Keeping hearts beating

by Chanuka Mannapperuma

The year 1953, the Head of State of the newly independent Ceylon falls off a horse, during his morning exercises. D. S. Senanayake suffers a head injury and is rushed to the General Hospital Colombo. He gradually becomes unconscious and doctors diagnose an Intracranial Haemorrhage. Sri Lanka has no Neurosurgeon. Pakistan's leading Neurosurgeon is flown down albeit too late.

An Intracranial Haemorrhage will kill within a few hours as the brain lies within a rigid enclosure of the skull or cranium with no surplus space. The expanding clot compresses the brain and kills quickly. D.S Senanayake had no chance to survive.

The Health Ministry recognized the necessity of a Neurosurgical service and groomed Doctor Shelton Cabraal who after under going a training in the U.K. in 1956 started performing the first Neurosurgical operations in the country.

Initially he had five male and five female beds lent to him by his colleagues in the surgical wards and subsequently he graduated to the 4th floor of the Bandaranaike Building in 1959. This 4th floor was a purpose built service with male and female wards, Theatre, X-ray and EEG.

Dr. Cabraal considered the Godfather of Sri Lankan Neurosurgery, reigned supreme till his retirement in 1982, after 26 years of devoted service. He trained many Neurosurgeons most of whom are in foreign countries.

Amongst Dr. Cabraal's trainees is the present country's top Neuro-specialist, Dr. Colvin Samarasinghe whose Neurosurgical career spans over 27 years. We cannot stop death. Those who live because of him, pray that this wonderful man should continue in service for many more years.

As these patients hope in this manner, the walls of the National Hospital too and its staff do not wish to lose the services of this surgeon who created history there, by upgrading the Neurosurgical Unit for the benefit of all.

A man who cures a patient who suffers from brain disorders, be it a tumour sometimes malignant, performs a meritorious act. Such a man, a specialist doctor is a rare specimen, such great men are created by nature to protect mankind.

He who performs such a meritorious act is a person engaged in a noble profession. A brain tumour could strike anyone at any moment. The more affluent can pay for the best possible treatment at home or abroad. But what about the majority?

Due to the relentless commitment and unbounding perseverance of a single individual, Dr. Colvin Samarasinghe, was the one who espoused the need to extend facilities to the poor in this country. Echoes saying that 'Poverty is no criteria for treatment. With 30 years of experience as a top medical specialist, he is doing a great service to the people in this Nation.

A product of St. Thomas' College Mt., Lavinia he passed out from the Colombo University, and completed higher training at the Charing Cross Hospital in London and The National Hospital for Nervous Diseases in Queens Square, London. He decided to serve his Motherland.

In 1991 Dr Samarasinghe became Sri Lanka's Senior Neurosurgeon at The General Hospital Colombo and it was then that the care for the poor Neurosurgical patient improved. At that time Neurosurgery was confined to Colombo with two Neurosurgeons at The General Hospital.

The stench of urine emanating from the 4th floor nauseated even the dedicated medical staff. Nobody liked to come to work in the NSU. When a Doctor or a Nurse was allocated to the ward, it was considered a punishment transfer.

Investigations were primitive. For example for diagnosis of a neurosurgical problem inside the skull, Angiography was performed - where a needle was threaded into a neck artery, a dye injected to the brain and X-rays taken. There was a high risk of complications like paralysis, permanent maiming or even death. In the two Private Hospitals in Colombo CT Scanning facilities were available.

The affluent who could afford Rs. 5,000 obtained a brain scan from the private sector and came to GHC for treatment.

Dr. Samarasinghe saw the discrepancy and double standard of treatment and he together with a group of leading individuals of the country established the Neurosurgical Trust Fund in 1993 with the idea of upgrading the facilities in the Neurosurgical Unit and purchasing its own CT Scanner.

However, through an appeal made by Dr. Samarasinghe to the Government of the Federal Republic of Germany a brand new CT Scanner was donated to the Neurosurgical Unit of the General Hospital. This NSU Scanner was declared open by the Prime Minister Sirimavo Bandaranaike, in April 1995.

