Golden years of Health Education

There was a time in Sri Lanka, when nobody, not even health professionals, took health education seriously. Prior to the seventies, traditionally, it was a subject handled almost exclusively by Public Health Inspectors (PHI), some of whom were later designated as full time Health Educators. As a medical student in the sixties, I remember a solitary one-hour lecture given by a senior Health Educator. Apart from the many empty seats in the lecture hall, quite a few of those present there were half asleep. That was a time when a “health talk”, a leaflet or a public announcement over a loud speaker fixed on top of a van, passed off as a package under the “Health Education” label.

All that changed in 1972, with the appointment of an MBBS qualified doctor with the designation of Senior Medical Officer (Health Education) to take charge of the Health Ministry’s Health Education Division that was then located in an insignificant corner at the “Boatyard” adjacent to the Beira Lake, just behind the old Parliament Building at Galle Face. The gigantic task of developing health education as a recognized discipline in the country, fell on the shoulders of Dr.Tilak Munasinghe who had long years of experience and specialist qualifications in Public Health (DPH and MD).

The World Health Organisation (WHO) stepped in to give a helping hand by assigning a long-term consultant to assist in developing a plan to upgrade the existing Health Education Division to a fully-fledged Bureau. Dr. S. Nagaraj from India thus started his long stint in Sri Lanka and helped Dr. Munasinghe in accomplishing his assigned task. Patronage at the highest levels in the WHO was forthcoming with Dr. V. Ramakrishna of India as the Regional Adviser in Health Education for the South East Asia Region. Sri Lanka continued to enjoy such patronage in later years with our own countryman Dr. C.H. Piyaratne taking over from Dr. Ramakrishna as the WHO Regional Adviser.

One politician who took a personal interest in health education was Mrs. Siva Obeysekara who provided political leadership at a time when it was most needed. She spearheaded a movement to launch a series of Community Health Pilot Projects in selected Medical Officer of Health (MOH) areas. The other Health Education arm of the Health Ministry – the Health Education Materials Production Unit (HEMPU) located at Kynsey Road, played a prominent role in organizing exhibitions at those venues showcasing the work done under the pilot projects. The Officer-in-Charge of the HEMPU was senior Health Educator (HE) K.D.C. Perera.

The creative talent that KDC possessed went a long way in making the pilot community health projects and the health exhibitions a great success. As the Assistant Medical Officer of Health (AMOH) at Matara, I assisted the Chief MOH Dr. K.M. Sugathapala in ensuring that the project at Urugamuwa (a village near Dickwella) was second to none.

Unlike the developed countries that had fully qualified health education specialists, Sri Lanka at that time had none. In 1973, the United Nations Fund for Population Activities (UNFPA) provided funds through the WHO to the Health Ministry to send five medical doctors with experience in Public Health (selected through interviews) to universities in the United States on 18 to 24 month Fellowships, to be trained as health education specialists. The WHO found placements for the five doctors in prestigious universities that had reputed Schools of Public Health. Thus Merle Perera and Walter Patrick went to the University of Michigan at Ann Arbor, Marcus Fernando and the writer himself to the University of California, Berkeley, and Upali Perera to the University of North Carolina at Chapel Hill.

By the end of 1975, the newly qualified health education specialists had dutifully returned to their home country after completing their Masters degrees in Public Health (MPH) majoring in Health Education. On their return, they were posted to the Health Education Bureau (HEB), which by then had been upgraded and shifted to the HEMPU premises at Kynsey Road. According to the plan drawn up by Doctors Munasinghe and Nagaraj, the Bureau was made up of a number of units, each handling a special area of work. The identified units and areas were: Training, Community Health Education, Hospital Health Education, School Health Education, Special Campaigns (Malaria, Tuberculosis, Filariasis, Venereal Diseases, Leprosy, Rabies), Research and Evaluation, Oral Health, Media and Publicity, and Health Education Materials Production.

Apart from the six doctors (Director and the Health Education Specialists), we had senior health educators L.W. Karunaratne and H.I. Karunadasa as the Chief Health Education Officer and Deputy Chief Health Education officer respectively. Dr. K.D.G. Saparamadu, a Consultant Dental Surgeon with specialist qualifications in Community Dentistry was placed in charge of the Oral Health Unit. Health Ministry Publicity Officers Quintus Fernando and Piyasoma Medis staffed the Media and Publicity Unit. They were in later years replaced by well-known media personality Thusitha Malalasekara and the reputed film and teledrama director Chandraratne Mapitigama.

While a few other health educators functioned at the central level, others were scattered in the provinces with at least one HE for each Superintendent of Health Services (SHS) division. The combination of medical and non-medical staff worked well as a team under the HEB Director Dr. Munasinghe’s leadership. In the period that I have covered in this article (1972 to 1990), Dr. Merle Perera replaced Dr. Munasinghe who retired in the mid eighties to take charge of an internationally funded Non-Governmental Eye Care Organisation.

