Sir Sabaratnam Arulkumaran
Doctor to Mums and Babies
Sri Lanka-born Sir Sabaratnam Arulkumaran has devoted his medical career to enhancing the quality of life for mothers and newborns, coming up with techniques that have saved lives the world over. Several of his medical innovations came about during the 15 years that he lived and worked in Singapore.
A decision to move to Singapore in 1982 started Professor Sabaratnam Arulkumaran on a journey that led to him becoming an internationally-feted clinician and researcher in the field of Obstetrics and Gynaecology (O&G). In 2009, Prof Arul, as he is often called, was conferred a knighthood by Queen Elizabeth II for his services to medicine and health care. He is currently professor emeritus of Obstetrics and Gynaecology at St George’s, University of London. He was a former president of the Royal College of Obstetricians and Gynaecologists and has published close to 30 books as an author and editor, among
other accomplishments.
As a child, Prof Arul was taught by his father that the most important virtue a person can have is kindness. This led to him going into medicine. He completed his medical degree at the University of Ceylon in 1972 and did training stints at hospitals in Sri Lanka and the United Kingdom, before applying for a lecturer's position in the O&G department at the NUS.
While lecturing at the university, Prof Arul worked in the wards at Kandang Kerbau Hospital (now KK Women’s and Children’s Hospital, KKH). He was a protégé of Professor S. S. Ratnam, who was already a well-known obstetrician at that time. While Prof Arul's posting opened doors to an area he had set his heart on, he recalled having to adjust to an overwhelming workload. Kandang Kerbau Hospital, which handled around 20,000 births each year in the 1980s, was then organised into two departments—one linked to the university and the other, a government department. Prof Arul’s university unit managed about 10,000 births a year, when typically, other hospitals would manage between 3,000 and 4,000 births a year. This required Prof Arul to put in 10 to 12 hours a day at work.
Fortunately, the medical team was well-organised and competent, said Prof Arul. The members included Professor P. C. Wong, a gynaecologist who is now a senior consultant with the National University Hospital (NUH). The group also had strong support from the university and the government, he added, and all this was a big help. In 1985, the NUH opened an O&G department, helping to reduce the KKH’s delivery load. Prof Arul decided to plant roots here as Singapore was “safe and research funds were abundant”, he said.
Prof Arul went on to graduate with a PhD from NUS and in 1990 became associate professor at the Department of Obstetrics and Gynaecology at NUH. In 1995, he was made the head of NUH’s O&G department. One of his earliest achievements was developing a method, using an anti-contraction medicine, tocolytic, to prevent babies from being deprived of oxygen (known medically as foetus asphyxiation) during labour. He went on to work on a sound stimulus that detects if the child in the womb is healthy. Both techniques are now used widely in hospitals throughout the world.
In 2004, Prof Arul and Dr Chong Yap Seng, now a senior consultant at NUH’s O&G department, came up with a cheap way to prevent excess bleeding after delivery. To do this, they used misoprostol, a drug for treating peptic ulcers, and worked out the most appropriate dosage of the tablet that was needed to get a woman's uterus to contract.
It also does not need to be kept in the fridge, unlike the conventional treatment, oxytocin, making it more convenient for use in developing countries, where basic facilities are lacking. The preliminary findings have been endorsed by the World Health Organisation. It is one of three methods to stop bleeding during childbirth.
Prof Arul was still at NUH when he popularised the second method. This involves inserting a fluid-filled balloon into the uterus. It puts pressure on the blood vessels there, encouraging clotting. In developing countries, a condom can be used instead of the balloon.
The third technique, a compression suture, was devised after he left Singapore for the UK. The procedure can be carried out by anyone who can deliver a baby by ceasarean section, and circumvents the common but complicated method of removing the uterus. Prof Arul’s innovations have helped to reduce maternal mortality rates worldwide, especially in developing countries.
But Prof Arul added that, as is expected in the medical profession, not all medical treatments or innovations turn out successful. His religious beliefs—he is a Hindu—have helped him tide through emotional moments with a measure of equanimity. He would take time to recollect his moves and put on paper a plan to avoid repeating the same mistake. Such retrospection is something he expects of his students too. His one piece of advice to young doctors, during his tenure as chief of NUH’s O&G department, was to always have some “R&R” at the end of their day, that is, to review and reflect on their day’s work.
Prof Arul left Singapore in 1997 at the age of 49, when he was at the peak of his career here. The father of three said he did so for family reasons. In an interview in the August 2009 issue of the Singapore Medical Association’s (SMA) monthly magazine, he explained that by 1997, several members of his family had already made United Kingdom their home. At his new role at the University of Nottingham, he helped start its new medical school and was also appointed one of five non-executive directors of a trust which ran two hospitals. The task of the non-executive directors was to merge the two hospitals into one, plan a new hospital building and start new research laboratories and programmes.
In 2005, Prof Arul worked to turn around the operations of the maternity department at London’s Northwick Park Hospital, which had, for a short period, experienced an unexpected increase in maternal deaths. There, he developed a “maternity dashboard”, which has since won him accolades. This dashboard tracks clinical activity in the maternity ward, while monitoring the clinical performance of the O&G department.
Prof Arul became a British citizen in 2002. He still comes to Singapore regularly to lecture at events organised by the Asia and Oceania Federation of Obstetrics and Gynaecology, and to attend medical panel studies at the Duke-NUS Graduate Medical School.
He also has fond memories of his colleagues at NUS, citing in the SMA magazine interview his research collaboration with colleagues and looking after staff, their relatives and friends. Singapore, he said, gave him a strong foundation for his career in the UK. He said, “In some way, I am who I am because
of Singapore.”
References
Allison Lim, “New Head set to take O & G dept further,” The Straits Times, November 26, 1995.
Chang Ai-Lien, “Making Childbirth Safer for Women,” The Straits Times, October 30, 2010, http://newshub.nus.edu.sg/news/1010/PDF/MAKING-st-30oct-pA22.pdf
“Interview with Professor Sir Arulkumaran,” Singapore Medical Association 41 (2009),
http://news.sma.org.sg/4108/Feature.pdf
K Singh, EL Yong, PC Wong, “The Teaching of Obstetrics and Gynaecology in Singapore from 1905 to the Present,” Annals of the Academy of Medicine 34 (2000)
http://www.annals.edu.sg/pdf/34volno6200506/v34n6p121c.pdf
K Tan and S Cher, “Progress Obstetrics from 19th to 21st Centuries: Perspectives from KK Hospital, Singapore – the Former World’s Largest Maternity Hospital,” The Internet Journal of Gynecology and Obstetrics 2 (2003).
Kumudini Hettiarachchi, “Lankan Knight who Saves Mothers From Death,” The Sunday Times, November 23, 2014.
Maternal health ISFiT 2011 (3) speech by Professor Sir Sabaratnam Arulkumaran, YouTube video, 7:50, posted by ISFiTube’s channel, Jun 15, 2011.
“Queen’s birthday honours list: Knights,” June 13, 2009, The Guardian,
http://www.theguardian.com/uk/2009/jun/13/queens-birthday-honours-knights
Sara Pek, “S. Shan Ratnam,” Singapore Infopedia, accessed December 2014,
http://eresources.nlb.gov.sg/infopedia/articles/SIP_1405_2008-12-30.html
Interview with Prof Sabaratnam Arulkumaran over the phone in December 2014.
Sir Sabaratnam Arulkumaran
Sri Lanka, b.1948