New lease of life for neuro trauma patients

By Carol Aloysius
The large goldfish tank at the entrance is the first thing that catches my eyes as I step into the airconditioned unit of the Neuro Trauma Centre of the National Hospital in Colombo. The elegant décor complete with potted plants and paintings are reminiscent of a modern office complex rather than the interior of a hospital unit. I tread carefully along the gleaming ultra clean grey and beige floor tiles, and stop at the reception desk where a courteous, friendly staff greet me. After checking out my credentials, a helpful nurse escorts me to the male ward where I meet some of the recent patients who have been brought into the Trauma Centre for treatment.

It is Wednesday April 13, 2011. Outside I hear the sound of crackers as millions of Buddhists and Hindus in Sri Lanka, celebrate the dawn of another National New Year. There is little rejoicing or celebration however, for the 70 odd patients at the Neuro Trauma Centre in the Accident Service at the National Hospital in Colombo. Many are even unaware that the New Year has dawned. The one thing they are painfully aware of as they lie in their beds, is the agony and discomfort they are undergoing mentally and physically, as they wait in fear for their imminent surgeries, or struggle to breathe through their oxygen masks.

Nor are they aware of our presence. The few who saw me and photographer Ravi walk in, had no smile for us or wanted to talk to us, some even turning their faces to the wall as a clear sign we were obtruding on their privacy. Only a very few were prepared to face the cameraman and share their shattering experiences with us.
Podimahatthaya, was one of those rare exceptions.

The skinny and diminutive casual labourer who hails from Mawanella, Ambunugala, is not yet 60, but looks much older than his years. Long years of hard work have clearly taken their toll on his body and his appearance. Sitting upright on his bed , legs barely touching the ground, sarong tucked up to expose his knees, and his entire chest swathed in bandages from which numerous tubes stick out, he makes a grotesque, if not pitiful sight. Adjusting a urine bottle stuck to the lower part of his kidney, he however to greets us with a smile as wide as a mile, as his wife hovers by his side constantly adjusting the saline drip and his sarong.

By far, he is the most cheerful inmate in this ward. Courage and optimism are written all over his face as he talks, the words spilling out fast as if to release the inner turmoil and pain he had suffered.
“I do odd jobs for a living as I don’t have a permanent occupation. Three months ago, I climbed a Jak tree to pluck some fruits for our noon meal, when I slipped and fell. It was a bad fall as the tree was very tall. I fell on my back and as I couldn’t move, my wife had to run to the neighbour’s house and get help”.
He pauses for breath, and his wife Menike takes over the rest of his story.
“We took him to the Mawanella Hospital and after examining him, the doctors made arrangements to bring him to the Accident Service in Colombo. The doctor in charge ordered an MRI test and he was operated thereafter.”

Worried that her husband has had to undergo another surgery since the initial surgery done on him, and is still to recover fully, she asks anxiously, “We have no children and only each other for the past thirty years. I am praying he will be able to go home soon. Do you think he will?”
Reaching out to pat her hand and reassure her, Podimahaththaya tells us, “After the initial operation, I was asked to go home and visit the hospital clinic a month later. That was when I learned that I needed another operation, which was performed two weeks ago. See”, he points to his legs and knees. “These legs were so swollen I could barely move, let alone put my legs down like I’m doing now. I’m already feeling better”. He smiles and reassures his wife once again, that he will soon be up on his feet and go back to work “davas tikakin”.
A nurse comes to his bedside to take his temperature and asks him if he needs anything. He thanks her gratefully, then turns to me and says, “The treatment and post operative care I have received in this Unit is excellent. I am also grateful that we are not charged for the treatment and medication, since I have no way of paying for it , as I am now without a job since my accident.”

