By Dr. Sapumal Dhanapala As a medical specialist with over 20 years of working experience at all levels from divisional level to provincial level and having also worked for the United Nations, I decided to pen these words out of a sense of responsibility to give an insight into how I felt as a patient [...]

The Sundaytimes Sri Lanka

A second chance in life: Those who made it possible for me

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By Dr. Sapumal Dhanapala

As a medical specialist with over 20 years of working experience at all levels from divisional level to provincial level and having also worked for the United Nations, I decided to pen these words out of a sense of responsibility to give an insight into how I felt as a patient about the system of medical care in the government hospitals, the skills and dedication of the health teams and generally about how delicate life is.

After a few months of experiencing a hearing loss, which was originally thought to be due to wax in the ear, I got a hearing test done which confirmed that there was a hearing loss in one ear. I then contacted a family friend, ENT surgeon Dr. Ethulgama, who wanted an MRI scan done to exclude any lesions although he suspected my having one. The only MRI available in the Kandy District was at Sirimavo Bandaranaike Hospital and being a specialist, I could have got it done as a priority but decided it would be best to get it done in Colombo. Lanka Hospitals was recommended and I was given a priority date and courteous service and the report given on the same day.

I was diagnosed with Vestibular schwannoma or acoustic neuroma, a benign tumour which needs surgical intervention by a consultant neuro surgeon before complications take place. The dilemma of having to inform friends and family is an area where people have a difficult choice to make. Most of them would have panicked. Until confirmed, it is difficult to disclose the prognosis, so I felt it was best that families and friends were told once the medical teams had all the facts with them.

I immediately informed the Consultant Neuro surgeon at Kandy Dr. Ranjith Wickramasinghe of the pathological findings and met with him and Consultant Anaesthetist Neuro Surgery Unit Dr. Ravi Weerakoon, a school mate, co-house officer and family friend. They suggested that I go in for surgery the following day to which I agreed and got myself admitted to ward 51 Neuro Surgical Unit.

I had not yet divulged about the condition to any family or friends. The second issue that patients have is that family, friends and doctors advise on various options such as the best surgeon, best place for treatment, best medical management , second opinions etc. The patient, if given the choice, should have full faith in the procedure that is to be followed and allow the specialised surgical team to handle matters. Being a medial officer and having access to information on the net is good, but knowing unnecessary detail will only add more pressure and confusion for the patient.

The patient has more important priorities than thinking of the medical procedures to be done by the medical team. For example- As all surgical procedures have a certain element of risk have you written your will? How will you break the news to your wife and children 18, 16 and 8 years, how do you break the news to your parents and family, whom do you inform without informing the entire family tree. Inform your office and staff, make arrangements for payments of home bills, tuition etc. etc. I had less than 24 hours to do all this.

The most important decision was to allow the professionals to do their work without being a pain in the neck. After getting all the tests done, I phoned my family lawyer, Manisha Seneviratne and made an appointment in the afternoon to prepare my will- he was nice enough not to ask too many questions about the illness. Next I had to tell my wife who was in Colombo, to come immediately to take care of the kids. I told my father in detail of the condition and procedures. You can imagine the disbelief and shock they felt, but the good news was that I was one of the lucky ones to have a benign (non cancerous) tumour. It could have been worse.

On the last evening I played a game of cards with the children (a game that my youngest likes) and after a few games told them I was getting admitted the next day for some tests. I had told my father to explain the details once I was taken in for surgery.

The same principle was applied when informing my mother and father-in-law. I sent a hurried email to my very close immediate family about the “small surgical procedure” which would have shocked them out of their beds as most are overseas. I was confident that I had so far done what was right and that nothing would go wrong and with that positive frame of mind I went in for surgery the next day.
Only a few family and friends accompanied me while most were at religious places. It is nice for a patient to have his close family by his side when he is rolled into the Operating Theatre. But it would have not been the same for those around as they would expect the worst.

It was nice to have familiar faces at the operating theatre but to be a patient was an experience. After a simple needle prick , I went into a deep sleep and woke up only after six hours in a pleasant neurosurgical intensive care unit. While I was in deep sleep the team from the Neuro Surgical Unit 1 and team of anaesthetists were doing their job to make sure that the surgery would proceed without complications and to preserve the acoustic nerve and facial nerve. The patient being a known party to both teams would have had added nervous concern to both teams. I will not go into detail about the surgical procedures.

I heard that family and friends were in close contact to find out about how the surgery was progressing. When I woke up in the Neuro Surgical Intensive Care Unit (NSICU) , I remember a few known voices and faces. The pain relief was very good. I was not in pain from the surgery but had pain at the sites that had been created to access the delivery of anaesthetics and other medication.

