Base Hospital, Polonnaruwa (1982-1988)

My first posting

I was 32 years old, just returned after qualifying as a Fellow of the Royal College of Surgeons (FRCS) and a post graduate training in the UK. After a short spell as the Resident Surgeon of the Accident Service of the General Hospital Colombo, I asked for a transfer from this unit. I was offered the post of Consultant Surgeon at the Base Hospital, Polonnaruwa.

I was in two minds. I had never worked out of Colombo and I was warned that Polonnaruwa was infested with Malaria. Moreover, there was also the danger of being exposed to wild elephants. Some even said that this might be considered a punishment transfer. It was only the encouragement given by my friend, batch mate and colleague, the late Dr B F S Samaranayake (Sam) who was the District Medical Officer (DMO) at Base Hospital, Polonnaruwa that made me finally take the plunge.

I had no idea what my future would be. One thing however, I was sure. The people and their welfare would be uppermost in my mind.

Background

• There were three hospitals in the District of Polonnaruwa.
• The main hospital in Polonnaruwa was equipped with surgical facilities and a surgeon was appointed at the end of the 1970’s
• Three specialists were appointed – Surgeon /  Physician / Obstetrician & Gynaecologist. Surprisingly an anaesthetist was not appointed to the hospital.
• Population served was 260,000
• The nearest hospital to Polonnaruwa  with surgical facilities was 115 Km away in case a patient had to be transferred.

Move to Polonnaruwa – Initial Problems – Living Facilities & Other Issues

• My first journey to Polonnaruwa to accept the job was by train and it took 7 long hours to travel 240Km.
• I lived in a room in an old dilapidated building adjoining the hospital. The facilities within the room were less than basic. There was no choice. I spent six months in this room until the official Surgeon’s quarters were repaired and renovated.
• Travel to Colombo once in two months or so, was by bus or train and that took six to eight hours.
• My salary was Rs 2200/= per month. I was entitled to private practice, but there was no Nursing Home to perform surgery. It was only a Consultation practice, the fee per patient being Rs 25/=

Visit to the Hospital / Hospital Facilities

• There were more patients than the number of beds. The waiting list was long as there was no surgeon for a while.
• There were no junior Medical Officers in the ward. The House Officers were Registered Medical Practitioners (RMP).
• There was a small lab which could only do two investigations, namely urine, full report and full blood counts. The Blood Bank was primitive and so was the Radiology section. Only Plain X ray’s could be done.
•  The Operating Theatre had an old operating table, a dim light and an old Boyle’s anesthetic machine.
• However, the nursing and other staff members were very enthusiastic, keen to work and promised to extend their cooperation.

Starting Work

• I started work and performed ward rounds and held clinics daily.
•  Surgery was also started on a low key on a daily basis under local anaesthesia.
•  I was on call in the surgical wards 24/7. 
• Whatever I could not manage was transferred by ambulance to hospitals at Matale and Kandy many Km away.

In the absence of proper facilities for investigations, I had to practice what every budding doctor learns In Medical College – take a good history and examine the patient well. That will give a correct diagnosis on most occasions. It also reminded me of Lord Platt who said: “if you listen to your patient long enough, he/she would tell you what is wrong, thus demonstrating the value of what is called bedside medicine”.

Equipment

I obtained the equipment necessary for my work from the Health Department stores in Colombo. They officers there were more than happy to help to supply the equipment to do my job efficiently.

Learning Anesthesia

 Some patients needed to be anaesthetised for surgery. There was no Anaesthetist and I was not competent to do that job. So I decided to follow a crash course in anaesthesia with a Consultant Anaesthetist in Colombo for two weeks. I learnt regional blocks, spinal anaesthesia, tracheal intubation and some aspects of general anaesthesia which would suffice for my work. I started operating after anaesthetising my patients when necessary. Intravenous Thiopentone was used to induce anaesthesia which was maintained with Halothane, oxygen and nitrous oxide for the duration of the surgery. It was indeed a risk, but risks had to be taken. I collected the data on my experience in this field and submitted a paper for the Annual Sessions of The College of Anaesthesiologists. The title of the paper was “The Role of a Surgeon as an Anaesthetist”. The President of that Association said that “a surgeon has no role as an anaesthethist”. That first academic paper that I submitted to a medical association was rejected and ended in the dust bin of history. But I did not give up. More academic papers were to follow.

Junior Medical Officers

There was a dire need for junior medical officers in the hospital. Sri Lankan doctors were reluctant to work at the Polonnaruwa Hospital for various reasons. The Department of Health finally had to appeal to the World Health Organisation (WHO) to get down overseas doctors to fill the gap. They selected doctors from Burma for a period of two years and sent them to the Polonnaruwa Hospital. There was an Anesthetist as well in the Burmese team. This suited me well although they did not understand Sinhala.

Recognition by the Sri Lanka Medical Council

The Sri Lanka Medical Council decided to recognize the Polonnaruwa base Hospital for training of Intern Medical Officers in view of the wide variety of clinical conditions being treated by the specialists in the hospital. This cleared the way for local doctors to be appointed to the hospital for their internship training. An anaesthethist too was appointed after the departure of the Burmese doctors.

Improving the Operating Theatre:

The operating theatre too was modernized with new equipment being supplied by the Japan International Cooperation agency (JICA). They were helping rural hospitals and my request to JICA was accepted. This made a huge difference to the hospital and I was able to serve the people better.  

Surgical Problems

The Surgical problems encountered were vast and varied – hernias, goitres, cancers of various organs, kidney stones, abdominal emergencies,  injuries caused by trap guns, by wild animals such as bear, wild buffalo and elephants, by agricultural machinery, stabs, assaults, burns and those caused by road accidents. Half of the workload was related to trauma. The management of the surgical patients will be described in the subsequent posts.

Transformation of Hospital

• Improvement of facilities with increase in the bed strength
• The recognition of the hospital by the Sri Lanka Medical Council for training of Intern medical officers was a significant change.
• An upper gastro-intestinal Endoscopy Unit, too, was set up with support from JICA.
• The setting up of a special military ward and the management of war casualties added extra impetus to this hospital.
• Opening of a small Intensive care unit with two beds
• Inaugurate a Clinical Society for the District for medical interaction and fellowship
• The presentation of scientific papers, publications and orations from data collected at this hospital brought recognition not only to the Consultants, but to the hospital as well.

MANY ORGANISATIONS VOLUNTEERED TO IMPROVE THE HOSPITAL

Departure from Polonnaruwa

After working for over six years, the time had come for me to leave Polonnaruwa. It was heart-breaking to say the least. This was a period where I had to work in relative professional isolation. The scope of practice was wide with limited resources to get the job done. The period was highly rewarding in terms of the lessons learnt although under high pressure at times.

Photos with staff and patients prior to my departure from Polonnaruwa

As a General Surgeon in a rural hospital with limited resources, I had to perform surgery on many patients suffering from a wide variety of surgical diseases and injuries incorporating almost all branches of surgical specialization. This was truly a learning experience or what is called today “Experiential Learning”

“A challenge awaits us with each new day breaking.

Run swiftly to it, it’s yours for the taking”

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Keywords : Polonnaruwa, rural surgery, farming injuries, surgical challenges, injuries, surgical innovation, war injuries, land mines, antipersonnel mines, general surgery, saving life, surgical education.

Dear Reader, if you like to read more about my web stories, you might want to read my next story, where I get my first exposure to war injuries : FIRST EXPOSURE TO WAR INJURIES

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