A little jab that goes a long way to ease pain
As a little boy, no toys would be given to him by his Thaththa, a teacher and President’s Scout. Having seen a latent talent in his son to tinker with knick-knacks and come up with unique stuff, he just presented him with an empty box.
Dr. Anupa Herath after receiving his Gold Medal in Geneva
It is in this box that the boy collected any kaella (piece) found lying around, which he would experiment with. Soon he was mending his own shoes and by 12, repairing his bicycle.
This is the boy who has now grown into 32-year-old Anupa Herath, medical doctor- turned-inventor, who has won gold at home and abroad.
One of four inventors to represent Sri Lanka at the International Exhibition of Inventions held in Geneva, Switzerland, in April, Dr. Herath not only struck gold there but was also the recipient of a special congratulatory message from the Jury.
The journey to worldwide-fame came after he tentatively put forward an invention that he had come up with during his long hours with pain-ridden patients and his commitment to providing some relief, while serving at the Kandy Teaching Hospital.
It was to the National Inventors’ Exhibition 2014 held by the Sri Lanka Inventors’ Commission that he submitted his ‘medical marvel’ as others call it, to be awarded the Gold Medal for the ‘Best Invention’ under the ‘Health and Nutrition Category’, while also securing a Special Award for Electronics. The invention was the ‘Low-cost peripheral nerve-stimulator needle with extended functions’. (See box please)
The Sunday Times was able to talk to Dr. Herath during a brief respite in his busy schedule as a Registrar in Anaesthesiology under the Post-Graduate Institute of Medicine and its Board of Study Head, Consultant Anaesthetist Dr. Shirani Hapuarachchi at the National Hospital in Colombo and also his stringent study hours for his MD Part II.
His interest had been more towards electronics than medicine when he was a lad, with his parents based in Nuwara Eliya and his primary schooling being at Gamini Central College in his hometown and later Kingswood College, Kandy.
Dr. Herath’s invention
Passionate about physics, his eyes take on a different light when he says that “the most important subject under the sun other than Buddhism is physics. This is the foundation of everything else – if you understand how certain phenomena work, everything falls into place”.
If you know the fundamentals of physics, he adds that “you can work out anything”. Having put his hand to radio and television repairs and been fascinated with electronic lighting systems, his first choice of a degree was electronics engineering. He cannot pinpoint what made him switch pathways and take to medicine, only that his teachers encouraged him to change his mind.
Awaiting admission to the Peradeniya Medical Faculty, he did, however, acquire a Diploma in Electronics. The rest followed like for any other medico. Five years immersed in the study of medicine, then internship at the Kandy Hospital from 2009 to 2010, post-internship at the Mahiyangana Base Hospital, a stint at the Kandy Hospital — working and studying for the MD Part I in Anaesthesiology which he successfully completed in 2013 — followed by his current duty at the National Hospital.
He devised the ‘Low-cost peripheral nerve-stimulator needle with extended functions’ while at the Kandy Hospital with the full encouragement of Consultant Anaesthetist Dr. Saman Karunathilake, after which it was at the insistence and guidance of the Professor in Anaesthesiology, Prof. Lakshman Karalliedde attached to the Peradeniya Teaching Hospital that he went onto develop the stimulator.
Laughingly, Dr. Herath adds that earlier he was bent on specializing in surgery but it was Consultant Anaesthetist Dr. Vasantha Pinto of the Peradeniya Hospital who persuaded him to venture into anaesthesiology. The College of Anaesthesiologists Sri Lanka has also been supportive all along, while his friend Asanga from Ukuwela had given a helping hand with the electronics.
The precursor to our discussion about his invention is ‘putting patients to sleep’. “As doctors, we are duty-bound as far as possible to prevent a patient from feeling pain as well as surgical stress during an operation,” says Dr. Herath, pointing out that this is achieved by administering either general anaesthesia (GA) or regional anaesthesia (RA) to a patient.
Picking out GA, he underscores that it is of high risk with the possibility of complications linked to the airway, cardiovascular system or anaesthetic drugs, cropping up. While it is a risk to the patient, which could come in the form of illness (morbidity) or even death (mortality), it also creates much stress to the medical staff.
The risks are magnified in elderly patients and also those suffering from heart disease, respiratory tract infections, uncontrolled diabetes or hypertension, it is learnt. This is why the low-risk RA is preferred by anaesthetists especially in orthopaedic (limb) or vascular surgeries.
“There is minimal use of drugs in RA and it is also good because of the excellent post-operational pain relief (analgesia),” says Dr. Herath.
Earlier, following anatomical landmarks, anaesthetists would touch the nerve with a needle, making the patient feel as if a current was passing through, to ‘elicit’ paresthesia (an abnormal sensation such as numbness, tingling or burning).
“However, all patients are not identical and variations from patient to patient created a major drawback, with anaesthetists having to jab the patient several times to elicit paresthesia,” he explains, adding that the failure rate was quite high.
The “challenging but satisfying” peripheral nerve stimulation technique of performing a regional nerve block – delivery of a small, direct electrical impulse (current) to the proximity of a peripheral nerve followed thereafter. When the supporting muscle begins to twitch, the nerve is identified, located and blocked by using a local anaesthetic. Regional blocks with peripheral nerve stimulation have higher rates of success and fewer complications, he says.
The needle used for peripheral nerve stimulation though is costly (about Rs. 4,000) and not freely available in the setting of government hospitals, it is understood.
Conventional needles also have certain drawbacks, according to Dr. Herath and that is when his knowledge of medicine and electronics came into play.
He harks back to his childhood experiments and tells parents not to shower their children with expensive and mostly useless gifts but to hone their creativity by allowing them to be innovative. He also urges the government to “invest” in innovation as that is the way forward for the country.
Getting back to “helpless” patients when under anaesthesia, he is of the view that pain affects patients both physically and mentally. Religion helps the mind and medicine the body.
He sees relieving pain as doctors as the basics of healing and that is why Dr. Herath hopes to become a Pain Specialist.
Improvising both needle and stimulator
Here is how Dr. Anupa Herath came up with the ‘Low-cost peripheral nerve stimulator needle with extended functions’, improvising both the needle and the stimulator.
Describing the needle-assemblage, he says that he took two different–standard wire gauge 18 and 22–intravenous cannulae (tubes usually used to inject or infuse drugs into the venous circulation). He then removed the flashback chamber of the 18-gauge cannula while taking out the needle of the 22-gauge cannula and inserting this needle-tip through the needle of the former.
Next using a crocodile clip he connected the bare proximal part of the needle of the 22-gauge cannula to the conduction unit or the extending negative electrode. Then he connected the syringe containing the local anaesthetic to the extension line, completing the device.
The regional nerve blocks administered by this device result in minimal use of opioid analgesics, early mobilization and minimal respiratory and cardiovascular complications. It allows for the continuous infusion of drugs and provides “excellent” post-operative pain relief for around eight to 10 hours.
Dr. Herath has also improvised the stimulator (original one is more than Rs. 200,000), with his device costing less than Rs. 5,000. While working on further improvements to guarantee electrical safety, he has already applied for a patent.