By Dr B. J. C. Perera 

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

This must surely be quite a resounding bombshell—from the computer keyboard of a Specialist Consultant Paediatrician. What I have written in this article is most definitely from the past, quite a bit of it from over 50 years ago. I have to qualify the title of this article with the caveat that it should not be misinterpreted as hating children. I loved children with no reservations whatsoever, and still do. Witnesses to that statement are my daughter, three grandchildren, a large number of nieces and nephews, and even grandnieces and grandnephews as well as a very large cohort of little ones that I have seen and treated over many a decade. I have unconditionally loved children; period. Now then, one might wonder, quite justifiably perhaps, what on earth is this character talking about? How is it that the word ‘hate’ has come into the picture?

The term “Paediatrician”, is derived from two Greek words; pais meaning “child” and iatros meaning “healer”. Paediatrics is the science, which deals with the medical care of infants, children, and adolescents. Child healthcare has a legacy as old as any other constituent of medicine. It is also held in the highest esteem because of the notion that children are the jewels of our future, and consequently, their health and well-being are a matter of broad social concern. Of course, if you are a healer of children, you cannot hate children!

At the very outset, I have to explain why I hated paediatrics over five decades ago. At that time, as a late-teenaged medical student and a young junior doctor, I had the bitter experience of seeing scores of children succumbing to many different diseases for which we had very few answers. At the Lady Ridgeway Hospital for Children, it was not an uncommon sight to see bodies of innocent little children being wheeled out of the wards as a regular occurrence. As a young man, I could not come to terms with these frightening manifestations of a branch of medicine which was somewhat unsuccessful in saving children. Hence the intense dislike for paediatrics and a firm determination to avoid getting into the field of paediatrics at any cost.

In that era, the newborn death rate was around 40 per 1000 live births, meaning around 40 newborns out of 1000 did not live beyond 28 days. The Infant Mortality Rate was around 55 per 1000 live births, meaning 55 of 1000 did not reach their first birthday and the Under 5-year Mortality rate was around 70 per 1000 live births meaning 70 out of 1000 live births did not survive up to their 5th birthday. These were horrendous statistics that accounted for significant numbers of child deaths, year in and year out. What killed these children were prematurity, congenital defects including heart malformations, many types of major infectious diseases, malnutrition, acquired heart problems, accidents, and a whole host of a multiplicity of other childhood maladies. To make matters worse, some diseases that affected the brain and others like polio which affected the peripheral nervous system, left the afflicted children maimed for life with cruel disabilities. As a medical student and a young junior doctor, I felt helpless in not being able to do something, or anything worthwhile at all, to try and stem the tide and the slide. Hence my intense dislike for paediatrics. I desperately wanted to be a Consultant Physician who treats adults. At that time, it was quite a glamorous speciality.

Yet for all this, destiny dictated otherwise. I was forced to do paediatrics for the second six months of the internship. I went to work as a very junior House Officer at the Lady Ridgeway Hospital for Children and quite honestly took up that position with the greatest reluctance and very serious concerns about my abilities to treat children. It was extremely hard work as large numbers of children were admitted to the ward with all kinds of diseases. It was a matter of working day and night, even foregoing meals, to try and save children.

As time went by, something struck me very strongly and ever so forcefully as well, while working with children. Of course, the deaths were there and that was the worst scenario that one could ever imagine. But there were a considerable number of children who recovered and went home as well. We managed to even save many desperately ill children. We were sending back those who recovered, into a full life of many decades to be spent as useful citizens of our Motherland.

As it happened, when you work with children, they kind of ‘grow on you’. At the end of my internship, my feelings towards paediatrics were a bit mollified and somewhat neutral. At the end of the internship, fate decreed for me to be posted to the Out-Patients Department of the Lady Ridgeway Hospital for Children as a Medical Officer in the OPD. That was a most rewarding experience as we treated and cured quite a large number of children who came with various illnesses to be treated in the OPD. By the end of one year in the OPD, I had secured a postgraduate qualification that enabled me to get a position in the Faculty of Medicine of the University of Peradeniya. I spent a year there doing adult medicine and teaching pharmacology.

At the end of that year, as was decreed ever so firmly by providence, I applied for a position and came back to the Lady Ridgeway Hospital for Children as a Paediatric Registrar, the second-in-command of a Children’s Ward. By that time the die had been cast; firmly and forever more. I was going into a lifetime career in paediatrics and there was no turning back from then onwards. A 3-year training period in the UK ensued where I did adult medicine simply because the mandatory MRCP examination was in adult medicine. Then I came back to Sri Lanka and at the rather early age of 31 years, I was posted as the Specialist Consultant Paediatrician to General Hospital Badulla; the only paediatrician for 70 to 80 kilometres around. I was thrown unceremoniously, into the deep end.

The rest is history. Over a stint as a Consultant Paediatrician spanning 46 years, right up to the present time, I have seen it all. I served in Badulla, Ratnapura, Kurunegala and Colombo. More than anything, I have seen the tremendous advances made by the incessant forward march of child healthcare. We are now able to handle quite successfully a lot of the diseases that killed children 50 years ago. Many of the killer infectious diseases are practically eliminated from our country. Loads of congenital malformations including major heart problems are now being effectively treated. We save many lives of children who would have succumbed to all those major diseases just 50 years ago. Many people do not believe it but the Cardinal Health Statistics of Sri Lankan children are now on par with the developed Western World. Currently, the newborn mortality rate is around 4 per 1000 live births, the infant mortality rate is around 7 per 1000 live births and the under 5-year mortality rate is around 6.5 per 1000 live births; ALL IN SINGLE DIGITS. When compared to the really high values of the 1960s and 1970s, the extremely significant fall of these parameters is nothing but miraculous. People all over the entire world are really in wonder about this little island nation which has achieved so much with so few resources

The success story of paediatrics in Sri Lanka is not only due to the dedication and clinical acumen of Consultant Paediatricians but also to the untiring efforts of all other grades of child healthcare staff, in hospitals as well as in the field over many a grassroots level. The way the paediatric scenario has developed in Sri Lanka is most definitely due to a team effort of absolute splendour. We now see only very few deaths of children in our hospitals. We have collectively turned the tide for the better.

As for me, to have worked in and given my all in a branch of medicine that I originally tried hard to avoid, practically loathed and intensely detested, is perhaps the kind of thing that dreams are made of. It has very definitely warmed the cockles of my heart to be a witness to the vast strides that have been made in child healthcare over the last few decades. Today, to see a little child recovering and going home is akin to a precious gift that nothing else could even remotely match. My attitude and perceptions towards child healthcare have gone through a complete 180-degree swing, quite early in my career as a practising doctor. For me, quite thankfully and over the years, the practice of paediatrics has become not only a matter of doing what I love, but most clearly and persistently loving what I do; daily. I believe that I have adequately given back to this country, even more than what I owe, for the most beautiful things that it has given me, including free education.