ISSN: 1391 - 0531
Sunday December 30, 2007
Vol. 42 - No 31

The OPD at Kalubowila Hospital - unseen side and untold stories

By Dr. Lakshman Abeyagunawardene

In any hospital, the Out Patients Department (OPD) is the place most frequented by both patients and visitors alike. Beyond that, public access to the wards and other units is strictly limited. More often than not, impressions are formed and judgments passed, based on what is visible in and around this gateway to the health care centre. The Colombo South Teaching Hospital of today, now a major tertiary care facility, was better known as Kalubowila Hospital in the late sixties.

Much has been written about this hospital not only by journalists, but also by casual visitors and those who had availed themsleves of the services it offered. Both bouquets and brickbats have been hurled mainly at the hospital administrators. In this article, I will touch on my own experiences and impressions while serving there as a Medical Officer (MO) in the OPD from January 1969 to September 1970.

At that time, Kalubowila Hospital was a showpiece in a sense. It was no doubt one of the cleanest government hospitals in the country (by standards of a developing country). It was relatively new and had a cleaner look unlike the Colombo General Hospital, which was much older and therefore difficult to maintain. Much of the credit in this regard should go to the Medical Superintendent (MS) of the hospital at that time - Dr. Malinga Fernando who was a stickler to cleanliness.

The MS had a reputation as an excellent administrator. He never “warmed” his seat in his comfortable office on the upper floor in the main Administration Building. It was much easier to spot him doing “ward rounds” or inspecting the kitchen, stores, pharmacy, blood bank, operating theatre and even the mortuary! We in the OPD too saw much of him, as he made his customary visit from room to room or as he unfailingly stood near the main entrance shortly before 8 a.m. each day.

It was a little known secret that Dr. Fernando who ultimately occupied the Secretary’s seat in the Health Ministry, had used the floor polisher that was his personal property, to polish the floors at Weligama and Panadura hospitals where he had served earlier as District Medical Officer (DMO).

As in most OPDs, the medical staff was predominantly female. Most of them had spouses who held “permanent” jobs in Colombo, and Kalubowila was a convenient workplace for these lady doctors. The Senior Medical Officer in Charge was Selvam Fernando who had to arrange the week’s roster for us. Needless to say, late and nightshifts were not as popular as regular daytime hours. But the genial Selvam was always fair in preparing the roster, making sure that each of us had night duty once in three weeks. From 7 a.m. to 5 p.m., though the full complement of staff worked, only a single doctor sat in the OPD as “admitting officer” during late shifts from 5 p.m. to 8 p.m. and 8 p.m. to 7 a.m. the following day.

When there was no permanent Judicial Medical Officer (JMO) attached to the hospital, one of the senior MOs in the OPD had to act as JMO. Thus, Juanita Wilson was acting as JMO most of the time and spent much of her working hours in the Mount Lavinia Courts giving “expert” evidence. S.Thurairetnam was a jovial small-made person with a penchant for “leg-pulling” and practical jokes. He was the ideal family man and often the life of the party when he frequently entertained friends at his home on De Silva Road. Dressed in his immaculate white overcoat with a stethoscope dangling from his neck, he spent more time parading up and down the OPD corridors with the air of a very busy doctor than actually tending to patients at his desk in the OPD!

Among the other seniors was H.K. (Herby) Abeygunawardene (brother of the well-known tennis twins Susima and Srima) who later specialised in Otolaryngology (or ENT - ear, nose and throat), S.Vamadevan who qualified as a Paediatrician, D.W. Abeysundera who took to Medical Administration, Pari Bartlett (now settled in New Zealand), Vinitha de Silva (sister of present Attorney General C.R. de Silva) and Chintha Fernando (wife of the MS and sister of Vajira Chitrasena – the doyenne of oriental dancers in Sri Lanka).

