News
LRH’s spine-curvature corrections in jeopardy
Essential high quality implants available only for 8 of 52 children on the list
By Kumudini Hettiarachchi
Smiling teenager Sayuri Anjalika from Rajanganaya gets off the bed in Ward 14B of the Lady Ridgeway Hospital (LRH) for Children in Colombo and moves about with the walker under the watchful eye of her mother, Tharanganie Ratnayake and the nursing staff on Friday.
Close by, S.K. Malisha Hansamali (14) accompanied by her mother W.V. Shama Priyadharshini from Moneragala is awaiting admission to the same ward.
Dr. Nirmal Marasinghe
Sayuri has just undergone complex definitive surgery for the correction of severe scoliosis (curvature of the spine) on May 31 (Tuesday) and Malisha will undergo surgery next Tuesday (June 7).
Malisha is among children and adolescents from across the country, Colombo to Jaffna, Batticaloa to Galle, Kandy to Akkaraipattu, Negombo to Dehiattakandiya, Puttalam to Embilipitiya and more on a list of 52.
Just as everything was moving smoothly, an unseen factor stemming from Sri Lanka’s economic crisis and dollar shortage is about to ‘break the back’ of the LRH’s scoliosis surgery programme.
The danger lies not in staff issues or theatre time even though more would be better – but the looming crisis is the lack of essential implants (rods and screws made of titanium) which are critical in holding up the straightened spines of these children.
With worry lines wrinkling his brow, Consultant Orthopaedic Surgeon Dr. Nirmal Marasinghe is very concerned about the 52 children on the list awaiting surgery because he has implants only for just eight of them.
He says that in these complex and lengthy surgeries of the spine which last around eight hours each, while the skill of the team is of paramount importance, the quality of the implants is also critical. This is because unlike other surgeries, there is very little room for revisions (later changes through repeat surgeries) as the vertebrae are set together to straighten the backbone.
Stressing the specific advantages of reputed and worldwide accepted quality spinal implants, he says that such implants also come with high-quality long-lasting instrumentation which helps to shorten surgical time as much as by an hour. These are very sensitive surgeries as the spinal cord – which connects the brain to the lower back and carries nerve signals from the brain to the body and vice versa – runs through the vertebrae.
The Sunday Times learns that a company which imports these quality implants is now unable to open Letters of Credit (LCs) and thus these implants are very much in short supply. Credit lines may bring in other implants but the question is whether they are the best for Sri Lanka’s children who will be compelled to have them all their lives.
It was soon after Dr. Marasinghe’s return from intensive training in the United Kingdom, that he was appointed in March 2020, amidst the raging COVID-19 pandemic, to the LRH not to perform general orthopaedic procedures but to address the huge burden of spinal deformities including scoliosis in children and adolescents.
Surgery has given Sayuri a straight back
Till then, this arduous task of correcting scoliosis had been the responsibility of the National Hospital’s Orthopaedic Surgeons who had to allocate time amidst their already-busy schedules, while a few had also been handled by the Orthopaedic Surgeons at the Jaffna Teaching Hospital. This led to time-consuming scoliosis surgery being few and far between with very long waiting lists.
With the appointment of a dedicated Orthopaedic Surgeon for spinal deformities including scoliosis at the LRH, the pace of these time-sensitive procedures had quickened with Dr. Marasinghe’s colleagues giving him part of their precious theatre time at the old Operating Theatre (OT). Here two scoliosis correction surgeries were done every month.
After the new OT complex was opened last year, Tuesdays have been dedicated for scoliosis correction – four per month. The multi-disciplinary team including Dr. Marasinghe’s juniors; the anaesthetists; the neuro-monitoring doctors; the radiologists; the Intensive Care Unit (ICU) staff; the nursing staff; the ward staff; and minor staff had got into their element to help all those children and adolescents with scoliosis, which formed a majority of the spinal deformities.
This OT complex on the 7th floor of LRH’s Accident Service building had been opened in October 2020 but had become functional with staff allocations only on Children’s Day – October 1, last year. Currently only one of two theatre suites is being utilised due to lack of adequate staff.
Now Dr. Marasinghe’s team not only does the surgeries but also manages children with scoliosis from the time they are born and those referred to them at different ages.
Within the last 14 months alone, the LRH team has carried out definitive scoliosis correction on 38 children.
The current acute shortage of quality implants is posing a grave danger to this programme and what would happen to children like Sayuri and Malisha comes to the fore as Tharanganie tearfully murmurs that the doctors should attain bo-sathbava for curing her daughter.
Sayuri walks ‘straight’ after the surgery with Tharanganie close by
Appreciating the effort being made by LRH Director Dr. G. Wijesuriya to secure adequate stocks of implants, Dr. Marasinghe says that if they are compelled to halt the scoliosis correction surgeries for lack of implants, children would be badly affected. The curvature of their spine is progressive and even though it is not a life-threatening condition, these children face much social and psychological trauma.
“Children with scoliosis refuse to go to school, refuse to sit examinations such as the Ordinary Level and are shy to go to public places due to their deformity,” he says, adding that there is no hope for them and “this is why we cannot give up”.
| SOS to friends and colleagues abroad for help Desperate to help his humble patients, Dr. Nirmal Marasinghe has not only dug deep into his pocket and those of his kith and kin in Sri Lanka to make local purchases but also reached out to many abroad.The need is dollars and so several of his friends and schoolmates in Australia have banded together to launch a Facebook campaign, while a close relative in Dubai has got activated to drum up support from friends and colleagues there.Meanwhile, Dr. Marasinghe has also reached out to his boss under whom he trained in the United Kingdom to lend a helping hand. A strong plea goes out to all those who live abroad to help in whatever way they can to secure the rods and screws needed to make Sri Lanka’s children with curved spines stand up straight again and face the future with dignity. | |
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