Anyone who suffered a head injury and was admitted to the Accident Service had access to the above Scanner located on the 4th floor of the Bandaranaike Building.

Inward patients had their diagnoses made almost on admission, the staff was motivated, job satisfaction improved. Thus overcrowding was reduced, deaths declined. The restructuring of the Bandaranaike Building by the Government in 1993 gave Dr. Samarasinghe an opportunity to add more facilities to the Neuro Unit.

Children who were kept together with their mothers in the female ward were allocated a new Paediatric Neurosurgery ward on the 5th floor, twin Theatres were built, a purpose built Intensive Care Unit was declared open by the then Minister of Health in 1993. This ICU is the fruits of Dr. Samarasinghe's untiring efforts. Almost everything in the ICU was obtained through his skill.

The 12 beds were gifted by a Neurosurgical Colleague in Japan through the goodwill of Mr. Sarath De Costa. 36 Nurses allocated by the Ministry were specially trained in Neurosurgical Nursing. This ICU and its Staff still continue in the same pristine glory to save hundreds of lives of the poorest of the poor.

Dr. Samarasinghe annually sent three Nurses and doctors to Japan for three month periods of Advanced Neurosurgical Training. For this all funds were provided by donors and well-wishers. Gradually the NSU became the nurse's and doctor's first choice.

For diagnosis of Spinal problems and complicated problems of the brain MRI Scanning is the best. In 1994 MRI scanning was available in the private sector. At a cost of 15,000 rupees it was beyond the means of the majority.

The affluent obtained an MRI Scan from the Private Sector and had surgery performed at the General Hospital whilst the poor had to depend on a Myelogram - where a long needle is inserted to the spine (lumbar puncture) a dye introduced and x-rays taken. Inadequate information, a high failure rate and complications were the result.

At the inauguration ceremony of the CT scanner in 1995 Dr. Samarasinghe launched the MRI Scanner Fund. The first donor was Pesi Pestonjee (Abans), The cost of the Scanner was Rs. 80 million. People laughed at Dr. Samarasighe, but no task is too big for an astute and meticulous planner. Over the next five years he collected money. Dr. samarasinghe sent one hundred letters daily to prospective donors.

The Courts diverted their fines, Caps were sold, Musical shows were conducted, Artists held exhibitions of their paintings channelling all proceeds to the fund. 40 Million was collected. On a personal appeal made to President Chandrika Bandaranaike Kumaratunga another 40 million was allocated from the President's fund. Sri Lanka's first Government Hospital MRI Scanner was declared open by President Chandrika Bandaranaike Kumaratunga in January 2001.

With the systematic upgrading of the Neurosurgical Services in Colombo the poor had access to a service on par or even better than the Private sector. During the five years of collection of funds for the MRI Scanner (1995-2000), a philanthropist - Yaseen of Readywear Industries provided Rupees Three Million that enabled two Government Hospital poor patients to have MRI Scans from the Private Sector each week.

Further Advanced facilities such as Operating Microscopes, Stereotactic Equipment, were purchased through donations and also provided by the Ministry of Health. The Unit came up to international standards. Trainee Neurosurgeons from USA and UK came annually for three month periods of training in Dr Colvin's Unit.

Today we have Neurosurgical Units and Surgeons in Kandy, Galle, Ratnapura, Kurunegala,Badulla, Batticoloa and Anuradhapura. Most of these Surgeons have been his trainees. All these units have their own CT Scanners provided by the Ministry of Health. Some have MRI Scanners.

All Units are well equipped to perform quality Neurosurgery. But it was one man's vision, foresight and personal efforts that brought Neurosurgery to its present state in Sri Lanka.

Following the Central Bank blast over 125 casualties with head injuries were operated over two days and nights continuously by him and his team of doctors. The Director of the National Hospital, Dr. Hector Weerasinghe has stated that Dr. Samarasinghe is amongst the first to arrive at the Accident Service whenever he hears the explosion of a bomb in the city.

His leadership and tremendous sense of devotion to the National Hospital's poor patients remains unparallelled in the history of the Health services of Sri Lanka. Thousands of men and women cured by him from every part of Sri Lanka bear testimony of his skill as a great Neurosurgeon.

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