It is with much regret that I record here that three of the above named doctors (Merle, Marcus and Upali) and Quintus passed away relatively early in life, but after serving the HEB for a substantial period of time. On the other hand, it is with much pleasure that I write here about the academic achievements of Walter Patrick, Karunaratne, Karunadasa and Medis (now domiciled in Sydney, Australia) who went on to complete their PhDs. In 1986, the writer himself completed (by research), the advanced public health degree of Doctor of Medicine in Community Medicine (MD) offered by the Post Graduate Institute of Medicine (PGIM) of the University of Colombo. Dr. Walter Patrick who played the lead role in training health educators emigrated to the US soon after obtaining his Doctorate and accepted a position with the University of Hawaii where he retired from the position of Dean of the School of Public Health. He is now serving as Secretary General of the Asia Pacific Academic Consortium for Public Health (APACPH) with headquarters in Honolulu, an organization he himself founded nearly 25 years ago.

The Health Education Bureau worked closely with a number of prestigious institutions of that era. Among them were the Curriculum Development Centre (CDC) of the Ministry of Education, Sri Lanka Institute of Development Administration (SLIDA), the Mahaweli Authority and the Post Graduate Institute of Medicine (PGIM). Most of the funding came from the WHO, UNFPA and the United Nations Children’s Fund (UNICEF).

We were able to team up with a number of eminent academics and media minded doctors who shared a common goal and interest – that of demystifying medicine and imparting health information to a large receptive audience with the long term objective of promoting desired health behaviours and changes in lifestyle. Names that come to mind are Professors Nandadasa Kodagoda, Carlo Fonseka, Colvin Gooneratne, Narada Warnasuriya, Nalaka Mendis, Priyani Soysa and clinicians such as D.P. Atukorala (cardiologist), H.T. Wickramasinghe (paediatrician), D.A. Sonnadara (paediatrician) and even former Director of Health Services Dr. W.A. Karunaratne who had also served as the WHO Representative in Liberia. Dr. Karunaratne gave leadership to the campaign against smoking and tobacco use at its very beginning. One of the very first educational booklets on “Heart Attacks” authored by Dr. D.P. Atukorala was published through the HEB.

It was in the 1980s that a postgraduate course leading to the degree of Master of Science (M Sc) in Heath Education was developed by the HEB. Significantly, it was with this new degree course that the PGIM broke tradition by throwing open the M Sc course in Health Education to non-medical candidates. All recipients of degrees from the PGIM had up to that time been either medical or dental graduates. In conducting this programme, the HEB had unstinted support from hand picked Resource Persons drawn from varied fields and disciplines. We worked with academics like J.B. Disanayaka, Nandasena Ratnapala, Tissa Kariyawasam, Newton Gunasinghe, Swarna Wijetunga and other eminent personalities such as Dr. A.T. Ariyaratne (founder of Sarvodaya), Tissa Abeysekara (a well-known name in the film world) and Dr. Hiranthi Wijemanne (UNICEF) to name a few.

A number of international short-term consultants too assisted the HEB in this pioneering venture. The teaching faculty mixed freely with the trainees both at work and play, when the residential course was conducted at the Diyagala Boys’ Town in Ragama.

In place of the one-hour “lecture” on health education by a non-medical person in a by-gone era, the physician / health education specialists (whose credibility among medical students was considerably higher), were able to provide greater input into undergraduate medical curricula. Concepts drawn from the behavioural sciences such as sociology, anthropology and social psychology were introduced to future doctors. This went a long way in convincing new medical graduates that occurrence of disease in human beings is not just a biological phenomenon, but a social phenomenon as well. They were also shown that making a community diagnosis in a populace is as important as making a clinical diagnosis in individual patients.

Health education work took us to the far corners of Sri Lanka extending from Puliyankoodal in Kayts to Beragama in Hambantota. In those peaceful days when all races co-existed in perfect harmony, we thought nothing of spending weeks in far off Jaffna, occasionally enjoying frothy palmyrah toddy freshly served straight from the tree!

Bands of young volunteer health workers were recruited and trained to work closely with Public Health Inspectors and Family Health Workers at village level to educate families and look into their health needs. New settlers in Mahaweli areas needed special attention in this regard. Thus HEB staff spent days and nights travelling and working in far flung places like Mahailluppallama, Maduru Oya, Digana, Kotmale, Teldeniya, Mahiyangana and Girandurukotte. We all enjoyed sipping plain tea in wayside boutiques or in humble thatched homes while chatting with villagers, occasionally throwing in health messages when appropriate! The concept of primary health care along with the health volunteer movement was the key that shaped our thinking and future work.

The aforementioned period extending from 1972 to 1990, will certainly go down in history as the Golden Years of Health Education in Sri Lanka. The pioneering work of the first Director of the Health Education Bureau in bringing together a dedicated set of professionals to build up a discipline that has now come to stay will long be remembered. If our revered Guru the late Dr. C.H. Piyaratne was a virtual “Godfather” to the HEB and its staff, Dr.Tilak Munasinghe undoubtedly is the Father of the Health Education Bureau.

Incumbent Director of the HEB Dr. Sarath Amunugama (not to be confused with the Minister of Enterprise Development and Investment Promotion or the Dean of Humanities, University of Kelaniya who both share not only the same first and last names but also the prefix!) had recently requested some of us “seniors” to review the new HEB website. Dr. Amunugama is making a valiant effort to restore the image of an institution that shone like a beacon a few decades ago, but had fallen into an abyss in recent times following the exit of the old brigade.