Two of the younger doctors were outstanding cricketers. Health Ministry bigwigs justifiably kept the sporting doctors in Colombo to enable them to represent the department in the very popular Government Services Tournament. They continued to play club cricket as well, having earlier helped the University of Ceylon to win the P. Saravanamuttu Trophy while they were medical students. Old Thomian Buddy Reid who also excelled in Table Tennis represented the BRC. Old Anandian Mohanlal Fernando was an outstanding all rounder not only in cricket (playing for NCC), but also in life in general. He showed his prowess in all racquet games and played badminton, tennis and table tennis at the highest levels. Mohan’s talents did not end on the sports field. It was a treat to listen to him when he sat at the keyboards of a piano or played popular melodies on his piano accordion. Buddy followed most other Burghers when he emigrated to Australia. Mohan settled down in England after qualifying as a Consultant in Rheumatology.

Among the other sportsmen was Sidath Jayanetti who continued to play Rugby as a stand off, after leaving Royal College and was a member of the crack university team that gave leading clubs like CR and FC and Havelocks a good run in the Clifford Cup tournament. He is now an Obstetrician and Gynaecologist in Virginia. G.N. (Nimal) Lucas was national champion and Sri Lanka’s Number 1 in Table Tennis at that time. He specialised in Paediatrics and retired as a Consultant from Lady Ridgeway Hospital.

I had many of my medical school batchmates working with me in the OPD, most of whom specialised in various fields. S.A.P. Gnanissara (who retired as a Deputy Director General of Health Services), T.Yoganathan (now an Anaesthesiologist in NJ), J.G. (Janaka) Wijetunga (Ophthalmologist), Puwan (Ramalingam) Sivananthan (Rheumatologist) and Chandra Silva (General Physician) were the others. My dear friend R.M.C. (Chandrasiri) Rajakaruna was a very popular Obstetrician and Gynaecologist who had a large practice in Matale and Kandy. I was his bestman when he married Anoma shortly before I myself married. But he was destined to die very early in life, when he was at the peak of his professional career. My other OPD colleagues were Malini Arumugam (now domiciled in Australia), Chandra Dissanayake (Orthopaedic Surgeon in California), Manel (Bogollagama) Fernando (wife of former national tennis champion Lasantha Fernando and mother of tennis ace Lihini Weerasuriya) and Tissa Cooray (later of the WHO) whose father Professor G.H. Cooray taught us Pathology in Medical College.

A very tragic incident that I was witness to during my stint in that OPD is one that is indelibly etched in my mind. I happened to be the admitting officer one late night when a victim with burns was brought to the OPD. The female patient on the trolley who was covered with a bed sheet had very extensive burns with the skin peeling off in several places. It so happened that she was the sister of a hospital employee. Being a resident in the area and young mother with little children, she had been a frequent visitor to the hospital. Having seen her before, I remembered her as an attractive lady who probably would have been in her early thirties. But in the state she was in, I could not recognise her.

The patient, however, was quite conscious and alert. With tear-filled eyes and a touch of remorse, she looked at me pleadingly. In perfect English but in a feeble voice, she posed the pathetic question, “Doctor, will there be any scars?”- And almost as an afterthought added, or rather muttered, to herself, “I did something foolish”. I was speechless. In my own heart I knew that she would be fighting for her life in the next few days if she survived at all till the next morning. Her relatives who accompanied her told me that in a sudden fit of anger following a domestic dispute, she had doused kerosene on her body and set herself on fire. Though more common among the lower social classes, it was a shortsighted, rash act rarely seen in middle class families. I promptly “stamped” the case (a special signal to alert ward staff that the House Officer should see the case immediately) and admitted her to a surgical ward. She passed away two days later.

Another unforgettable scene was how the victim of a train accident was wheeled in, again when I was on duty. The man’s head had been severed from the body, but with little damage to the body and the head. It was such an incredibly “clean” cut at the neck. The night labourer on duty had unloaded the body from an ambulance on to a hospital trolley and neatly placed the severed head with the face upwards on the man’s lower abdomen. Whether it was deliberate or not, it gave the morbid appearance of a man holding his head in his own hands! I definitely remember the strong smell of alcohol in the air. But I was not too sure whether it emanated from the accident victim or the labourer who was enthusiastic but clumsy when assisting me with my chores!

