The National Hospital of Sri Lanka:

A 150-year journey of healing

The saga of the National Hospital of Sri Lanka (NHSL) has been recounted by Dr. C. G. Uragoda in his book; `History of Teaching Hospitals in Sri Lanka.' According to his account, the General Hospital (as it was then known) was established during Sir Henry Ward's Governorship (1855-1860), with 3000 pounds sterling being earmarked for the project...

In 1900, Longden Place was renamed as Kynsey Place, in commemoration of Sir W.R. Kynsey's services. During this era, Mutwal was the residential area of Colombo. Thus, the hospital was chosen to be located in Cinnamon Gardens, as its suburban setting was deemed more appropriate for its functions. Dr. Andreas Nell, who was incidentally born the same year as the hospital was founded, provides this account of the environs of the hospital's geographical setting:

Kynsey Road

"The General Hospital was not built in a very populous area. Coming from the north, there was a shady, narrow avenue behind the mansions. `Titchbourne Hall' and `The Gutharium'. From the east, there was a similar avenue running from the Welikada Prison. Among the houses built there were also two undertakers' business establishments. From the western direction, coming from Turret Road, there stood a small villa called `The Mango Lodge', where the Eye Hospital stands now. This had been used as a rest house by the Dutch administrators during their many hunting expeditions.

"There were only five houses in the whole of Regent Street, which extended from 'The Mango Lodge'. On the right hand side of the hospital, a long road ran all the way to the Colombo cemetery. During the time the streets of Colombo were being named, this road was named Kynsey Road after the head of the Medical Department, Sir William Kynsey."

General Physician

In 1885, the Hospital could claim 22 wards that included 212 beds. These wards, connected to each other by narrow corridors, were divided as Naval, Paying, European, Surgical, Emergency, Indigenous, Surgical and Venereal.

The only General Physician of the hospital was Dr. G.W. Fowler, while the only Surgeon and Pathologist was Dr. H.G. Thomas.

They were assisted by Resident Physician Dr. Eliyatamby. Of the 212 hospital beds, 112 were dedicated to the Medical Unit, whereas the rest was provisioned for the Surgical Unit.

However, in 1882 alone, the hospital treated 3,714 admitted patients of whom 1509 were surgical patients. According, in 1894, the number of wards was increased to 24, while beds were also increased to 280.

By 1879, the nursing service had been institutionalised well into the hospital's working structure, particularly with the drafting of the constitutional documents pertaining to their roles and duties within the hospital. All nurses were brought under the purview of the Chief Nurse's supervision. These nurses were not initially afforded any technical training; the only relevant qualifications were literacy and the possession of a certificate of good character. Nurses were proportionately distributed among each ward, or clusters of wards, based on their scale and number of interned patients. They were required to work night shifts. The day-time shift, consisting in 14 hours, was from 6 a.m. to 8 p.m.

The government faced many difficulties in recruiting nursing staff for the hospital. In the end, the Governor was compelled to request clergywomen to man the nursing staff through the Catholic Church, after Dr. W.R. Kynsey who headed the department, made an official statement on February 8, 1886, to the effect that Governor of Ceylon Sir Arthur Gordon was eager and enthusiastic to recruit Catholic nuns as trainee nurses.

Most Rev. Christopher Bonjean, OMI, the Archbishop of Colombo at the time, considered this request and, upon His Grace's satisfaction, provided the hospital with Rev. Boisseu OMI and six Franciscan nuns who arrived in Colombo on June 15, 1886 from Marseilles, France. They were accommodated within the hospital's premises in a small house, after having it consecrated by Revs. Boisseu and Collin (OMI), with the participation of the hospital administration.

Eye Hospital

An eye hospital named after the recently deceased Queen Victoria was first conceived by the wife of the then Governor of Ceylon, Sir Joseph West Ridgeway. Accordingly, a fund was established in aid of those suffering from visual impairments. Lady Ridgeway also made public announcements regarding the project through the media. The newspaper companies supported the projects enthusiastically. Ceylonese magnate Muhandiram N.S. Fernando donated an amount of Rs. 5,000 in aid of this fund. In record time, the fund succeeded in amassing one lakh in rupees through public donations alone.

On August 6, 1903, the laying of the foundation stone for the new hospital was carried out under the auspices of Lady Ridgeway. This hospital remains to date, and is still visible in all its splendour at one corner of the Colombo Town Hall/Eye Hospital junction. Influenced by Hindu architectural traditions, the buildings were designed by renowned architect and member of the Royal Institute of British Architects, Edward Skinner.

