Evolution of Paediatric Medicine in Sri Lanka: Honouring Professor Herbert Aponso on his 100th Birthday.

Professor Herbert Allan Aponso, born on March 25, 1925, recently celebrated his 100th birthday at his serene home in Kandy. Surrounded by his cherished children, the occasion not only honoured his extraordinary life but also served as a tribute from his academic colleagues, recognising his outstanding contributions to the field of paediatrics in Sri Lanka. Professor Aponso is widely recognised for his exceptional ability to combine extensive field experience with academic teaching and groundbreaking research. He emphasised social causes of disease and maintained that a disease is not just a manifestation of biological factors in the human body, but an expression of social and environmental factors as well. He encouraged his students to consider social aspects, such as family factors and poverty, in order to explain diseases, particularly childhood diseases such as malnutrition.

Born in Lakshapathiya, Moratuwa, Aponso began his academic journey at Prince of Wales College, Moratuwa, excelling in the Senior School Certificate and London Matriculation Examinations. His medical aspirations led him to the University of Colombo in 1943 and subsequently to the Medical College, where he graduated MBBS with honours in 1949. Pursuing further specialisation, he trained in paediatrics at the prestigious Great Ormond Street Hospital for Children, the largest and oldest children’s hospital in the UK, earning his DCH (London) in 1956 and MRCP (Edinburgh) in 1957.

Upon his return to Ceylon in 1958, Aponso earned his MD in Medicine and commenced a distinguished academic career. He joined the Faculty of Medicine in Colombo as a Senior Lecturer in 1963 and subsequently took on the role of Lecturer-in-Charge of Paediatrics at the University of Ceylon in Peradeniya in 1964. His career saw steady progression as he was promoted to Associate Professor in 1974 and ultimately attained the position of full Professor of Paediatrics in 1977.

Aponso was a Fellow of both the Royal College of Physicians (Edinburgh) and the Ceylon College of Physicians. He actively contributed to the Kandy Society of Medicine, where he served as President from 1974 to 1975. Beyond medicine, he played key roles in community organisations. Before relocating to Kandy, he was the president of the Moratuwa YMCA and a founding member of the Moratuwa Y’s Men Club. Later, he led the Kandy Y’s Men’s Club, which evolved into the Mahanuwara Y’s Men’s Club.

His contributions extended into promoting nutritional advancements, notably advocating for the consumption of soya. He pioneered the preparation of soya products in the kitchen of the Peradeniya Teaching Hospital and established a Soya Centre linked to the Kandy YMCA. Further showcasing his dedication to public health, he presided over the Sri Lanka Association for Voluntary Surgical Contraception and Family Health during two separate periods: 1977–1979 and 1986–1987. Additionally, he led the Sri Lanka Paediatric Association from 1976–1977.

Even after retiring from the University of Peradeniya in 1993, his impact endured. In recognition of his lifelong contributions, the university awarded him an honorary DSc in 2022. Through his tireless dedication, Professor Aponso profoundly influenced paediatric medicine in Sri Lanka, leaving an enduring legacy in both academic and medical spheres. Paediatrics as a specialised field of medicine in Sri Lanka has evolved over centuries, shaped by indigenous healing traditions, colonial medical advancements, and modern institutional developments. During colonial times under the Portuguese and Dutch, children continued to be treated through traditional medicine. The British colonial administration formalised Western medical education and established hospitals. In 1870, the Ceylon Medical College (now the Faculty of Medicine, University of Colombo) was founded, producing doctors trained in Western medicine. Paediatric care as a distinct discipline began to emerge in the early 20th century, having previously been part of general medicine. The introduction of vaccination programmes, particularly against smallpox, was a major public health advance introduced under the Vaccination Ordinance of 1886. It was during the1920s that Maternal and Child Health Clinics were setup in villages, laying the foundations for addressing child health issues in the country.

The early decades of the century saw the establishment of paediatric units in major hospitals, a critical step towards recognising and addressing the distinct medical needs of children. The establishment of paediatric units in major hospitals in Sri Lanka began in the mid-20th century, with significant developments occurring in the 1950s and 1960s. These units were set up to provide specialised care for children, addressing their unique medical needs. For example, the Lady Ridgeway Hospital for Children in Colombo became a national tertiary care centre, offering advanced paediatric services Hospitals such as the Colombo General Hospital (now the National Hospital of Sri Lanka) and played a pioneering role in creating specialised wards dedicated to paediatric care, laying the foundations for future advancements in the field.

