Health of the nation in the 1960's

            Those of us who worked in the hospitals in the periphery of Ceylon in our younger days, have many stories to tell. I was a DMO at Koslanda 200 miles from Colombo, in 1966, but fortunately had electricity, telephone, 4 nurses, a matron and two Apothecaries. I was Physician, Surgeon, Obstetrician, Pediatrician, Medical Officer of Health, Judicial Medical Officer doing post-mortems in the field and the Administrator of a 60 bed District Hospital. Diyaluma the waterfall was 3 miles from the hospital. It was a fairly regular thing for us to go to the waterfall for a bath, beer and lunch on Sundays, during my bachelor days.

            Twenty two miles away was the District Hospital, Butthala, where our teachers at Medical College, used to preface a problem with the proviso "If you are in Buththala, what will you do?"meaning 'You are on your own with no support'

            Pregnant mothers in labor would be carried on jungle tracts on an improvised stretcher of 'gunny bags'. Market produce to Wellawaya 11 miles away, was brought by 'thavalam' (on the back of buffalos). To ford a swollen river on the way to do a post mortem, it was the usual thing for the Magistrate, the Police officer and the DMO to be carried piggy back.

            This had its positive side, as we were treated like Gods. It was nothing for some people to help push start a medical officer's car. All the homes felt honored, to receive us.

            I am giving you below the stories of an earlier generation.

 Little do we realize the major breakthroughs made by the Health services of the Island of Sri-Lanka, over the last one hundred years? Here are a list of the problems we had.

1. Anemia, mainly due to hook-worm infestation, wreaked havoc in the Island. The main cause was absence of closed toilets. Defecation in open wet fields and transmission of hook-worm larvae through the bare feet was the cause. Introduction of the pit latrine as far away from the dwelling in the early part of the last century was the first step. The bucket latrine was introduced in urban areas. In fact in the 1950's, Wellawaththe had bucket latrines. Now almost every newly built house has an attached bath and toilet. It was very common to see pale pot-bellied children by the road in areas like Mihintale, Polonnoruwa. We do not see them now. Maternal morbidity and mortality and infant mortality were very high those days due to the anemia. As a DMO at Koslanda in 1966, I have gone to schools supervising the administration of "chinnapodium", the anti-hookworm drug to the entire school population..

2. Tuberculosis was rampant. In our earlier days in the 1970's extra-pulmonary tuberculosis, especially bone and joint TB was common. We see it rarely now.

3. The plague, Cholera and Small-pox are unheard of now. I heard from my elders how whole villages were wiped out by Cholera.

4. Polio and Diphtheria which were rampant has been eradicated. In 1965 as an intern at the Lady Ridgeway hospital,  we had special Diphtheria and Polio wards. The 'Drinkers apparatus' - the so called 'Iron Lung' was available in the Polio ward. Dr. Jonas Salk gave us a lecture when we were medical students a few years earlier in 1962.

5. Measles was a common illness of childhood. It killed children with broncho-pneumonia and meningitis in the 1960's and earlier is now, being prevented by immunization.

6. Home deliveries attended by a midwife was the norm. Hardly any deliveries are done at home now. I as a DMO had to go to a home in Lemastota to do a suture of a torn perineal bleed after delivery, working by torch-light during my DMO days.

7.Outlying hospitals did not have ambulances and telephone networks were primitive. A retained placenta had to be done by the DMO. Anesthesia was ether administered by a "Schimmel-Busch" mask, by the Apothecary. I have done this as transfer would entail a delay of a minimum 6 hours to a hospital with a specialist Obstetrician. We now have a good telephone service, an ambulance in each hospital and good roadways for fast transport.

    

There are many stories to tell of our past. Here is one told me by one of our former Director of Health Services. I hope you find it interesting.

The nursing mother dying of malaria in Kurunegala

    This is a story related by Dr.Joe Fernando former DGHS. He was working in Nawalapitiya Hospital when one of the older MO's told him this story.

            It was in the late 1930's when an epidemic of malaria was raging in Kurunegala. The hospital could not handle the crowd. The new arrivals would come in bullock carts from far and near. It was the duty of the OPD MO to go out to the carts in the courtyard where the patients were lying, to see them. It was a pathetic site where whole families moved with the patient in these carts. The cart was parked and the bulls untied to take their well deserved rest. The patient was left lying in the cart and the elder of the family went looking for the doctor, who was guided to the cart and the patient.

            The older MO wended his way to see this patient, who was apparently a month after delivery and had a suckling child at the breast. She had developed fever with chills and was very weak. On reaching the cart the MO had lifted the curtain and peeped inside. The child was seen feeding on the breast peacefully. The mother was lying apparently fast asleep after a tiresome journey. When the MO tried to rouse the mother, there was no response. When he felt the pulse it was not there. The pupils in the eyes were large and the heart must have stopped beating only a few minutes back. The child was sleeping, suckling at it's mother's breast, in all innocence. The MO with tears in his eyes, gently removed the child from the dead mother and handed it to the father of the child. He broke the news of his wife's death to an unbelieving father and resumed his duties. This scene was a recurring nightmare to him and was etched in his memory, nearly thirty years later.