The facade of the hospital spans an area of 200ft by 197ft. Initially, the hospital could only house 45 patients.

The wards were illuminated with gas lamps. In 1906, a room in the Planters' Ward was specially set up with four beds for the internment of members of the postal service. It became known as the Skinner Memorial Ward.

The first administrative building was established in 1904, and it still stands majestically today, knows as the White House'. The safes installed in this building were employed by the Colombo Hospital board to store the moneys relevant to the administration of all the hospitals under the bard in Colombo.

Laboratories

Several laboratory divisions were set up within the National Hospital of Sri Lanka, based on the needs of the specialists.

The laboratory established in 1921 to identify venereal diseases and the laboratory established in 1962 as the Blood Bank was later institutionalised as the National STD/AIDAS Control Programme and the National Blood Transfusion Institute. In 1978, all of the various laboratory divisions were amalgamated into one Department of Pathology.

Our -Patient

In 1910, the first ever out-patient department was established. Today, that building is occupied by the Main X-Ray Unit.In October of 1918, Sir William Henry Inaugurated the Merchant Ward, which is known today as Ward No. 15.

The history of the Rheumatology and Physiotherapy Unit traces back to the 1920- 1930 era. During that period, electrotherapy and massaging lamps and muscle simulators were administered by nurses.

Dental

As at 1920, the public dental health service provided only the most basic dental services. None of the significant dental surgeries were provided during that time. However, as per a strategy drawn up in 1924, a private residence down Ward Place was converted in 1925 into a dental clinic.

The Hospital Radiology Unit was established within the administrative building in 1926. While the use of radium in treating cancer patients in the General Hospital was first begun in 1929, such use was continued until the establishment of the cancer-specific institution in Maharagama.

Specialists

A majority of specialist doctors in the year 1930 were General Surgeons. Although they served in a large number of hospitals, the Health Director was a British national. During the period of the World War II, the OPD unit of the General Hospital was requisitioned as a war hospital; war patients were interned in the school premises of several schools including St. Joseph's College, St. Peter's College, Holy Family Convent and Nalanda College. The year 1939 saw the break out of World War !!. On May 9 of that year the Colombo College of Nursing was launched under the able guidance of Ms. Baird.

Teaching Hospital

With the creation of the University of Ceylon in 1942, the Colombo General Hospital was selected as its teaching hospital.

Dr. J.B. Peiris assumed duties as neurology consultant in 1972, founded the Neurological Intensive Care Unit. Subsequently, on April 8th of 1984, a formal Neurological Unit was installed.

The first orthopaedic workshop had been established in the General Hospital in the year 1947, subsequent to the enactment of a special statute in the National Legislative Assembly.

In 1958, an administrative complex named the Bandaranaike Block was erected, consisting of five storeys that included operation theatres, wards, as well as a sterilisation unit. This complex remains as the administrative block, even today.

Hospital kitchens

The hospital kitchens were also started in 1952 with the initiative of American-born Ms. Jailor, assisted by seven Catholic sisters.

The first cardiothoracic unit was established in 1952. The year 1955 saw the beginning of the hospital's many open-heart surgeries. Further, a six-bed, air-conditioned intensive care unit was also declared opened immediately adjacent to the cardio unit, on June 16th of 1968, by the then Minister of Health E.L. Senanayake.

ECG Unit

An ECG Unit was opened in the out-patient department on November 1, 1955, where approximately six patients were provided with the facility each day, with nearly half an hour being spent on each patient's assessment.1955 also saw the recruitment of the first Genito-urinary specialist of the General Hospital, Dr. George Nelson Perera,

In 1957, the College of Physiotherapy and Occupational Therapy was inaugurated as an affiliated institution of the Colombo General Hospital.

The School of Radiology that was founded in 1957 and situated in the X-Ray Reporting Room has, since then, been relocated to a new building adjoining the X-Ray Unit.

Pharmaceutical services were launched in 1958 in all the hospitals island-wide, including in the General Hospital. Initially the in-house pharmacy of the General Hospital was operated by two pharmacists. While this setup was not adequate to cope with the scale and number of patients of the hospital in that era, by 1970, the unit came to be manned by 15 pharmacists who worked round the clock. It was the first of its kind to provide such a service. On the 2nd of February, 1958, the then Prime Minister S.W.R.D. Bandaranaike declared open the Surgical Ward and the Surgical Complex. After the opening of this block, known as the Bandaranaike Building, the first patients to be treated were neurosurgical patients. In 1960, a Electro Encephalography unit was begun in the Neurosurgical Unit. In 1988 the first training school for Electro Encephalography was established in the neurosurgical unit by four trained personnel.