When his wife complains of the ward being too hot in spite of the fans, and points to the droplets of sweat pouring down her husband’s bare chest, he interrupts to say that the excellent care he gets makes up for any minor discomforts he may have to endure.
Unlike Podimahaththaya, his immediate neighbour Francis Silva 60, is in no mood to talk to us. Which is not surprising as he is scarcely aware of his surroundings, after having been brought here with a loss of memory following a bad accident on his head. Lying on his side with half closed eyes, his thoughts far away, he however nods when we ask if we can talk to his son who stands by his bed.
“My father was knocked on the head by a speeding motorcyclist in our home town Minuwangoda” his son Sarath tells us. “Thaatha was going to the boutique to buy a loaf of bread, on his bicycle, when the accident happened three days ago, on April 10. We took him to the Minuwangoda hospital, and after examining him and because he was getting constant headaches and had memory lapses after the accident, the doctors at the Minuwangoda hospital told us to bring him to the Neuro Trauma Unit. He is being operated on today and is afraid of the operation”.

Hearing his words, Francis opens his eyes suddenly, and asks us in a trembling voice, “The Loku Mahaththaya says I will be all right after this operation and my headaches will disappear. Will I?” We nod in assent, eager to reassure him, and his son pats him on the hand and says, “Baya venne epa thaththa. Ikmanin saneepa veneva. Methana hama pahasu kam thiyanava. Dosthoro mahaththarunuth hari hondai”. (Don’t be afraid father. You will get well soon as the hospital has all the newest facilities and the doctors are excellent.”)
We now meet the youngest of the patients. A little boy of 4 years, a victim of a speeding motorcyclist. He lies in bed looking at us with one eye. The other is closed as his cheek is still swollen and a bandage covers the eye. He turns his face to the wall when he sees us while his mother standing near his bed tells us how his injury had occurred.

“The motorcyclist was speeding so fast that accident happened before I could do anything about it. I was standing outside a boutique to where I had gone to buy a bottle of milk, and was carrying my younger son aged 8 months with one hand and holding the older boy with the other. Then this speeding maniac came whizzing past us on his motor cycle and knocked down my son. He was thrown a few yards and hit his head and face. As we live in Nattandiya, I immediately took my son to the Mawanella hospital which in turn dispatched him here.”
The accident occurred two days ago. “My son was operated that day itself. He still complains of a pain in his head. But doctors say he is recovering” she says. We ask her if she needs anything and if the paper could help her in any way.

“Nothing except your prayers for his quick recovery”, she says, adding that her husband was a casual labourer who was engaged in coir work, but had to abandon his work after the accident to tend to his son’s needs. “We practically live in the hospital as my son wants me around all the time. It is difficult as I have to manage the baby as well, but the gods are helping me to cope,” she says with a ghost of a smile.
We move on to the female section where we meet teenager Fathima Arussia. She is 19 years old. Although not an accident patient, Fathima’s case is as tragic and heart breaking as every other case in the Neuro Trauma Unit. Lying supine on her narrow hospital bed she stares at the ceiling with a hopeless look of utter despair in her eyes. Refusing to talk at first, she lets her aunt Sifaya to do the talking instead.
“Fathima was a very active girl until recently. Then suddenly, she developed a spine ache and we took her to the Kalubowila hospital. The doctors who examined her said there was nothing wrong with her. But gradually she found she couldn’t move her legs and so we brought her here for an MRI scan three weeks ago. We were told that she had a urine block which in turn was also affecting a nerve connected to the legs. She underwent an operation three weeks ago. We have been told to get her a belt to wear and she also gets physiotherapy exercises to help her relax. The belt was given to us free by our mosque.
“My niece has no father and her mother is a mental patient. So we are the only ones who are there to help her and it is a big strain for us as well”.

At this point, Fathima opens her eyes and speaks to us. “I used to do some sewing for the neighbouring houses earning around Rs. 200 a day. If I can get back the use of my legs, and as I have just got my OL results and have passed well, I wish to work in an office”.
Before we leave we meet the youngest inmate, a baby aged 1 year five months. The baby has water in the brain and a tube has been attached to his head to let out the excess water.
“He has already had three operations after he developed this condition when he was eight months old,” his mother Mallika tells us. “The first operation took place in December 2010, the second in January this year and the third was on April 5. My husband is a mason. Our dream is that our child will recover. The doctors here are doing their best. The rest is up to the ‘deviyo”.
We now speak to Dr. Prasad Ariyawamsa, Director of the Neuro Trauma Centre and the Accident Service of the National Hospital.

