Its time: All good things come to an end
“It was an Experience of a Lifetime” “You see things; and you say ‘Why?’ But I dream things that never were; and I say ‘Why not?’”
George Bernard Shaw
When I was appointed as the Consultant Surgeon, Base Hospital, Polonnaruwa in January 1982 it was a shock to me as I had never worked in a hospital out of Colombo and I did not know my future. I was in two minds whether to accept the appointment or not. I took up the appointment as I had no other choice. The conditions were extremely difficult for me considering that I had just returned from the UK. I was hoping that I would be able to get a transfer to a hospital close to Colombo after a short time. But it never happened that way, and I continued to serve in that District for a record-breaking period of six years and four months. I have written much about my experiences in Polonnaruwa in many of the blogs. I wish to add a few more short stories for the sake of completeness of my accomplishments during this period for the benefit of the younger generation of doctors who will be called upon to work in similar situations and to persuade them to undertake challenges in life for their own benefit.
“The life-changing situation was brought about when I realised that I could gather rich experiences in this distant outpost, not only in matters related to medicine and surgery but to a gamut of life situations especially of the rural poor who were exposed to the harsh conditions of the dry zone”
Serving the Poor and a Great Surgical Experience
As I started working and progressed slowly but surely, I realised that I was getting exposure to a wide variety of clinical conditions that I had never seen or heard before. The surgical experiences were awesome! I do not think I would have come across such patients in city hospitals. What was even more stimulating to continue there was the fact that the patients were the rural poor who had no one to care for them at a time of distress, illness, and suffering. They were the farmers in the Polonnaruwa District working hard in their fields in sun and rain and exposed to the harsh conditions of the North Central Province to earn their living while producing our staple diet, rice. They were the victims not only of the harsh conditions of the dry zone but also victims of wild animals such as elephants, wild boars, bears etc., trap guns and other agricultural implements that interfered with their earning capacity and living. They were also exposed to a whole lot of other socio-economic conditions. The main problem was poverty and ignorance. It is then that I realised that I could not only provide a valuable service to these downtrodden masses but also gain a wide experience in my field of surgery. Thus, I was not in a hurry to ask for a transfer out of that District and continued, regardless of all the difficulties. In fact, when I was offered a transfer out of Polonnaruwa after four years of service, I declined and continued for another 2 years and four months.
“It was a challenging period with much adventure and gave me ample opportunities to demonstrate compassion, care and concern for human life”
My attachment to the people in Polonnaruwa grew as time went on. It was a close-knit family as far as the staff in the hospital was concerned and we were able to work together for the greater good of the patients, over-looking all the shortcomings we faced. There were disputes too when trying to improve the service and change practices. These were sorted out through discussions and sometimes, gentle force. As a team, we adopted, accepted challenges, learnt and treated a wide variety of conditions in a hospital with limited resources and staff to the satisfaction of all. Our work was appreciated. Looking back, I can now confirm that my decision to go to Polonnaruwa was correct and paid rich dividends as I progressed in my life as a surgeon over the next few years. These experiences also helped me in a big way to compile my book titled: IN THE LINE OF DUTY- the life and times of a surgeon in war and peace.
We worked as a team, adapted, accepted challenges and learnt while working in a hospital with limited resources
In my earlier posts, I have mentioned the variety of cases that we treated as a team and the improvement of services at the hospital which allowed me to provide a better service to, especially the poor. I have not lost anything by working in this rural outpost, but in fact gained much, and since then I have always advised junior doctors to take up appointments in such stations if they need to gather experience.
Please refer the following posts:
My life as a general surgeon in Sri Lanka (drgamini.org)
Reminiscence of Six Exciting Years as a Surgeon (drgamini.org)
Clinical Experiences Presented at Academic Meetings
I started treating many patients with surgical problems that I had never seen before. My experiences allowed me to publicize the case studies at clinical presentations and was useful for teaching young personnel. I started collecting data relating to a variety of surgical conditions. Photographs of these conditions were also taken, on admission, during surgery and on recovery. My camera was not a sophisticated one, but a simple Olympus Trip 35 mm camera which I purchased in the UK. That served me very well. They say “a photograph is worth a thousand words”. True enough, the large and varied collection of photographs of various surgical conditions helped me immensely in my audio-visual presentations. They had a tremendous impact at presentations to both medical and lay audiences. The presentations on injuries caused by blasts, missiles and antipersonnel mines were something new at that time and only a few had the experience in treating these injuries. In fact, I had the opportunity of delivering at least four orations related to these subjects in addition to an oration on agricultural accidents.