Mental Health

Ward No. 59 is the Mental Health Ward affiliated to the University of Colombo. Its inception was in the latter half of the 1960s. At that time the Dean of the Medical Faculty of the University was Prof. Stanley Dissanayake. In 1969, he was succeeded by Dr. C. P. Wijesinghe.

Accident Ward

The Victoria Memorial Building that originally housed the Eye Hospital was vacated when the present-day Eye Hospital complex was declared open adjacent to it in 1955. Two years later, on New Year's Day of 1967, a newly constituted Accident Ward was inaugurated in the Victoria Memorial Building.

Intensive Care

Sri Lanka's first Intensive Care Unit was opened in the Surgical Complex on June 15th, 1968. The Emergency Trolly/Crash Cart concept was also incorporated to Sri Lanka's medical history.

Cardiology

The founding of the Cardiology Unit was spearheaded by Dr. I. O. Obeysekara. At its inception in 1969, this new unit laid claim to two wards and two ICUs. Today, it claims two ICUs and three wards (Wards 60, 61 and 70). This year (2014), preparations are underway to incorporate another ward (Ward No 71) to the unit. While six units are in operation, 13 doctors manage their operations. A Coronary Care Unit was opened in 1973.

Respiratory

In 1989, a new service was launched in relation to the respiratory system; for the first time in history, a Sri Lankan hospital was able to administer fibre optic bronchoscopies on patients.

The Burn Unit opened on October 28, 1974 in the Lady de Soysa Ward was the brainchild of specialist surgeon Dr. Joe Fernando.

Historic architecture

In the 1960s a far corner of Ward No 56 was demarcated for dermatological patients. In 1978, the Dermatological Ward was relocated to a different building. While, today this location is known was Ward No 13, it was then known as the Naval Ward. The ward comprised a wood-panelled upper floor, a rope-operated elevator and an old-fashioned staircase. Thus, the building bore the allure of historical architecture. The first phase of the project was to completely refurbish the Accident, Emergency, Orthopaedic, and Trauma Units with state-of-the-art equipment.

Renal Transplant

The Renal Transplant Unit of the General Hospital was opened on May 6, 1987. The first CT-scanning machine was installed in the year 1989.

Bomb blast victims

January 31st of 1996 is etched permanently in the collective consciousness and memory of the staff of National Hospital of Sri Lanka as the day hospital of Sri Lanka as the day hospital was called upon to admit and treat approximately 1200 patients as a result of the bomb blast that devastated the Central Bank. 76 lives were lost that day.

The National Poisons Information Centre was established January 1st 1988, under the supervision of Prof. Ravindra Fernando. The Centre was also the first of its kind in all of South Asia. It provides 24 information service through telephone hotline (0112686143) as well as email ([email protected]). The year 2000 also saw the opening of the innovative Speech Pathology Unit. Also in the same year, the first ever MRI machine began its operations in the hospital.

Vascular

The first Vascular Surgical Unit of the hospital was launched by Prof. Sherifdeen.Rabies Treatment Unit began operations on April 4, 2005, in Room No 2 of the Out-Patient Department.The foundation stone to the Neurotrauma unit was laid by President Mahinda Rajapaksa on September 26, 2005.On June 21st, 2013 the Pain Management Unit was opened under the directives of consultant Anaesthetist Dr. Rohini Ranwala. On May 2nd, 2014, the Cornea Collecting Centre was launched under the auspices of the National Eye Bank of Sri Lanka (NEBSL). A health assistant from the National Eye Bank of Sri Lanka coordinates the services, working round the clock daily. The collected corneas stored in a deep freezer and are transported to the NEBSL.

(The above is an excerpt of the chapter titled 'A short History of NHSL' in A Legacy of 150 years, researched and written by S.S. Jayasinghe, Mrs. P.D.C.S.N. Withanage, Miss. R.A.D.C. Karunarathne, V.P. Wimalasena, R.P.H. Perera, Chanaka Darmawikrama, E. Dharmakeerthi, Chathura Dharshana and Mrs. P. Dayani)