Of heated rocks and hidden rings

The Central VD Clinic of the General Hospital, Colombo (GHC) was the place where patients with sexually transmitted diseases (STD) were treated way back in the sixties. The latter term (STD) would be more familiar to the younger generation because it was only in the 1990s that venereal diseases (VD) came to be known as STDs.

The word “Venereal” is derived from the Latin word “Venereus”, after the name Venus – the Goddess of love and physical beauty in Roman mythology. The term “social disease” is a euphemism often used for venereal disease. Sri Lankans would be even more familiar with the simple Sinhala equivalent “samaja roga” than with the more correct, but high- sounding “lingasritha roga”.

Just as the Central VD Clinic is now an unfamiliar name, the GHC too has undergone a name change more recently. It is now the National Hospital of Sri Lanka (NHSL) and is the premier teaching hospital and tertiary care facility in the country.

Soon after I completed my internship on June 30, 1968, I was absorbed into the permanent cadre of Medical Officers in the Department of Health (there were no waiting periods and backlogs then). Thus with effect from July 1, 1968, I was a fully-fledged medical practitioner registered with the Ceylon Medical Council, and ready to fly out into the world!

My very first appointment as a Preliminary Grade Medical Officer was to the Central VD Clinic of the Colombo General Hospital as a House Officer (HO). In terms of my designation, I was technically “on call” to the small ward within the clinic complex that was set apart for indoor patients. However, during the six months that I worked there, I was never disturbed at night by any calls, simply because there were hardly any indoor patients! Though physically located within the GHC, the Central VD Clinic functioned under the Anti VD Campaign (now the National STD / AIDS Control Programme).

Although the Central VD Clinic had an address at De Saram Place off Deans Road in Maradana, there was no name board to indicate its existence. No one in his or her right mind would have wanted to be seen entering or leaving through that unobtrusive doorway. The anonymity of the place was further enhanced by the fact that even hospital employees referred to it as Room 33 of the OPD (“thisthune kamare”). That speaks volumes for the social stigma attached to the disease.

The Central VD Clinic was divided into two main parts with the section for females being almost totally concealed behind the other sections in the complex that included the Office of the Superintendent, Anti VD campaign. Once inside, a female visitor could do a “disappearing act” into the female section almost unnoticed. A staircase located near the female section led to the laboratory on the upper floor. Male patients had to traverse a long corridor to get to the desired place. A patient had to first proceed to the office that was situated on the right, get a file opened (with an assigned number) and be seated on a bench in the corridor until an attendant ushered him into one of the doctors’ rooms on the left through swing doors.

After ‘history taking’ by the doctor at his or her desk, and a physical examination on a bed in a screened cubicle, an attendant took over from the doctor to complete the remaining procedures depending on the patient’s complaint. It could be either getting a smear from a penile sore on to a glass slide and then dressing it, or getting a sample of a urethral discharge for bacteriological examination in the laboratory upstairs. A blood test was routinely ordered, and the patient then had to go to the nurses’ section, armed with a labelled, rubber capped glass tube. In most cases, the patient had to be referred to a Public Health Inspector (PHI) who was in another room, for contact investigation. The patient was then given another date for the next visit.

The Superintendent of the Anti VD Campaign was Dr. W.L. Fernando. I remember him as a kind-hearted gentleman and a good boss to work with. He was an ardent cricket fan who gave all encouragement to his young son who was a budding cricketer at Nalanda Vidyalaya at that time. It would certainly have been one of Dr. Fernando’s happiest days when his son Bandula Warnapura was appointed as Sri Lanka’s first test cricket captain a few years later.

The Senior Medical Officer in Charge was soft-spoken Dr. Navaratnam. Dr. R. Mahendran had just returned to the country after obtaining his specialist qualifications in UK. The male section also had Dr Gowri de Silva and two HOs Dr. Desmond Gunatilaka and the writer himself. Desmond was a batch mate of mine in Medical College who migrated to the US very early in his career. He is now a Pulmanologist and critical care specialist in San Jose, California.

The female section had Dr. Indrani Jayawardene (wife of Professor Lester Jayawardene who taught Anatomy to generations of medical students in Colombo and Peradeniya), Dr Erin Christoffelsz and an HO Dr. Virginia De Vos (better known as Virginia Swan who excelled as a champion swimmer at Holy Family Convent, Bambalapitiya). Virginia who was also in my Medical College batch migrated to Australia soon after completing her stint in the Central VD Clinic.

The male doctors were occasionally called to relieve the lady doctors in the female section. Dr. T.J.P. Ratnayake was the bacteriologist in charge of the laboratory. Apart from the Central VD Clinic in Colombo, there were few other peripheral clinics that were managed by Drs H.C.B. Premachandra, Indra Wijetilake, W.J.H. Yapa, Upali Fernando and Dr. Herath Gunaratne.

Chief Clerk Bertie Fernando ably assisted by Somapala provided administrative support in the office. Contact tracing and field investigations were handled by Public Health Inspectors Sinhawangsa and Kenny Fernando. The Health Educator was Wijeratne whose wife worked as a nurse in the clinic. The ‘pillars” of the Central VD Clinic were attendants Jakolis, Perera and Piyadasa who had been working there for years.

All visitors to the clinic were not necessarily “patients”. There was a regular flow of new employees from different government and private sector institutions who came there for a routine blood test for confirmation in service. At a time when efficient medical services were not readily available in the private sector, well-known personalities including politicians, sportsmen and even popular film stars had no choice but to come there in their “hour of need”. Most of them being educated people, they knew that they would get the best possible service at this government institution. Above all, they were also confident that at least the doctors who worked there, maintained strict confidentiality. To this day, I can vouch for the fact that I have never ever revealed to anyone, the identity of the numerous friends and even relatives who were forced by circumstances to pay a visit to the Central VD Clinic during my time. But my high ethical principles will not preclude me from relating a few “stories” that might interest readers of Sri Lankan newspapers.