By taking the risk of getting involved, I learnt many things that a surgeon will not learn from books. The wisdom of experience gained in the field of work always complements academic learning.
“I did not consider my work as a burden but as a pleasant and sacred duty, not as a problem, but as an opportunity; not as a misfortune, but as a reward in terms of not only the experience in my specialty but in activities outside my specialty”
Appreciation by the Military and War Surgery
With the onset of the conflict in the North- East of the country, the Base Hospital, Polonnaruwa became a centre for the treatment of war casualties. That led to the development of a close bond between the Military officers and myself. All activities were coordinated from the Military Camp at Minneriya and this became a centre of activity for training as well. Many were the occasions that I was invited for these ceremonial functions and fellowship at other times in appreciation of the services rendered to the armed forces’ men injured in the war. The Chief of Staff of the Joint Operations Command (JOC) at that time, General Cyril Ranatunge himself visited the Hospital on many occasions to express his thanks to the staff and to see the victims of war. On learning that I am leaving the Polonnaruwa Hospital he visited the hospital with senior Army Officers to present a memorable plaque in appreciation of the services rendered to the soldiers injured in conflict.
Development of the Catholic Church and Religious Amity
Polonnaruwa was and is even today a predominantly Buddhist city. That did not in any way interfere in me practicing my religion as a Roman Catholic. Everyone knew that. There were two small churches in Polonnaruwa, one in the New Town and the other at Palugasdamana on the road to the famous Somawathiya Chaitiya. There was only one Catholic priest in Polonnaruwa. He was Rev. Fr. Ranjith de Mel. I developed a close friendship with him and helped him in many ways in his religious duties.
We got on well with the Buddhist clergy as well. In fact, many Buddhist monks used to come to me for treatment. If they came to meet me privately, I never took any fee from the respected clergy. I respected all religions and their followers.
One morning I was doing my ward round and examining every patient in my ward. I did not notice, a Buddhist monk standing outside the ward was observing me. After my ward round the respected monk approached me and asked a very significant question which I remember to date. “Doctor, are you a Catholic”. In turn, I asked the monk, how did you know? The monk’s reply…. “from your actions I can say that you are a Catholic”. I believe that is one of the finest compliments a Catholic could get!
The Chief Monk at the Dimbulagala Hermitage, Ven. Matara Kitalagama Sri Seelalankara Thero used to come to me for medical advice. On every occasion, he used to bring me a bottle of pure bee’s honey from the jungle. This famous monk was living in a cave temple in a remote village called Dimbulagala situated in the jungle. He was promoting the settlement of Sinhala families in the bordering villages of Polonnaruwa. It is sad to note that he was killed by a terrorist bullet on 26th May 1995 many years after I left Polonnaruwa.
Expansion of our Catholic Churches
The building that was used as a church was a small house that had been converted to a church. It did not have enough space even for the small catholic congregation attending services. With the help of many people in and out of Polonnaruwa, we were able to expand this building to accommodate all the worshippers. The church at Palugasdamana was a cadjan hut. We were able to build a new church here with donations from various organisations and people. Thus, both churches were uplifted for the greater good of the Catholic community in Polonnaruwa.
Family support, friends and Cricket Club
If a surgeon is to concentrate on his professional duties, he must get the required support and understanding of his family. If the family is living many miles away, it is not easy for the surgeon to concentrate and do his job well. He will be thinking, when he could get home, how long he could spend at home, and also when he can get a transfer to a hospital close to his home. He would not even be interested in improving the services in the hospital.
