Dr Navadeva Harendra Cooray completed his undergraduate training from the All India Institute of Medical Sciences, New Delhi. He has the rare distinction of being amongst the first Emergency Medicine MD and postgraduate diploma in Critical Care Medicine holders from Sri Lanka. He is the acting Consultant Emergency Physician of the ETU Neuro-trauma Centre at the National Hospital of Sri Lanka. He is the Founder Past President of the Sri Lankan College for Retrieval & Emergency Medicine and is a member of the Sri Lankan Society of Critical Care and Emergency Medicine for over a decade and has held the posts of General Secretary in both the Critical Care and Emergency Medicine arms of the society. Harendra has amassed a wealth of clinical practice experience by working in many parts of India, Sri Lanka & Australia for the past 26 years.
Harendra has a keen interest in teaching and has been a regular member of the instructor group of the Emergency Life Care (ELC) , Basic Assessment and Support in Intensive Care courses (BASIC), Advanced Paediatric Life Support (APLS) conducted by the SSCCEM & Sri Lanka College of Paediatrics.
He had the privilege of gaining valuable work experience at the Canberra Hospital Emergency Department from 2017 to 2019. Harendra is striving to improve the patient centred care and efficiency of health care services by promoting and developing Emergency Medicine in Sri Lanka.
What are the main emergency medicine challenges that you face in Sri Lanka?
Emergency medicine in Sri Lanka is brand spanking new. It was a long, hard struggle to establish emergency medicine in Sri Lanka as I’m sure it has been all over the world.
I would like to just reflect upon the past very briefly because whatever we have achieved up until now, is all thanks to the hard work of a few very committed individuals. Two names that I have to mention are both my teachers and mentors, one of them I’m sad to say has passed away and never saw the fruits of her efforts, is the late Dr Mrs Neelika Karunaratne. She was a very dynamic individual, she was an anaesthesiologist who had a passion to improve standards of care to all critically ill patients by providing optimum intensive care, as well as emergency medicine care. She initiated and was one of the founders of the Society for Critical Care and Emergency Medicine in Sri Lanka.
The real force behind and credit for what we are seeing today in regards to our trainee program and creating specialists in emergency medicine goes to Professor Chula Gunesekera. He’s an exceptionally talented man and has dual specialization in both anaesthesiology and paediatrics. He developed the training program from scratch into what it has evolved into today.
Those are the two people who worked really hard to establish emergency medicine as a specialty in Sri Lanka, and of course I cannot forget the role played by several fellows of the Australasian College of Emergency Medicine who have been supportive in the establishment of emergency medicine in Sri Lanka.
When I spoke recently to Professor Chula Gunesekera who is currently working in a position at King’s College London, he wanted to impress upon the fact that our curriculum was based on the core curriculum developed by IFEM way back in 2008. He was so grateful that he had something to base our structure of training on. He told me he attended the IFEM conference in 2008 and I believe that’s the time that we got affiliate membership for the Sri Lankan Society of Critical Care and Emergency Medicine.
In 2004 the Boxing Day tsunami created such devastation in Sri Lanka. That was the time that policymakers & government officials understood the need for emergency medicine because we were completely taken by surprise by this massive loss of lives. Sri Lanka did not have an EM specialty, it was evident that it would take time to establish, but the IFEM core curriculum provided a great foundation and enabled Sri Lanka to fast track the development of a training program.
I was among the first trainees in the specialty, and we had a very comprehensive training course, but we still had to rely on our base specialties to teach us the fundamentals of managing emergencies. We are so grateful to the physicians, cardiologists, neurologists, anaesthesiologist, general surgeons and the list goes on. It was all of them together who created who we are today.
I take pride in being amongst the first 17 trainees who completed the first specialty training and who got the opportunity to train overseas. I am very thankful to my supervisor Dr Nick Taylor a director of emergency medicine training at the Canberra Hospital in Australia where I spent two wonderful years working with a fantastic team. It was a real eye opener, and I really got a feel for emergency medicine working in such a busy tertiary level emergency & trauma centre. Taking this wealth of experience and expertise back to Sri Lanka we’re now striving hard to develop the specialty with two main intentions – improving patient centered care and improving the efficiency of our health care services through the emergency department. So that in itself is the greatest achievement, establishing the specialty.
What are the main emergency medicine challenges you’re facing currently?
The main challenge in Sri Lanka at the moment is continuing the development of the specialty, and transforming what we call emergency treatment units (ETU) into proper well managed emergency departments.
At the same time, we have a fledging specialty training course where I’m really happy to say, is one of the, if not the most sought-after specialty training courses and gets the most number of candidates sitting for the primary exam. This is just fantastic for us, and we currently have about 170 trainees in the program. So, teaching emergency medicine is the second most important challenge we endure and we’re really banking on IFEM to support us in this endeavour.
A third challenge is because it is a new specialty, garnering support and reassuring our colleagues that we are here to complement them and not to compete with them. Plus getting administration to understand what we are really trying to do.
What are you hoping to achieve over the next few years?
We want to establish more and more emergency departments around our country. Sri Lanka is a country which has a completely free public health service, where we provide the simplest kind of healthcare service to the most complex healthcare service absolutely free of charge to our citizens. Sometimes I wonder how we do it being a low to middle income country, but it’s fantastic that we can and now one of our main goals is to incorporate emergency departments into all parts of Sri Lanka.
As part of our postgraduate training, there is a requirement that we have to go overseas for at least a year in our chosen field in a recognized training centre. So that wealth of experience we gain over a year or two is something that is so useful when we come back and establish new departments. So with the dramatic increase in EM specialists returning to Sri Lanka the challenge is to spread out our specialty, so that every single person in this country who presents to hospital is seen in an emergency department by a highly trained physician.
Why did you become an Emergency Medicine Physician?
Well, my initial career prospect was in anaesthetics, and although I didn’t do postgraduate training, I had basic training as an anaesthetist. After some time, I found that although it gave me a fantastic grounding and a huge skill set to manage patients who are very sick and no offense to any anaesthesiologists but it was a little boring for me !
After some time, I was looking into other possibilities and then critical care medicine was on the cards and I just jumped into it. I’m so grateful to my anaesthesiology teachers because they gave me the best grounding to become an exceptionally confident emergency physician.
What do you enjoy the most about being an Emergency Medicine Physician?
It is the challenge that is in front of me, so what I look at when I’m working in the department is every emergency is really determined by the patient, so even a patient who has a very, very irritating tummy ache and wants to go for a maybe an interview the next day morning, that becomes an emergency, the undifferentiated chest pain is an emergency, the unconscious patient is an emergency, the child who is fitting is an emergency, so the variety, the challenge, the uncertainty, and also knowing that you make a huge difference to all categories of patients who present. You kind of fix their problem and sometimes you save a life so that is what I love about Emergency Medicine.
Is there anything else that you would like to add?
We are extremely happy to be part of IFEM, we want to contribute to IFEM at the same time, and see a wonderful future for IFEM and Sri Lanka emergency medicine.
And just to kind of reiterate that emergency medicine is going to improve and develop in Sri Lanka and this opportunity that IFEM provides to lower middle-income countries like ours to really deliver emergency medicine to the people who really need it is wonderful, and we are so happy that you have embraced us, so thank you.