It would not be incorrect to say that I developed an interest in Public Health in this very first job after completing my internship. On certain days of the week, as part of my duties, I had to accompany the PHIs on field investigations to trace contacts named by patients. That was one way of controlling the spread of the disease. These “field visits” took me to such interesting places as Thotalanga, Mayfield Lane in Kotahena, “high-class” brothels housed in posh “residences” in Cinnamon Gardens, and seedy massage parlours that were far less in number than today.

Without any exaggeration, I can say, and many will agree, that the residents in numerous “wattas” or shantytowns in the vicinity of the old Victoria Bridge by the Kelani River at Thotalanga, live in a world of their own. At least at that time, they were a law unto themselves. Any stranger seen in that area was looked at with suspicion. Some of the burly men folk with tough exteriors but tender hearts (as I discovered later) had vicious looking knives and daggers prominently tucked in at the waist. However, our PHIs were not only known to them, but were even treated as friends because the residents were frequent visitors to the VD Clinic. I was therefore safe and in good company.

Illicit liquor and “taste” or “bites” in dirty uncovered dishes (with flies buzzing around) were openly displayed, even by the roadside. Gaudily dressed women with heavy but crude make-up, stood enticingly at the doorstep of many a shanty, awaiting “business”. Words and phrases that are generally considered as “filth” in other places were liberally interspersed in conversations of locals (including children).

I also had the opportunity to visit a row of wooden shacks at Mayfield Lane in Kotahena where an entire community (often treated as outcasts by the rest of society) lived in isolation. Although all inmates were males, the tiny rooms had items of women’s clothing stacked on shelves and hanging on pegs on the walls. These strange people were called by different names, some very unkind (especially the Sinhala ones)! They were the “Female Impersonators”, “Male Prostitutes”, “Pansies” or whatever else that would fall into the category called “unprintable”. Even when “off duty”, they were recognizable by their plucked eyebrows, the way they walked, and by other feminine mannerisms. They earned a living as dancers at weddings in the poorer sections of the city. But it is a well-known fact that they had a better income from what they did at night, standing in dark corners on lonely Colombo streets dressed in female attire.

“Hostesses” from some night clubs in Colombo were frequently brought to the Central VD Clinic for “check-ups”. But one incident that I remember very well was how a vanload of women was once brought to the clinic following a police raid on a brothel. They had been produced before a Judicial Medical Officer who had then referred them to the Central VD Clinic. One particular “patient” was rather reluctant to get on to the examination bed where they were routinely subjected to a gynaecological examination. Having inserted a speculum, the doctor had noticed a “foreign body” which looked like a cloth swab. Using a pair of artery forceps, the “swab” was gently pulled out and dropped into the nearby metal bucket. The characteristic sound of impact of metal on metal was clearly heard. A female attendant rummaged through the contents in the bucket and fished out a woman’s handkerchief that was tied into a knot. She untied the knot only to find a heavy gold ring! The “patient” later confessed that she had stolen it from a client who apparently had taken “one too many” before he embarked on his sexual adventure. When the police rushed in during the raid, she had found a convenient hiding place for the stolen goods!

In that pre HIV/AIDS era, long before a mysterious disease first hit the gay population in San Francisco in the eighties, most patients who sought treatment at the Central VD clinic presented with a genital sore or a white discharge. The symptoms were manly due to syphilis or gonorrhoea. During the doctor-patient encounter, in taking a proper history, the question had to be asked about sexual contact and possible exposure to the disease. Some patients had the temerity to vehemently deny any form of sexual contact. Little did they know that it was possible for a trained doctor to arrive at an immediate clinical diagnosis (to be confirmed later by a bacteriological examination of a smear and blood test) simply by looking at the clinical signs.

The typical appearance and location of an ulcer (called a primary chancre in medical jargon), together with enlarged regional lymph glands etc., tell a tale. Some enterprising patients persisted with their own theories on the origins of an ulcer. I remember a patient who came out with a tall story about how he was seated on a heated rock for a long time under the scorching sun and how he noticed a few days later that his “private part” had got “burnt”! In pithy Sinhala he said “Ira mudun welave rath wechcha galak uda wadi wela hitiya. Tika dawasakata passé thamai dekke pichchila bawa”.

Although my stint at the Central VD Clinic was short, many events and new developments in my personal life, both sad and happy, took place during this period. It was in August 1968 that my father passed away at the relatively early age of 62. Just before that, I had acquired my first four-wheeled vehicle – a second hand Austin A35 with the registration number 2 Sri 185 (as a medical student, I was independently mobile, but on just two wheels!). At a time when it was no easy task finding an eligible person as guarantor to sign for a government car loan, it was my senior VD Clinic colleague Dr. Erin Christoffelsz who came to my rescue. I paid off the loan in full just two years later and I dutifully informed the kind lady about the settlement while thanking her profusely again for that unforgettable gesture.

The Superintendent Dr. Fernando tried hard to persuade me to join the Anti VD Campaign on a more permanent basis and take up Venerealogy as a career. I was in two minds, but finally opted out because I was keen to get involved in broader Public Health issues. Thus, with effect from January 1st,1969, I resumed my career in different surroundings as a Medical Officer in the OPD of Colombo South Hospital. That too only for a short while, for I exercised the option to take up Public Health as a career, just a couple of years later.

That also explains why I no longer treat individual patients on a regular basis (as a doctor would normally do), but instead, try to help entire communities to find solutions to the multitude of public health problems that they are faced with.