Sunday Times 2
No margin for error: Precision, passion, and perseverance—A surgical journey
View(s):The following is an edited version of Dr. Udayangani Samarakkody’s keynote address at the 34th Susan George Pulimood Oration. Dr. Samarakkody is a Paediatric Surgeon and Paediatric Urologist, Waikato Hospital, Hamilton, New Zealand. She is also Hon Senior Clinical Lecturer, University of Auckland.
Madam Principal, Chairperson and Board of Trustees of the Susan George Pulimood Trust, teachers, students, colleagues, and friends—thank you for the honour of addressing you today for the 34th Susan George Pulimood Oration.
Dr. Udayangani Samarakkody
I stand here in the legacy of Mrs. Susan George Pulimood—a visionary principal, botanist, and educationist who pioneered science education for girls at Visakha Vidyalaya in 1946. It is no exaggeration to say that her bold leadership seeded the success of generations of Visakhians in medicine, science, and engineering. As a paediatric surgeon, I am proud to reflect that her vision lives on in research labs and leadership roles around the world through countless Visakhians.
What is paediatric surgery?
Paediatrics is the care of children. Surgery is the art and science of operative healing. Paediatric surgery is where these two vocations meet—requiring not only technical mastery but also the ability to care for the most vulnerable: those who cannot speak for themselves. Children are not miniature adults. They differ vastly in anatomy, physiology, and pathology. From premature babies the size of a small syringe to robust teenagers—each child presents unique challenges and risks. Nowadays babies survive at 23 weeks’ gestation, bringing on a unique set of surgical problems that paediatric surgeons are called upon to manage. Many are critically ill, and often the first sign of distress is silence, not complaint. On the other hand, an obese child at age 15 brings on another set of surgical problems needing our attention. The two cannot be treated equally.
As a paediatric surgeon, I care not just for the child but for their entire family—stressed parents, anxious grandparents, and tearful siblings all look to you for hope and clarity. You become not just a surgeon, but a communicator, counsellor, and anchor.
To offer a glimpse into the daily realities of paediatric surgery, let me share a case of necrotising enterocolitis (NEC), a life-threatening intestinal condition that affects premature infants. These babies, sometimes born at less than 34 weeks and weighing less than 500 grams, have immature organs and minimal physiological reserves. In NEC, parts of the intestine lose blood supply and begin to die, eventually leading to perforation. Emergency surgery is often the only life-saving option. The tiniest of incisions, the softest of sutures, and the calmest of hands are required to handle such fragile patients. Every second counts, and each surgical move must be deliberate and thoughtful. Following these procedures, babies need intensive care treatment for a number of months, including artificial ventilation, artificial nutrition, and intensive medical management. Surgery is only a small proportion of their care.
Training for the role
Becoming a paediatric surgeon requires rigorous training—over a decade of study after medical school. That includes 3-4 years in Sri Lanka and further training overseas for about two years in a centre of excellence. I was fortunate to be the first postgraduate paediatric surgeon trained through the Postgraduate Institute of Medicine of the University of Colombo in Sri Lanka. Later, international training in Australia further shaped my skillset. I served in the Lady Ridgeway Children’s Hospital in Colombo on my return and migrated to New Zealand later. I have given it back by helping over 30 Sri Lankan postgraduates access specialist training in New Zealand. I have also trained over 50 surgeons at different phases of their careers in New Zealand.
Surgical training is intense. You learn through long hours, high stakes, and continuous reflection. The steepest learning curve often lies not in technique, but in humility—recognising that despite our best efforts, outcomes are not always in our control.
Inside the operating theatre
The surgical space is a dynamic, high-risk environment where hazards lurk in every corner for every patient. The invasive procedures cause physiological challenges to patients. Every decision, every action, and every word matters. One lapse or error in judgement can magnify to epic proportions, leading to irreversible consequences. There is no margin for error. It is a space that demands mental sharpness, physical precision, and emotional stability. And yet, it is also a space of “”flow”—where surgeons, anaesthetists, and everyone in the team become so deeply immersed towards a common goal physically, mentally and intellectually that time disappears and the only thing that matters is the wellbeing of the patient.
Success in surgery goes far beyond technical skill. The technical skill is one of ten competencies expected of a surgeon. You must communicate clearly, adapt rapidly, lead compassionately, and remain calm under pressure. You must also be a team player, a teacher, a mentor, and a scholarly contributor to the profession. Cultural competence is a new concept introduced by many surgical colleges all over the world.
Beyond the operating room
A surgeon’s responsibilities extend beyond clinical care. As a teacher, you pass down your craft. Every move, every incision, every suture becomes a teaching moment. As a researcher, you challenge the status quo, contribute to evidence-based practice and guide your juniors for lifelong learning. As a member of regulatory bodies and professional associations, you shape the ethical and operational standards of your profession.
The professionals need to be governed by professionals while keeping the focus on the safety and welfare of the unsuspecting public. The professional and regulatory bodies should have a formal complaint process to investigate issues raised by a public member without using social media as an outlet.
Community engagement and volunteering are also vital. Many surgeons participate in these projects in underprivileged countries.
