by Professor H. R. Seneviratne
Professor of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo. DN Mon Dec 13 2004

Services like everything in life evolve with the passage of time. Similarly Reproductive Health Services in Sri Lanka have evolved to what it is today due to a multitude of events which have occurred over the years. It is recorded in the country's history that from early times royal patronage ensured free health care for our people while maintaining the status of women in high esteem. With the advent of colonial rule, which commenced five hundred years ago, Western type of healthcare was eventually introduced to Sri Lanka.

A landmark event in the progress towards enhanced healthcare was the establishment of the De Soysa Lying-in-Home (the LIH) on December 13th, 1879. The hospital owes its beginning to a philanthropic gesture by Sir Charles Henry de Soysa, a businessman from Moratuwa. He was deeply touched by the plight of women of poor socio-economic status who were deprived of the facility for safe care in a hospital during childbirth. Hence he proceeded to establish a hospital by personal donation of property and funds for their care. The De Soysa Lying-in-Home is the second oldest maternity home in Asia. Since then it has played the lead role in providing for all aspects of healthcare for women and in the training of staff in all grades for this field of work.

During the initial years, maternity services was the main thrust of activities at De Soysa Lying-in-Home. At its commencement it consisted of 22 beds and provided for 52 births during its first year. A decade later the hospital was providing for 425 births annually then on to 1051 in 1909 and 2000 in 1921. The bed strength had now increased to 100. Today this mother of all maternity services in Sri Lanka provides care for over 14,000 maternity cases annually, most of which are of a high-risk nature.

The range of facilities in the hospital developed to include those to treat diseases of the reproductive system while the bed strength has increased to 343.

Along with the expansion of services the staff infrastructure was also developed. Dr. A. M. Fernando was appointed in 1887 as the first Medical Superintendent. The hospital was to see a glorious era of development from 1899 with the appointment of Dr. Murugesar Sinnathambi as its second Medical Superintendent and also as its first qualified specialist. The first caesarean delivery to be performed in Sri Lanka was done at the De Soysa LIH in 1905 and in 1907 the first organised operating theatre was commenced. During his term of office which lasted twenty years Dr. Sinnathambi was instrumental in establishing the De Soysa Lying-in-Home as the premier training institute in midwifery. Thus in addition to providing the clinical services for women's' health, initiating and developing training in midwifery for midwives (1909), Nurses (1916) and in Obstetrics and Gynaecology for medical students (1915) has been the greatest contribution of De Soysa Hospital to the people of Sri Lanka.

By the third decade of the twentieth century changes occurred in the total healthcare structure in Sri Lanka and De Soysa Hospital contributed as a leader in this sphere. These events mainly focused on improving the quality of care, establishing links with the community services and further enhancing its role as a leading institute for training. De Soysa LIH commenced the first Ante Natal Clinic in Asia in 1921. By this time the country was moving towards community based domicilliary healthcare with the organisation of health units and the first such unit was commenced in Kalutara in 1926. The unit provided a template for promotive and preventive healthcare in the country and maternal and child health constituted its main component of activity. Even today it forms the core organisation for Maternal and Child Health (MCH) care services in the country. De Soysa LIH was in the centre of MCH activity at that time as a tertiary care institution as well as the main training institute for all grades of staff.

Major changes were to occur in 1940 when the physical facilities of the hospital were improved with the opening of an administrative building. During that year the hospital was renamed the De Soysa Maternity Home (DMH). Even more significantly along with the commencement of the University of Colombo, the Faculty of Medicine was established and with it the appointment of the first Professor of Obstetrics and Gynaecology. This event brought university education in Sri Lanka in general and medical training in Obstetrics and Gynaecology in particular to the forefront. In addition to clinical care and training, clinical research also gradually commenced. Professor G. A. Wickremasuriya's work on the severe complications of blood pressure in pregnancy published in the Journal of the Ceylon Branch of the British Medical Association in 1941 is one such example.

The post independence period saw major changes in the facilities for healthcare in the country. The overall expansion of the preventive and curative services included integration of the field and hospital facilities. Maternal mortality was on the decline after the traumatic years of the malaria epidemics in the 1930s and 1940s. Free education was established and family planning was introduced with the commencement of the Family Planning Association of Sri Lanka. The establishment of a second tertiary care maternity hospital in Colombo namely the Castle Street Hospital for Women (CSHW) in 1950 eased the burden on the De Soysa Maternity Home which was renamed the De Soysa Hospital for Women (DSHW) that year. The hospital by then was a fully established teaching institute consisting of three specialist units headed by consultants from the Ministry of Health and an academic unit headed by the Professor of Obstetrics and Gynaecology along with the specialist academic staff who serve as honorary consultants.

From then onwards the hospital has continued to provide routine health services, training and research into Obstetrics and Gynaecology while introducing new techniques to the country for more advanced care.

In 1979 combined medical clinics were introduced so that women with medical disorders would be cared for jointly by a specialist in Obstetrics and Gynaecology and a specialist in clinical medicine. This introduced the concept of sub specialisation in maternity care. De Soysa Hospital for Women now has such services of specialist academics in Reproductive Medicine Endocrinology, Perinatology and Specialists in Neonatology etc.

Along with the introduction of a wider range of services, efforts have been made to improve the quality of care despite meagre resources.

The establishment of the Intensive Care Units for the mothers and that for the new born babies has provided major improvement in the care of high risk and life threatening situations. DSHW was declared a "Baby Friendly Hospital" by the UNICEF and the Government of Sri Lanka in 1992 and received the "Taiki Akimoto 5S Award" in 2003 for the bet implementation of "5S" in the service sector. These achievements have been possible due to the joint efforts of generations of all grades of staff of the institution, the members of the de Soysa family, the volunteers serving in the Hospital Welfare Committee and the leadership provided by the hospital administrators.

What is the role of the De Soysa Hospital for Women in serving the public of this country in the future? Like a true mother it has survived many crises from within and without. It has served the people of our country continuously even during times of national turmoil. It still has a leadership role to play in introducing more advanced facilities, improving quality of care and providing for training of care providers of the future. May those who serve in this unique institution be blessed with clarity of mind, a high level of dedication, physical strength and joy in service to our nation all of which is needed to take De Soysa Hospital for Women through the future years as the mother of maternity services in Sri Lanka.