Body and mind
Lanka treated Neurological disorders from ancient
Excerpts from an article on the history of Neurological disorders
treatment in Sri Lanka published in 'A legacy of 150 years' to celebrate
the 150th anniversary of the National Hospital of Sri Lanka. The author
is Ranjani Gamage, Consultant Neurologist, NHSL.
ancient Sinhalese were responsible for introducing the concept of
hospitals to the world. The oldest archaeological evidence of a hospital
can be traced back to the ruins at Mihintale. The layout of the building
and the amazing discovery of a medicinal trough (Behethoru) which was
used to treat patients with paralysis and other nervous system disorders
bear testimony to the skills of treatment of such disorders during the
Native Medicine practised in ancient Sri Lanka was primarily based on
the Ayurvedic system where Nervous System disorders were categorised as
'Vatha Roga' and was greatly influenced by the Indian Medicinal
traditions. In spite of the profound Indian influence, medical knowledge
in Sri Lanka developed on its own course. Western medical practices
influenced the native medicinal traditions during the Portuguese, Dutch
and British rule.
However, the initial appointment of an official Neurologist took
place only in the year 1951. Dr. George Ratnavale was the first
Neurologist in the country. Dr. Ratnavale assumed office and duties at
Ward 44 at General Hospital, Colombo (now known as NHSL).
He underwent numerous hardship due to the poor emphasis extended to
the field of Neurology in Sri Lanka at the time retiring after 21 years
Dr. J.B. Peiris succeeded Dr. Ratnavale on his retirement as the
second Neurologist of this country and served as the country's sole
neurologist for a period of 10 years.
During this period the only available method of ventilation for JB's
patients was an Iron Lung, which was obsolete in context with the
treatment prevailing at that time.
Dr. J.B. Peiris was able to solicit funds to refurbish and equip the
former staff tea room of Ward 44 into the first ever Neurology Intensive
Care Unit, comprising 3 beds, 2 simple 'Blease' ventilators and 2
cardiac monitors. The Minister for Health, Gamani Jayasuriya and the
Minister of Finance, Ronnie de Mel, were instrumental in channelling a
substantial donation for this activity from the Bank of Ceylon.
Institute for Neurology
The idea of establishment of an Institute for Neurology germinated in
the mind of Dr. JB and his vision was a well-planned and fully equipped
Institute of Neurology that could provide a total and comprehensive
Neurological service to all patients under one roof. However, this task
was obviously herculean. It was a challenge to find a site for the
building and also to arrange funding.
In spite of all the difficulties and many obstacles in the path, the
Institute of Neurology was born and ceremonially opened by then Prime
minister R. Premadasa on April 8, 1984.
The Institute of Neurology, NHSL, was commissioned in stages, due to
limited staff provision by the Ministry of Health. Initially, only the
clinics were functional, followed by the Neurology Intensive Care Unit (NICU).
It was only 2 year later that adequate staff was provided to make the
institute fully operational. Currently the institute has a bed strength
of 24 each in male and female wards and is equipped with a Neuro ICU
with 6 beds.
Dr. Jagath Wijesekera was appointed to NHSL in 1991, established the
second Neurology unit at Gnanasekeram ward, with 20 female and 23 male
beds. Upon retirement of Dr. JB, Dr. Jagath Wijesekera shifted to Unit 1
and Dr. Ranjanie Gamage took over the duties of Unit 2.
Dr. Jagath Wijesekera having recognised stroke as the second
commonest cause of mortality in Sri Lanka, pioneered the stroke program
in the country. Under his guidance a stroke unit was established in 1999
and a multi-disciplinary stroke management team was formed where Dr.
Udaya Ranawaka played a vital role. He initiated the special stroke
clinic and launched several awareness programmes and established a
comprehensive stroke rehabilitation programme at the NHSL.
Having recognised the importance of Neurophysiology, Dr. Jagath
Wijesekara took the initiative to establish the Neurophysiology unit in
1999, with the support of Dr. Ranjanie Gamage. Dr. Sudath Gunasekara was
appointed as the first Consultant Neurophysiologist and pioneered
Neurophysiological studies in the country.
As the fourth Neurologist of Sri Lanka, Dr. Ranjanie Gamage
identified the dearth and the desperate necessity of a comprehensive
program of patient care for the most prevalent and common chronic
Neurological disorder - Epilepsy.A dynamic team was banded together to
form the Epilepsy Task Force, comprising several specialists, involved
in managing Epilepsy patients.
objectives of the task force,
1 Establishment of a tertiary care clinic at the NHSL.
2 Facilitation of knowledge transfer & disease awareness via public
workshops, seminars & training programmes on a transnational basis.
3 Instigation & origination of Epilepsy Surgery.
4 Establishment of a Modern & Equipped comprehensive National
Epilepsy Patient care centre at the NHSL.
The only Epilepsy Tertiary Care Program to this date in Sri Lanka was
inaugurated and dedicated to the public in the year 2002 by then
Minister of Health, John Seneviratne. The Neurological & the
Psychosocial team established at the Institute of Neurology at the NHSL,
prolifically combines to provide comprehensive patient assessment and
care under one roof. The unit has been undisputedly acknowledged and
looked upon as the model unit of peer hospital emulation.
The establishment of an Epilepsy Surgery Care Programme was another
demanding priority. Prof. Ranjanie Gamage was instrumental in
coordinating and sourcing assistance from world renowned Neurologists &
Neurological centres to establish this programme.
An invaluable and exceptional contribution was made by Prof. Kurupath
Radhakrishnan who readily expressed the willingness to provide the
training needed by the team for the establishment of this programme.
Ensuring several training sessions both in India as well as Sri
Lanka, the first five patients with Epilepsy underwent surgery at NHSL
The inaugural Epilepsy surgery was performed by Consultant
Neurosurgeon Dr. Sunil Perera. Up to now we have carried out over 200
Epilepsy surgeries with a success rate comparable with best centres in
The Task Force was instrumental in the declaration of a National
Epilepsy Day and conducting numerous Epilepsy Awareness Programmes
island-wide, including an Epilepsy walk. The team was also actively
involved in formulating the National Guidelines for the management of
Prof. Ranjanie Gamage, also succeeded in securing US$ 20 million from
international donors towards the construction of a fully equipped state
of the art Epilepsy Centre, which will be housing the only PET and SPECT
facilities in the government centre. It is scheduled to be commissioned
early next year and will provide inward facilities for Epilepsy patients
and investigation procedures for other Neurological patients as well.
Once the epilepsy care programme was 'up and running', a Movement
Disorder clinic was established.
A surgical program was conducted with public and private sector (Asiri
Surgical Hospital) partnership. To date we have carried out 7 Deep Brain
Stimulation surgeries on Parkinson's patients.
After Dr. Jagath Wijesekara's retirement in 2004 August, Dr. Padma
Gunaratna assumed duties at Gnanasekaram ward. Since then the stroke
programme was spearheaded by Dr. Padma Gunaratna who actively instituted
measures to increase public awareness regarding strokes, established a
stroke rehabilitation programme, carried out numerous conferences on
stroke with international collaboration and initiated administration of
thrombolytic therapy for acute strokes which is currently practised by
both Neurology units at NHSL.
Today, the Institute of Neurology is a prime tertiary care institute
serving as a final referral centre with a clinic turnover of around five
thousand patients per month and an inward turnover of around 300
patients per month and looks forward to improving its services in