Body and mind

Lanka treated Neurological disorders from ancient times:

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.

The 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 ancient times.

NHSL

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.

Official

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 of service.

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).

Strike Unit

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.

Neurophysiology Unit

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.

Epilepsy

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.

The 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.

Epilepsy surgery

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 in 2003.

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 world.

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 Epilepsy.

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 future.