I have participated in humanitarian work, including Sri Lanka’s first renal transplant, tsunami relief, and regular donations of surgical consumables to Karapitiya Hospital, and I have used my professional networks to arrange specialist training for Sri Lankan postgraduates. Volunteering is not a side hobby—it is an ethical obligation for those privileged to serve.
Teamwork in surgery
Surgery is a team sport. Behind every successful operation stands a hive of professionals—surgeons, surgical trainees, anaesthetists and their trainees, nurses, technicians, laboratory staff, radiology staff, healthcare assistants, and more. It is a busy hive. Each has a specific role. Each is essential.
Perhaps the most logistically and ethically complex of my career—the separation of pygopagus conjoint twins demonstrated an epic example of teamwork. Joined at the pelvis, the twins shared bone, nerves, and internal organs such as the rectum and urogenital structures. The surgery, which lasted 22 continuous hours and involved 55 professionals, demanded not only surgical precision but also months of preoperative planning, team simulations, anatomical mapping, and psychological preparation of the family. Each medical team—paediatric surgery, orthopaedics, plastics, neurosurgery, and anaesthetics—prepared and executed its part with precision and discipline. The supporting staff—nursing, laboratory, radiology, technical and healthcare assistants—did their part effectively. The success was not individual but collective—a true testament to the power of coordinated, collaborative care. These cases reaffirm the power of meticulous preparation, team coordination, and compassionate care. They demonstrate why paediatric surgery is as much about skill as it is about empathy and collaboration. Seeing the twins thrive postoperatively has been one of the most profound experiences of my career. They celebrated their 21st birthday this year.
Why women in surgery matter
Let me now turn to a crucial issue: gender equity in surgery. Globally, women now comprise more than 50% of medical graduates. Yet, only a fraction pursue surgical careers. In Sri Lanka, women make up just an appalling 5% of surgeons—a shocking figure.
The reasons are complex: cultural bias, lack of role models, unequal domestic responsibilities, and systemic barriers. But the consequences are clear—we are losing half the talent pool. Worse still, we are denying our patients the diverse perspectives and qualities that female surgeons bring.
And it’s not just about equity—it’s about outcomes. A landmark study showed that patients of female surgeons have lower complication rates and mortality. Why? Because women often bring enhanced communication, greater empathy, and meticulous care—traits that matter immensely in healing.
Despite being the only woman on many surgical teams, I have persevered—and I urge young women not to shy away from this demanding but deeply rewarding path. They say, “To be a surgeon you need to have the fingers of a lady and the heart of a lion.” Why not find a lady with the heart of a lion? You do not have to choose between family and career. It is not easy—but it is possible.
Creating space for more women
The College of Surgeons of Sri Lanka started a Women in Surgery Forum with three old Visakhians leading the charge in 2022. In 2019 too in Galle, we addressed women’s issues in surgery at national academic sessions, but because of the pandemic, the intended programme was delayed.
Recently, we’ve begun reaching out to medical faculties to encourage female students to take up surgery and kindle their interest at those formative years of their careers. We have addressed female medical students in the Galle faculty recently and will have another project in Jaffna soon. My college, The Royal Australasian College of Surgeons, too, has launched a women’s forum to advocate for and mentor the next generation. It is a good time to be a girl. The Sri Lankan women surgeons have created a WhatsApp group privately to support, uplift and share information. We are just 30 in number—but I am proud to say 10 of us are Visakhians. We must continue to grow our tribe. We need more girls in operating rooms, in leadership, and in surgical academia. If half the class is female, half the surgical field should be too.
Staying grounded: Balance and passion
Surgery can be all-consuming. The stress becomes normalised, and burnout is a real risk. That is why personal resilience and work-life balance are critical. I recharge through tennis, yoga, hiking, and choreographing stage productions. Thanks to Zoom, my yoga instructor is in Germany while I stretch in New Zealand. I produce cultural performances—from hospital revues to community shows with over 40 participants. These creative outlets keep me balanced and connected, something I once gave up in pursuit of academics.
Mentorship and role modelling
As senior surgeons, we have a duty to mentor. Our juniors watch our every move. The way we treat patients, the compassion we show, the respect we command—all become part of their learning. Leadership is not about hierarchy. It’s about inspiration and service.
As a clinical director and teacher, I have tried to walk that path—supporting juniors, advocating for better training, and making space for diverse voices. The happiness, satisfaction, fulfilment, sense of achievement, sense of purpose, and meaning in life in the joy of healing, particularly children, is indescribable. If there was one profession where altruism is practiced in the exercise of day-to-day function, it is medicine and surgery. Giving is a powerful element of well-being.
A word to aspiring professionals
To the young women in the audience—whether you choose medicine, law, engineering, business or the arts—my message is this: There is no glass ceiling that cannot be cracked. The sky is the limit. Be proud, humble and resilient—but never arrogant. Let your work speak for itself.
Closing remarks
Mrs. Pulimood once said, “Science is the pursuit of truth.” That truth still lights our path. To Visakha Vidyalaya, to my mentors, to my teachers at Visakha, to my university teachers, to my colleagues, students, friends and family—thank you for shaping my journey. To the children I have cared for—thank you for trusting me. And to the future surgeons, scientists and leaders among you—I say: step forward. The world needs you.