There were six NICU beds. I was the only patient conscious while the rest were on ventilators. I recall not having much sleep the first night as the air mattress position was changed and it felt like worms creeping up your back. The next day I had to plead to get the air mattress out and had a good night’s sleep. The control of visitors and efficient patient care by the medical staff, nursing staff and minor staff was like clockwork. The teams were very professional, up to date in their knowledge, practices and had management protocols.
I was very proud of these government health staff for their dedication which usually goes unsung.

The media highlights only the negative areas while, like in all parts of Sri Lanka , we only talk about the gaps never on how much we provide. It is a logistical nightmare to balance 3000+ items of medicines and consumables, but the government health system does it to the best of its ability. Nobody seems to appreciate it. You have to get admitted to a private hospital (no offence) but services provided for the money are not acceptable. The medical care and nursing care is far below standard. Hence I would urge all our citizens not to get carried away with hospital brand names but in acute emergencies go to the closest government hospital. For those who can afford it, please get whatever tests done in the private sector but give back something to the Government Hospital unit where you were treated. When you are discharged in a private hospital you have to settle your bill first, but in a government hospital patients don’t even have the courtesy to thank the medical and nursing staff.

The NICU care that I received was on par with any healthcare standards. Dr. Ravi Weerakoon, the consultant anaethetist, MOs, ICU sister, nurses work as a team and it clearly reflects the good relationship the team leader has with his staff. Dr. Ravi does not get excited in a patient crisis. That is reflected in the team’s approach where there is no panic. He loves teaching his medical officers (MOs), but, as a suggestion, it is also good to teach the nursing staff on technical updates.

Dr.Ravi, with the support of his staff and well wishers, has been able to upgrade all facilities and purchase additional equipment. The only drawback is the inadequate basic space of the NSICU, while the MOs use a 4 feet X 8 feet room for their on call and other purposes. The handing over and taking over of patients is done very carefully and systematically by both nursing staff and medical officers.
On the post operative second day , I was sent to the High Dependency Unit (HDU) in ward 51.

The unit was completely rehabilitated about two years ago with donations, while 45 plus second hand HDU beds were received as a donation from Japan. I am glad that the facilities are used with extreme care and the usual damage expected in the government sector is not seen. The ward 51 staff are also highly competent and have been trained to do complete nursing for all patients.

No by-standers are allowed, which reflects the commitment to patient welfare. The medical staff, nursing staff and minor staff do not split hairs about chores but work as a team helping in the overall goal to ensure that patients are discharged safely and as early as possible. The nurses and doctors call each patient by name which is really nice and even to the unconscious speak to them kindly by name. It helps in keeping patient dignity, without identifying patients by bed number or disease. This should be promoted.

After two more days in ward 51, I was ready to be discharged. The MOs were always on time, courteous and appropriately and smartly clad. This needs to be promoted. Most nurses and minor staff had new uniforms and green gowns but some wore uniforms which would have been in use for a decade, This also needs to be addressed.

The part that I liked best was that the nurses and doctors handed over each patient at least 30 minutes to some 60 minutes before they went off duty as the replacement had arrived early. In normal practice you can see a rush of nurses at 7 a.m., 1 p.m. and 7 pm some running to clock in before time, some running off to catch transport. This was not seen in both ward 51 and NICU. This also reflects how good the team spirit is.

Last of all, the staff have a very high regard for the two consultants (Dr. Ranjith W and Dr. Ravi W) who are role-model consultants, prompt in their duty towards patients, patient care, staff and also in their attitude where they are always with a smile, soft spoken and not like some of our own colleagues who have the opposite attitude.

Other support services
The Radiological Department provides a yeoman service but always goes unappreciated. The Department needs urgent support for upgrading of services and facilities. The Physiotherapy Department staff are courteous and prompt, but here too the services provided are not recognized. Physiotherapy goes a long way in early and complete recovery. The infrastructure in the unit needs upgrading.
I have tried to give some feedback on what I observed during my five days in the NICU and ward 51 and I am sure with a few tightening of the bolts the system can be further strengthened. As a senior consultant, I would always encourage any Sri Lankan to get admitted to a government hospital system , as they provide the best patient care despite having challenges.

Personally, I have been given a second lease of life and would like to live the next one year, five or ten years happily knowing I have tried my best in my personal and professional life. If I don’t do that I would have let down my family, friends and the team of consultants and staff who operated and managed my post operative care .




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