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Bid to develop surgeons with a conscience
View(s):- Vision of new CSSL President Prof. Ajith Malalasekera to shape tomorrow’s surgeons on pillars of academia, integrity & accountability
By Kumudini Hettiarachchi
The promise came with fervency – to shape tomorrow’s surgeon on the three unshakeable pillars of academia, integrity and accountability.
Before delving into the meticulous details of how he would achieve this vision, the newly inducted President of the College of Surgeons of Sri Lanka (CSSL), Prof. Ajith Malalasekera, reiterated that “our future resides in the next generation of surgeons and trainees ”.
The induction ceremony was held last evening at the Noel and Nora Bartholomeusz Foundation, Colombo 7.
Prof. Ajith Malalasekera
With regard to academia, he said that the CSSL plays a crucial role in enhancing technical skills and training through simulation, priding itself in conducting immersive, hands-on training. Such training includes the internationally-recognized National Trauma Management Course (NTMC); the basic laparoscopy courses; and Senior House Officer training nationwide.
Simulation using human cadaver models is a centuries-old tradition that remains current, and the CSSL conducts this training for trainees and surgeons in general surgery, plastic surgery, orthopaedics, neurosurgery, and cardio-thoracic surgery to name a few. The latest is cadaveric laparoscopic training, according to him.
He assured that the CSSL will champion simulation to ensure patient safety and technical mastery. Much like the airline industry’s reliance on flight simulators, the CSSL intends to promote this model.
Going back in time to his own training as a Registrar, Prof. Malalasekera “vividly” remembered Prof. Kemal Deen’s insistence that he perform 15 animal cadaver bowel anastomoses (a surgical connection between two luminal structures) before he was permitted to perform his first live human surgery. “This rigour is what we aim to replicate.”
Conceding that research has historically been a challenge for the surgical community, hindered by time constraints, lack of support staff, accessibility of robust data and funding, Prof. Malalasekera explained how he would spur this academic drive by launching a Collaborative Research Programme in partnership with industry.
“This initiative will focus on developing study proposals, linking collaborative units both locally and internationally and providing research assistants and database management under the CSSL umbrella. Our goal is to generate essential knowledge that will impact on patient management, guidelines and national policy,” he said.
With integrity being a hot topic in
Sri Lanka these days, he says he envisions surgical integrity to encompass a broad spectrum, at the heart of which is the development of a “surgical conscience”. This involves the wisdom of knowing when to operate and – perhaps more importantly – the courage to know when not to. It requires adopting new technology with equity and the patient’s best interest at heart, treating every patient as a family member and ensuring a safe environment for staff and trainees.
“While our training often emphasises technical aspects, we must also address the non-technical or ‘power skills’ where many errors occur. We intend to incorporate these into our core curriculum, as in the Surgical Education & Training Sessions (SETS). We also plan to commence monthly cross-border case discussions with American surgical groups this month to promote evidence-based questioning and a critique of surgical practice through the lenses of ethics and professionalism within our local context,” said Prof. Malalasekera.
Referring to accountability and national interest, he said the CSSL bears a primary responsibility in providing cost-effective surgical services. Its surgeons sit on numerous boards evaluating the quality and financial burden of surgical procurements, working in close coordination with the Health Ministry.
Asking how progress can be balanced with economic stress, he brought the question: ‘Do we need a surgical robot in Sri Lanka’, under the spotlight. The clinical and functional benefits are proven and the rate of return to normalcy is astounding. But is it worth the cost?
He pointed out how more than 20 years ago they faced a similar dilemma when considering the introduction of laser technology for shattering urinary stones. Thanks to lasers, by moving from open surgery to endoscopic or keyhole surgical removal of stones, they enabled day-case surgery and a prompt return to work for patients. That initial investment was returned to the country exponentially. Due to the foresight of the surgeons and administrators of that era, Sri Lanka now delivers first-world technology in stone management, hindered probably and only by waiting lists.
Prof. Malalasekera concluded with a call for accountability when considering the investment made on surgeons and their training. Health Minister Dr. Nalinda Jayatissa had recently revealed a shortage of 1,139 specialist doctors.
“The migration of trainees and surgeons is a drain on both our financial and intellectual assets. However, as I look at this audience, I see many who did return – surgeons who serve our citizens tirelessly. World Health Organisation statistics indicate that the healthcare provided by workers in Sri Lanka is among the most cost-effective in the world. I am grateful to Health Secretary Dr. Anil Jasinghe for being our partner in this mission. The sacrifices made by our surgeons are often unbelievable,” said Prof. Malalasekera.
He added: “If we cultivate and beautify our garden, the birds will flock to it. Along with Dr. Jasinghe and his team, I am confident we can achieve this. One measure we will implement is the mentoring of newly arrived surgeons, welcoming them to the CSSL to ensure a smoother transition from the hospitals of other countries to the challenging terrains of our provincial hospitals. A team of volunteer senior surgeons will be available to guide these ‘bright young sparks’ on their journey to serve Sri Lanka.”
The Chief Guest at the induction was Marine Biologist and Founder/Executive Director of Oceanswell, Dr Asha de Vos; and the Guests of Honour were Emeritus Professor of Surgery, Prof. A.H. Sheriffdeen and Health Secretary Dr. Anil Jasinghe.
| Symbol of heritage brought back home Spreading a little nostalgia, Prof. Ajith Malalasekera said that the CSSL celebrates 22 years in what was once the charming home of Dr. Noel and Nora Bartholomeusz at Independence Avenue, Colombo 7. “At every event held within these walls, we pause to remember and celebrate the extraordinary benevolence of Noel and Nora Bartholomeusz and it is a moment of great personal pride that we were able to bring Dr Bartholomeusz’s cloak home to the CSSL, preserving it for posterity as a symbol of our heritage,” he said. The three pivotal figures who facilitated the donation of this home to the CSSL were the late Mrs. Anne Ranasinghe, the late Dr. Vimala Navaratne and Prof. Sheriffdeen.
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