A major turning point in the progress of paediatrics in Sri Lanka came with the appointment of Dr. C. C. de Silva as the first Professor of Paediatrics at the University of Ceylon (now the University of Colombo) in the 1950s. He was instrumental in formalising paediatric education and training, ensuring that future medical professionals were equipped with the knowledge and skills to provide specialised care for children. The introduction of dedicated paediatric courses in medical schools marked a shift from traditional general practice to a more specialised approach to child healthcare. The 1950s also saw the expansion of paediatric services beyond Colombo, with provincial hospitals establishing their own paediatric units, making specialised care accessible to a wider population.

The latter half of the 20th century witnessed remarkable progress in paediatric care, with the establishment of postgraduate training programmes aimed at producing highly qualified paediatricians. These programmes were designed to meet the increasing demand for specialised medical professionals who could address the complex healthcare needs of children. Alongside these educational advancements, there was a significant improvement in neonatal and maternal healthcare services, leading to better survival rates for newborns and reducing infant mortality. Innovations in paediatric research and healthcare policies further contributed to improvements in the overall well-being of children in Sri Lanka.

By the 1980s, paediatrics had firmly established itself as a distinct and essential medical discipline in Sri Lanka. The introduction of specialised paediatric subfields such as neonatology, cardiology, and nephrology allowed for more targeted treatment and improved health outcomes for children with complex medical conditions. The role of paediatricians expanded beyond hospital care, with increased involvement in public health initiatives such as immunisation programmes and nutritional interventions. The collaborative efforts of the government, medical institutions, and healthcare professionals ensured that paediatric care in Sri Lanka continued to progress in parallel with global medical advancements.

The development of paediatric specialization in Sri Lanka during the 20th century was a transformative journey that laid the groundwork for the country’s modern child healthcare system. From its humble beginnings in general hospital wards to the establishment of specialised training programmes and research initiatives, paediatrics evolved into a well-defined and essential medical discipline. This progress not only improved healthcare outcomes for children but also contributed to the overall strengthening of the medical field in Sri Lanka. Today, paediatrics continues to be a vital component of the healthcare system, building upon the foundations set during the 20th century to ensure a healthier future for the nation’s children. Professor Aponso was integral to the shaping of this process of development, in the 1950s and afterwards, fully engaged in every aspect. His involvement was not just academic, as he was an advisor to the government and other organisations, such as the World Health Organization, on matters about advancements in child health.

One of his most significant accomplishments was a six-year research project, generously funded by the World Health Organization (WHO) and the Canadian International Development Agency (CIDA). This initiative was integral to addressing pressing health challenges within the Mahaweli Accelerated Development Programme in its initial phase. The project focused particularly on improving healthcare services in System ‘C’ of Girandurukotte, a region populated by settlers relocated from villages inundated due to the construction of large tanks and reservoirs. The programme was launched shortly after the settlers arrived, aiming to tackle the myriad health issues they encountered as newcomers to the dry zone settlements.

Under Aponso’s leadership, ‘mothers’ clubs’ were established in hamlets in each of the four settlement units chosen for intervention. These clubs became vital community spaces where families could engage in discussions about the health problems they faced. The challenges were numerous and varied, including skin diseases, issues with drinking water, snake bites, elephant attacks, and accidents sustained while working in newly cleared paddy lands. Malaria and flu posed an especially serious threat at the time, necessitating timely treatment.

The mothers’ clubs operated as dynamic forums where settlers could participate in question-and-answer sessions about their health concerns. These sessions often culminated in providing treatments for those afflicted. The efforts were supported by Dr. (Mrs.) Fernando, a dedicated health officer in ‘System C’ of Girandurukotte, who attended most of the meetings, ensuring professional medical assistance. Professor Aponso was also assisted by lecturers at the Department of Paediatrics and a health education officer, Mrs. Alagoda, whose skills in engaging with mothers played a pivotal role in the success of the discussions and outreach programmes.