I am happy to say that I had no such problems. Shelendra, my wife was a great support to me. She had decided to shift to Polonnaruwa no sooner I found a place where the family could reside. The only delaying factor was the birth of our second son, Chaminda. This was a nerve-wracking event for me on the 9th of July 1982 as I was in Polonnaruwa when Shelendra developed labour pains. I had to make a quick departure to Colombo by CTB bus, but was able to be in the nick of time when the baby “popped out”, took a deep breath, and cried instantaneously to the joys of everyone present. With the mother and baby doing well, I returned to Polonnaruwa two days later, now a proud father of two sons and anxiously waiting for the arrival of the family in Polonnaruwa as soon as possible.
Before long, Shelendra, Shevan and the newborn baby, Chaminda were there and thereafter we were together in Polonnaruwa till my transfer in April 1988. This was a vital decision that both of us took to be together with our children. The presence of my family in Polonnaruwa helped me in a big way to concentrate on my job without rushing to Colombo on and off. Shelendra was a tower of strength to me and never complained even though we had difﬁculties in adjusting to our new home in Polonnaruwa. From Manchester, UK to Polonnaruwa, the change was unimaginable and people wondered how we were going to adapt, to the new setup in a rural District. There is no doubt that the strength and courage given by our God Almighty helped us in no small way to go through this period which we are truly proud of.
Another issue for parents is the education of their children. Shevan and Chaminda started schooling in Polonnaruwa; ﬁrst in the nursery school run by the Catholic Church, after which they were admitted to Royal College, Polonnaruwa for their initial education up to Grade 5. This was another good experience for them as they were able to mix and move with children from a different strata of society. This experience is something that the children studying in schools in the city do not get. They can proudly say that they studied in the same school that a former President of The Democratic Socialist Republic of Sri Lanka had his education and are now Former Royal College Students of Polonnaruwa or FRCS (Polonnaruwa) even though it may not be as good as the FRCS (England) which I possess.
As the only surgeon in the hospital, and for that matter for the entire district, I had to be available day and night. There were no days off. Treating patients and saving lives had to take precedence sometimes over family issues. There were many occasions on which I had to leave home late at night or in the early hours of the morning across the shrub jungle known to be infested with snakes to my ward to attend to emergencies. My presence in the hospital was all the more important when we were confronted with casualties from the war front.
This meant that the time spent with the family was limited. It is no exaggeration if I say that on many occasions the “Surgeon’s Knife came before the wife”. The overwhelming and ungrudging support that I received from Shelendra, Shevan and Chaminda during this period not only helped me to save many lives but was also a successful period of service in Polonnaruwa.
Friends and Cricket Club
In addition to my interest in my surgery, another important factor that kept us in Polonnaruwa for such a long time was the beautiful “bunch of friends”(too numerous to mention names) from all walks of life. Most of them were also active members of the cricket club mentioned in my earlier post, but there were others too who were very close to our family and that relationship continues even today. They appreciated my service, and we appreciated their support to us while we were living and working in a distant out-post away from Colombo.
Time to leave
I informed the Ministry of Health that I wanted to leave Polonnaruwa for personal reasons. That was after serving the District of Polonnaruwa as the only surgeon for a period of six years and four months at a very difficult period in the history of our country. The Officials at the Ministry responded to my request favourably considering my service and they decided to release me even though there was no replacement to take my place. That was sad!
For me, this period of service at Polonnaruwa was undoubtedly the most exciting, most enjoyable and the most educational in terms of my specialty of surgery. This was especially so in terms of the experience gained in treating war injuries and all other aspects of general surgery including injury. This is what is referred to as EXPERIENTIAL LEARNING.
The satisfaction, however of treating so many downtrodden people from villages gave me immense pleasure. That was the overriding factor that kept me there. The experience was enriching and rewarding.
It was a sad departure preceded by functions to bid farewell by the Infantry Training Centre of the Army at Minneriya, Cricket Club, Catholic Church and finally in my ward at the Base Hospital, Polonnaruwa in April 1988.
“The future belongs to those who Believe in the beauty of their Dream”
Dear Reader, you might be interested in the next story of a patient who struggled for survival : ‘THE CHILLING BOWEL TWIST’