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by Dhiraj Fernando

Medical anomalies are like freak shows. Remember the bearded lady, conjoined twins and the man with triple nose cavities? You may remember seeing hand rendered pictures in old history books of crowds flocking in vast numbers to witness these human deformities in the vein of the famous `Barnum and Bailey' or the latter day `Ringling Brothers' type of event or the fairground's in rural England and the U.S., especially at the turn of the century, which gained a great deal of notoriety and were proliferating coast to coast.

These `freak shows' which used human subjects with often horrendous physical deformities in order to gain profit, were fortunately phased out due to its inhumane nature and the farsighted legislation of lawmakers of that era.

Humans have a tendency to be naturally curious towards anything that is considered `different' or `anomalous' to what would be considered the human `norm'. However, what few people seem to realise is that the "Show Goes On" even today, albeit in a rather surreptitious manner through the media, primarily through the tabloid press of London and latterly via the Internet on sites dedicated to tales of medical discrepancy where basic human error has resulted in an irreversible situation for the patient concerned. These `sites' are primarily devoted to the `Hannibal lecter' variety of gruesomely perverted individuals who are out there in numbers. "The show must go on", they seem to say in a manner that befits a perverse `Broadway' musical.

Sri Lanka is a country that benefits from a farsighted system of liberal ,free, socialised medicare which is a tremendous boon to the population, a majority of whom are malnourished and many who lack basic sanitation facilities. These people would, to put it quite bluntly, have no other source of medical facility or care available if not for the system mentioned latterly.

Catering to the health care needs of a country with a population of apprx. 19.2 million is a gargantuan task for any country, including the developed West, much less a third world nation that relies on foreign aid and donations, directly and indirectly to maintain the standards of free medicare presently available.

A recent situation that occurred at the National Hospital, Colombo, (CNH), which was highlighted prominently in the 'Daily news' referred to an incident at the CNH in which a pair of 4 cm surgical scissors were found in the intestinal tract of a female patient who had undergone surgery.

There is however no corollary between the sensationalism of foreign tabloid reporting and the straightforward news article that appeared in the 'Daily News' recently. However, there seems to be a misguided perception among the Sri Lankan Public that surgical errors akin to this incident occur on an extremely frequent basis especially at the CNH.

The Director of the National Hospital, Colombo, Dr.Hector Weerasinghe speaking to the 'Daily News', admitted that instances of this nature do occur in rare and isolated instances, but he was also quick to point out the fact that the CNH handles an yearly average of over 80,000 surgeries (minor, intermediary and major), which , all facts considered is an awesome figure.

"This enormous number of surgical procedures, says Dr. Weerasinghe, inevitably filters down to the few surgeons who are prepared to handle them at that given moment, thereby creating an inordinately large burden of responsibility, and resultant stress, on the surgeons who are outnumbered, and thereby obviously overworked as it is, by the number of surgeries to be performed by them."

Commenting further on the topic, Dr. Weerasinghe went on to state that; "There are always two sides to any story, and most people seem to have a biased opinion with regard to the services we provide by airing prejudiced opinions that are detrimental to us."

Warming to the topic, Dr. Weerasinghe stated as to how a team of professional surgeons visiting the CNH, from the U.S.A. by coincidence on the same morning as this interview took place, had specifically been very impressed by the massive turnover rate of surgeries that the hospital undertakes with the few surgeons available, and with such dedication, thereby resulting in far fewer surgical mishaps than the figures should reflect, they had commended.

In answer to a series of questions with regard to this particular case Dr. Weerasinghe, despite his busy schedule answered the following:

"All surgical instruments are accounted for and sterilized individually, but as I suspect was the case in this situation, human error can and does play a part especially when the person's concerned are performing a task that requires extreme levels of diligence, precision and often hours of monotonous concentration under a degree of stress, and thereby, though extremely rare, can occur.

As a case in point I recently received some news from a colleague that a similar situation had arisen in which a much larger and more readily detectable surgical implement had been sewn shut and gone undetected for a considerable period of time in a leading surgical institution in London by an eminent surgeon of some stature. So, as you can see it can happen to the most experienced and the best of us. Surgeons are human beings too, most of the time anyway",;-(laughs).

In answer to a question regarding standard investigational procedures that are undertaken in cases of this nature, Dr. Weerasinghe said that there existed a procedural manner in which the case is investigated in a thorough and rigorous manner that made sure the person/s involved are reprimanded according to the degree of involvement and the particular details pertaining to the operation scrutinized, and the subsequent consensus in this case was that human error due to a lack of procedural concentration was to blame."Believe me, everything possible is being done to minimise error."

Dr. Weerasinghe continued; " We have a total of only 23 operating theatres in this hospital which are in continuous use. In fact there is a team of surgeons rostered to take over immediately after a theatre has been used. This goes on repetedly. Although we do not have the capacity to X_ray all patients individually after surgery, we do perform X-rays and radio opaque scans to rule out all possibility of error whenever there is reasonable cause of any such mishap having occurred. Procedures such as radio opaque scanning can detect non-stainless steel objects such cotton wool or gauze, so, we can be assured of an absolutely alien instrument free body in any doughtful cases.

In finality, the impression I got of the responsibility involved in being a surgeon was akin to a flight operator with lives at stake and minuscule mistakes creating irredeemable losses. "The public must realise that we are mere human beings. Highlighting our mistakes in a prejudicial manner helps no one, especially us surgeons', said Dr. Weerasinghe with a note of finality.

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