History and Development
The story of respiratory medicine in Sri Lanka — from a handful of tuberculosis specialists to a national College representing pulmonologists across the island.
The Journey So Far
The Early Years
The present-day pulmonologists were called tuberculosis specialists or chest physicians before the establishment of the Postgraduate Institute of Medicine, Colombo. There was a long waiting list in general medicine for the approval of no-pay leave to proceed to the United Kingdom to qualify for MRCP. The list in the national tuberculosis programme was much shorter, and it was easier to obtain MRCP. However, the MRCP-qualified doctors through the tuberculosis campaign had a commitment to work as tuberculosis specialists in the chest clinics.
There were three tuberculosis specialists in the country by the time the very first locally qualified, board-certified consultant in respiratory medicine joined the Ministry of Health in the mid-eighties. The work of these specialists was limited to the care of tuberculosis and pneumonia.
The major breakthrough came in the mid-nineties when two pharmaceutical companies brought in inhaled corticosteroids at a very economical price. A large number of patients with chronic cough and asthma began seeking treatment from respiratory physicians, giving them the recognition they deserved in the health care delivery system. As the field became much more popular, more young doctors started taking up respiratory medicine as a career.
Initially, these pulmonologists were placed in Colombo, Kandy, and Galle, fighting a lone struggle with the Ministry of Health and the tuberculosis campaign to upgrade respiratory services in their local stations. As the number of specialists increased to 8–9, they realised the importance of speaking with one voice and uniting to advance the specialty.
Formation of the Respiratory Disease Study Group (RDSG)
The "Respiratory Disease Study Group" (RDSG) was formed, consisting of pulmonologists, a few general practitioners, and a senior paediatrician who later masterminded the paediatric pulmonology stream in the country. The RDSG held three successful annual conferences in pulmonology, significantly raising the specialty's profile in the healthcare system.
Transition to the Association of Pulmonologists Sri Lanka (APSL)
By 2003–2004, as the number of pulmonologists rose to 15–16, unique challenges arose in the public sector, where all pulmonologists worked in government hospitals. A new organisation named the "Association of Pulmonologists Sri Lanka (APSL)" was formulated, consisting only of board-certified pulmonologists. APSL worked with the Ministry of Health to improve services in centers outside the main cities.
Evolution into the Sri Lanka College of Pulmonologists (SLCP)
After 2010, with the association handling large funds for various activities, accountability and transparency became key priorities. In this context, the association was converted into a college under the name Sri Lanka College of Pulmonologists (SLCP) and was registered under the Registrar of Companies.
Achievements of the SLCP
Annual Academic Sessions
The SLCP holds its annual academic session, "Respire", to upgrade medical education and popularise the specialty among junior doctors.
College Journal
The "Respire" journal, now evolved into the "Sri Lanka Journal of Medicine", has achieved international standards.
Facility Transformation
Conversion of chest clinics and chest wards into busy and dynamic institutions delivering state-of-the-art respiratory care to the public.
Effective Resource Management
Efficiently utilising support from well-wishers and donors without duplication of work.
Consultant Posts
Ensuring pulmonologist posts are advertised under main hospitals like any other consultant positions, rather than under chest clinics.
Clinical Leadership
Leading respiratory medicine services in district chest clinics.
Vacancy Preparation
Collaborating with the Ministry to prepare vacancy lists for pulmonologists.
Training Programs
Participating in the subspecialty board for respiratory medicine in PGIM and facilitating post-MD and DTCD training programs.
Establishment of End Posts
Supporting the establishment of end posts in Kandy, Galle, Kurunegala, and Jaffna.
Upgrading Welisara Chest Hospital
Converting Chest Hospital Welisara into the National Hospital for Respiratory Diseases under a separate director working under DDGMS.
NHSL Cadre Absorption
Colombo district consultant posts were absorbed into the NHSL cadre.
Paediatric Pulmonology
Supporting the establishment of paediatric pulmonology training.
Current Status
There are approximately 50 board-certified adult pulmonologists practicing in the country, while 15 are employed overseas in countries like the United Kingdom and Australia. Additionally, there are five thoracic surgeons and three paediatric pulmonologists associated with the college.
The present specialists cover the entire island, with at least one pulmonologist in each district. The number of specialists is growing, with over 20 post-MD doctors currently in respiratory medicine training programs locally and abroad.