News
CSSL puts forth solutions to stem brain drain and provide state-of-the-art surgical care
View(s):- Dr. Duminda Ariyaratne suggests a cluster system, allowances for peripheral surgeons and also hopes of introducing robotic surgery
By Kumudini Hettiarachchi
Scalpels downed, they gathered in the auditorium of the charming Noel & Nora Bartholomeusz Foundation in Colombo 7 to induct the President of the College of Surgeons of Sri Lanka (CSSL), the apex body of the surgical fraternity on January 11.
Humility and humanity were obvious as the newly-inducted CSSL President Dr. Duminda Ariyaratne took to the podium.
Senior-most CSSL Past President, Prof. Arjuna Aluwihare (3rd from left) lights the oil lamp
Reiterating that long before he entered medical school, his mother who is no more, had instilled the mantra of kindness and compassion, especially towards the underprivileged, and his 91-year-old father who was in the audience had told him that “what matters is not how much you make (money), but how you made that much”, Dr. Ariyaratne spoke on what ails surgical services in the country.
He paid tribute to the surgeons who work “tirelessly” in the peripheries, often with limited resources. He talks with experience as he has worked at the Trincomalee General Hospital during the conflict giving equitable care along with the other staff to the victims of the war; then moved to the Balapitiya Base Hospital; followed by the Horana Base Hospital; the Colombo East Base Hospital, Mulleriyawa, at the height of the COVID-19 pandemic; the National Hospital of Sri Lanka (NHSL); and finally the Colombo South Teaching Hospital, Kalubowila.
From left: CSSL Secretary Dr. Malik De Soysa, Guest-of-Honour & Health Secretary Dr. Anil Jasinghe, CSSL Immediate Past President Dr. S.M.M. Niyas, CSSL President Dr. Duminda Ariyaratne, Chief Guest & Attorney General Parinda Ranasinghe Jr. and Guest-of-Honour Dr. Mahanama Gunasekara. Pix by M.A. Pushpa Kumara
Moving onto the challenges being faced by surgeons currently, Dr. Ariyaratne said they include how to provide state-of-the-art surgical services across the country and issues linked to training of surgeons. They were working with the Health Ministry in the planning and implementation of health-related policies.
With regard to surgical services, he said that they have been grappling with financial instability, the mass migration of surgeons and the loss of skilled middle-grade medical and nursing staff. Peripheral units, in particular, are bearing the brunt of these issues and have been forced to scale down their services due to lack of surgeons. The Ampara, Moneragala, Hambantota, Nawalapitiya, Kilinochchi, Mannar and Mullaitivu District General Hospitals are covered by acting surgeons.
|  Dr. Malik De Soysa |  Attorney General Parinda Ranasinghe Jr. |  Dr. Anil Jasinghe |  Dr. Mahanama Gunasekara |
The statistics were disturbing – only 10 board-certified general surgeons are available to fill around 60 vacant slots in the Annual Transfer List of 2025. The 180 general surgeons on the Health Ministry’s annual list in 2014-2017, have decreased to 125 today. The situation in sub-specialties like cardiac, paediatric and plastic surgery is much worse.
Pointing out that current statistics reveal that a significant percentage of trainees on return from overseas training, subsequently migrate to developed countries in search of more favourable opportunities, Dr. Ariyaratne stressed that an urgent need is a mechanism to retain newly-qualified junior colleagues to serve the country.
“To mitigate this trend, I propose offering additional allowances to surgeons working in less-favourable regions, alongside the provision of regular time off for them to spend with their families. A cluster system in peripheral hospitals which is currently being piloted in nine regions with funding from the Asian Development Bank (ADB) offers a promising solution,” he said, explaining that the value of the ‘cluster system’ in improving working conditions and service delivery cannot be over-emphasised.
There may also be a need to consider re-employment of retired surgeons to serve in the vacant units until the situation improves, he said.
Dr. Ariyaratne assured the Health Ministry and the new government of the CSSL’s fullest support in addressing these challenges and also pledged to empower surgeons to achieve higher professional standards as trainers and ensure that trainees receive comprehensive exposure to the full spectrum of surgical practice.
Highlighting that robotic surgery has made significant progress not only in the west but also in Asian countries, he lamented that Sri Lanka had yet to acquire a robotic surgical system. The CSSL has recommended to the National Medicines Regulatory Authority (NMRA) to approve the introduction of a robotic system and he was optimistic that in the near future, trainees would get the opportunity to develop robotic surgical skills locally.
CSSL Secretary Dr. Malik De Soysa, while delivering the vote of thanks, said that the Council for 2025 would support Dr. Ariyaratne in steering the journey forward, while consolidating past victories and maintaining standards and traditions.
Stepping out of the norm, he said: “You may have come across the phrase, ‘I thank you in advance’. Often, it feels like an obligation. This evening, however, I want to thank you in advance with a different intention. This one is for all the times you do something for the college and realise that it has gone unacknowledged or not been appreciated enough.”
So, Dr. De Soysa thanked them in advance, requesting continuous service, volunteerism and good work by all for the betterment of surgical care in the country and the sustenance of the college.
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