During this period, the Centre for Intersectoral Community Health Studies (CICHS) emerged under the visionary leadership of Professor Aponso. As an interdisciplinary scholarly organisation dedicated to advancing health research in Sri Lanka, CICHS made remarkable strides in the field. Among its pioneering initiatives, the sexual-risk prevention programme stood out as a milestone. This programme prioritised fostering individual competencies while shaping cultural norms that encourage healthy sexual decision-making, reflecting the organisation’s commitment to impactful research and community well-being.

As the project manager of the WHO/CIDA project, I had the privilege of working closely with Professor Aponso. I travelled frequently from my office at the Department of Paediatrics at Peradeniya to the villages, coordinating the programme’s activities. We collected household data on a sample within selected settlement units, such as Teldeniyaya, Hombariyawa, Millaththewa and Rambewa. To make a comparison, we also collected data from Mawanella rural villages, which was considered the control area. This information was then meticulously analysed using an IBM computer, a remarkable technological feat at a time when computers were a rarity.

Our research team, comprising approximately ten recent sociology graduates, including KMHB Kulasekera, RM Karunasekara and Nandani de Silva, worked tirelessly to collect, compile and interpret the data. The findings were shared at various conferences in the form of scholarly articles, providing valuable contributions to both national and global conversations on the public health challenges faced by communities in transition.

Professor Aponso’s work not only made a profound impact on the lives of those settlers but also left an indelible mark on the field of social paediatrics, demonstrating the transformative power of community-based health initiatives supported by collaborative research.

Aponso’s contributions to child healthcare, particularly in the areas of neonatology, nutrition, and medical education are important. As a student of Dr. C. C. de Silva, he was deeply influenced by his mentor’s pioneering work in paediatrics and carried forward his legacy by further strengthening child healthcare services in Sri Lanka. Dr. L.O. Abeyratne was the first Professor of Paediatrics at Peradeniya, and, upon his retirement, Professor Aponso succeeded him, continuing to advance paediatric education and healthcare in Sri Lanka. Aponso was particularly known for his work in neonatal care and the prevention of childhood malnutrition. He played a key role in introducing and promoting best practice in newborn care, helping to reduce infant mortality rates in Sri Lanka. His advocacy for improved maternal and child health policies contributed to the expansion of paediatric services beyond Colombo, ensuring that specialized care was accessible to children in rural areas as well.

Beyond clinical practice, Professor Aponso was a dedicated medical educator. He trained and mentored numerous paediatricians, helping to shape the next generation of child healthcare professionals in Sri Lanka. His work in medical research and teaching influenced advancements in paediatric care and was

instrumental in establishing higher standards in paediatric training programmes. In 2011, in commemoration of his work, Dr. Ananda Jayasinghe edited a collection of essays titled ‘In honour of Herbert Allan Aponso, emeritus professor of paediatrics, University of Peradeniya, Sri Lanka.’

Professor Aponso is a remarkable individual whose humility is as profound as his ability to listen with intention and honour to the perspectives of those around him. A celebrated expert in his field, he was elected President of the Sri Lanka Paediatric Association in 1976 and ascended to the role of full Professor of Paediatrics in 1977. His dedication extended far beyond academia—he served as President of the Young Men’s Christian Association in Kandy during three pivotal periods: 1966–1968, 1973–1975, and 1984–1988.

In 1952, he embarked on a lifelong partnership with Jayanthi Vimala Dias, now deceased, building not just a family but a legacy of intellect and social impact. Together, they raised three children—Ajith, Heshan, and Charmalie—who each distinguished themselves in society. Their home became a vibrant epicentre of stimulating dialogue and collaborative ideas, welcoming friends to partake in lively, thought-provoking discussions.

For me, the memory of Professor Aponso is forever intertwined with the dynamic days of the Mahaweli research project and CICHS initiatives, where his presence enriched every endeavour. As he continues his retirement journey, I wish him abundant health and days brimming with vitality, joy, and a renewed sense of purpose.

by M. W. Amarasiri de Silva
(Emeritus Professor of Sociology, University of Peradeniya Sri Lanka and Lecturer at the University of California, Santa Cruz, USA).