There were many “stories” woven around one of our OPD colleagues that I cannot either confirm or deny. He was preparing to sit a postgraduate examination at that time and always carried a textbook in his hand. Whenever there was a lull in the flow of patients, he sat at his desk studiously concentrating on what he was reading. But to the consternation of other doctors, he sometimes continued with his studying even when there was a rush of patients.

He was happiest when one of the elderly female patients sat in front of him. These old women liked to go on talking about their ailments whether the doctor actually listened to them or not. All the while, the studious doctor was also reading his book and nodding his head occasionally. It was rumoured that he once asked a particularly talkative patient to open her mouth, but conveniently forgot to tell her to close it. The elderly patient had kept her mouth open for a good ten minutes and by that time, our doctor friend had finished reading a couple of pages totally undisturbed! But he met his waterloo when one woman complained to higher authorities that the OPD doctor had placed his stethoscope on her chest, but was quite sure that he was not placing the earpieces (the other end of the instrument) in his ears!

It was obvious that most patients who attended the OPD never needed to be there. Some of them simply couldn’t resist the temptation to “drop in” at the OPD to get a bottle of medicine while passing the hospital on other business. Some of them complained of vague aches and pains that we called APR (“athe paye rudawa”). Some mothers used to come with five or six noisy, boisterous children (who looked far from being sick) and ask for “worm treatment”. When the mother said in Sinhala “panuwanta beheth ganna awa” (came to get treatment for worms), one particular doctor’s stock reply was “aney amme, mey ispirithale beheth denne manussayinta vitharai, panuwanta nevei” (in this hospital, we treat only human beings and not worms)!
Another doctor was well known for his humour in making entries on the Bed Head Ticket (BHT) when admitting patients. On the BHT, there was space to record the admitting officer’s findings. A patient who came with difficulty in breathing was admitted to the ward and the OPD doctor’s findings were recorded thus: “OPD crowds drowning breath sounds”.

A large majority of regular patients at the OPD were chronic asthmatics. They often came at night to get their regular injection and often spent the whole night sleeping on one of the benches in the OPD. Long before these patients appeared in the room, we could hear the noisy breathing (wheezing) as they came in through the hospital gates.

We even knew them by name and quite often were able to have the prescription ready by the time they reached the patient’s chair. Aminophyllin in a large syringe had to be injected into a vein very slowly to avoid other complications. Halfway through the injection, as the patient began to breathe more easily, their relief and sense of gratitude showed in their eyes. That was something to remember.

Most patients who turned up at the OPD at that time expected a bottle of “mixture” (bona beheth). Brightly coloured Carminative, Sodium Salicylate with its characteristic “hospital odour” or Potassium Citrate mixture was liberally prescribed. While dispensing with the majority who came to the OPD to get treatment for minor ailments (which usually subside even without any treatment), it is the OPD doctor’s responsibility to pay greater attention to the minority who need appropriate OPD treatment, referral to a specialist clinic or urgent admission to a medical, surgical, obstetrical, gynaecological or paediatric ward.

I remember a middle-aged man who complained of difficulty in opening his mouth. Everything about him looked normal except for an untidy cloth bandage on the big toe of his right foot. On questioning, the patient revealed that he was working in the Pettah wholesale market area as a “Nattami”, unloading heavy sackloads of foodstuff from lorries. He had accidentally knocked his foot on a piece of rusty metal and injured himself. As he didn’t want to lose a day’s wages (and thereby starve his three little children at home), he had continued to work after dressing the wound himself with a strip of cloth. When he finally turned up at the OPD the wound was badly infected. He was admitted immediately to the surgical ward where the tentative diagnosis of tetanus was confirmed. Inability to open the mouth is an early sign of developing tetanus. Fortunately, he made a full recovery.

I wonder how many gallons of Carminative, “Sodi Sal” and “Pot Cit” I would have doled out during those two years. But detecting a case such as the one described above was certainly much more rewarding. -

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