your friends feel about these matters and you also probably know how I feel.

I am copying this to Prof Lamabadusuriya who is very interested in this work and asked for more information.  I have a feeling that he will contact you personally seeking help.

Our website is www.meththafoundation.org.uk

Unfortunately, I will miss the first batch get together later this month but hope to catch up with you all in the new year.

Best wishes for a Healthy and Peaceful 2015.

Pana