Briefly outlining the history of the state-of-the-art new unit, he says it was opened on April 1 by the President Mahinda Rajapaksa with a grant of US$ 15 million of the total cost of Rs. 3,000 million being donated from the Saudi Development Fund for the building. The ten-storeyed building comprises eight operating theatres, seven intensive care units, each with 66 beds and one unit with 228 beds and one observation unit. It has the biggest ICU in the entire hospital. Equipped with the latest technology and facilities for CT, MRI scan and X-rays, it is mainly for patients with head and spine injuries.

“Before we set up this unit, there were two units on either side of the National Hospital and all the patients with spine and head injuries were sent there. But after doing a study and research on the patients who were being admitted to the Accident Ward, we found that over two thousand patients with mainly injuries to the head and spine were being brought to these units.
“When we studied the death rate of these patients, we found that there was an average of 250 patients dying while they were still being treated. So we began analysing the cause for this high incidence of deaths, and all the surgeons involved in the study concluded that the majority of deaths could have been avoided, if they had proper Neuro Surgical treatment.

“At that time we weren’t geared to treat neuro-trauma patients as a speciality. We also found that consultant care by neuro surgeons was very minimal and so, because they had so many other duties to perform, most of the cases were being handled by other senior doctors. It was then that the idea of having a separate Neuro Trauma centre was conceived. Although there is a cadre for two neuro surgeons it was decided to appoint only one for this Unit., as the entire country has only nine neuro surgeons. This particular neuro-surgeon, is hundred percent involved with neuro-trauma patients.”

Discussing other problems they faced prior to setting up the new Unit, he says,
“We had to find ICU beds as most of the patients were in intensive care. Post operative care for these patients is extremely important which is why the ICU is a must. The new Unit has been built in such a way that when fully functional, it will have twelve times more beds than what was previously available which was just 66 beds. That means 228 beds to accommodate 228 patients. As we now have a high dependency unit also in the new building, we can now accommodate those in general care and intensive care, all under one roof.”
Why have head and spine injuries under the same roof? I ask.
“Because when a patient comes to us with isolated injuries like a head injury only or a spine injury only, it is all connected and if the patient is not treated fully, he can end up paralysed. So it is a holistic, multi disciplinary approach. In this Unit we have a physiotherapy dept. and occupational therapy department, plastic surgery, vascular surgery – in fact all the specialties needed.”
What about a psychiatric department since most of the patients also need mental counselling to recover from the shock of their injuries?

“Like neuro surgeons, there is a dearth of psychiatrists in the country. But when a patient needs counselling and psychiatric treatment, we refer them to a psychiatrist.”
Since the number of admissions is high on a daily basis Dr Ariyawamsa says that the Unit only admits acute cases. “People don’t realise how expensive it is to undergo treatment in the ICU. If they go to the private sector and spend even one week, they will have to fork out over one million rupees. Hence those who receive treatment in ICUs in private hospitals also request transfers to the ICUs at the National Hospital”.
So are these requests granted as well?
“We try to accommodate as many as possible. This hospital admits patients from all over the island and not from one district or area. Patients are brought in from Galle, Batticaloa, and Jaffna – from the North to the South and East to the west we have ambulances that bring them as fast as they can and we have them open 24 hour hours a day every day. Since immediate treatment is critical for patients with neuro trauma, we have built a helipad to bring in such patients quickly.”

Medical Administrator, with post graduate qualifications in the field, Dr. Ariyawamsa has had 30 years of active service behind him. For the future, he says all he wants is for the new unit to be fully operative as soon as possible to give the public a better service. A Master Plan is now in the making for the hospital. Once this project is completed, all general surgical wards and operating theatres now scattered in different parts of the hospital, will be brought under one roof, he says.
“The food is free and tailormade for each patient. Even clothes are provided for the patient if they don’t have a change of clothes when brought in with blood stained clothes. So they are well looked after,” he adds as we leave him.