Prof S. S. Ratnam

 

Putting Singapore on the Medical Map

 

Sri Lankan-born Prof S. S. Ratnam came to Singapore as a young medical doctor in the late 1950s. His groundbreaking work has since put Singapore on the medical map in more ways than one. While his work with transsexuals has won him media attention, he was also a leader in reproductive biology, helping couples have children.

 

The terms “visionary”, “formidable figure”, “trend-spotter” and “pioneer” are commonly used to describe Professor Sittampalam Shanmugaratnam, also known as Prof S. S. Ratnam. Much of his work broke new ground. He was a leader in reproductive biology, giving Asia its first test-tube baby through in-vitro fertilisation (IVF). He and his team also provided many childless couples with hope, by devising other methods of having a baby—by implanting frozen embryos and through improving the reproductive capabilities of weak sperm, among others.

Born in 1928, Prof Ratnam’s uncle, maternal grand-uncle and cousins were all doctors, and his mother wanted him to follow in their footsteps, so he attended medical school. In 1957, Prof Ratnam completed his studies at the University of Ceylon. He came to Singapore to do an internship at the Singapore General Hospital and in 1963, joined the University of Singapore’s Obstetrics and Gynaecology (O&G) department as a lecturer. In 1970, he became head of the O&G, retiring in 1995 at the age of 67. He worked tirelessly to train young doctors and saw the department through a series of firsts. He purchased its first ultrasound machine, and in 1971, he wrote medical history when he developed a series of surgical operations to transform the phenotypic sex or the physical genital characteristics defined within each sex. His interest in this field was sparked in 1969 when a Singaporean patient begged for a sex-change operation. At the time, the patient, who had been born a man, had attempted suicide twice. Prof Ratnam initially sent him to a psychiatrist, but the patient returned to his clinic every week, appealing to him to do the operation.

Prof Ratnam, who was influenced by his mother’s strong belief that one should help others, studied what had been written on the complex procedure and even practised doing it on cadavers in the mortuary before he agreed to operate on the patient. In 1971, he performed a successful operation and paved the way for sex-change surgery in Asia. He received many more requests, and doing his best not to decline too many, he worked 14-hour days—seeing patients, researching, writing papers and attending meetings. He did not take vacations or rest on weekends. In a 1996 interview with The Straits Times, he confessed, “I can’t bear the idea of not doing anything. I have to keep busy and asking questions. Otherwise, I have no business being in research.” During Prof Ratnam’s tenure at the O&G department, it was designated as one of 13 World Health Organisation Collaborating Centres for Research in Human Reproduction in 1972. This gave it worldwide recognition and international funding for its research projects.

In 1981, Prof Ratnam received an award from the Association of Southeast Asian Nations for his contributions to reproductive medicine. In 1983, he led a medical team to successfully produce Asia’s first test tube baby. This came after an initial failure—he tried to carry out embryo replacement in 1982 at his lab for IVF in Singapore, but the procedure failed. He attempted it again a year later, applying what he had learnt from that first effort. This time, a healthy baby boy was born.

In 1986, he became Asia’s first doctor to help a woman become pregnant using Gamete Intrafallopian Transfer (GIFT), a procedure whereby fertilisation happens naturally after eggs and sperm are placed directly inside one of the fallopian tubes. In 1987, he managed another first—conceiving a baby through IVF, using a frozen embryo. His patient had attempted twice to get pregnant through the usual IVF method—using a freshly fertilised embryo—but that had failed. On the third try, an embryo preserved from a previous cycle was implanted, a rare procedure then. In 1988, the Singapore Science Council conferred the National Science and Technology Award—the highest honour bestowed on outstanding scientists in Singapore—on Prof Ratnam.

In 1991, his team pioneered the world first’s micro-injection baby. The method involves injecting weak sperm directly into the egg. In an interview in 2001, Prof P. C. Wong, now a senior consultant at NUH, recalled how Prof Ratnam would encourage younger doctors to go overseas for training. Prof Ratnam’s advice to aspiring obstetricians and gynaecologists was also, “Don’t do anything because it gives you recognition or money. Ask what you enjoy doing most. Is caring for your patients your primary interest? If yes, don’t take on academic medicine, go and be a good doctor and be kind to your patients,” recounted Prof Wilfred Perera, a well-known Sri Lankan gynaecologist, at the 2nd Shan Ratnam Memorial Lecture in 2003. Under Dr Ratnam’s guidance, many of the doctors whom he nurtured have gone on to head O&G departments.

Prof Ratnam also represented Singapore as the secretary-general of the Asia and Oceania Federation of Obstetrics and Gynaecology for 21 years. During this period, he shaped its administrative functions, combining obstetrics, gynaecology and other related research areas into one unit. His efforts further raised the profile and reputation of Singapore’s O&G medical professionals. In 2000, he became the federation’s president-elect and was to be elected officially as its president at the next AOFOG congress. Unfortunately, he died of pneumonia in 2001 at the age of 73.

Despite his accomplishments and recognition worldwide, Prof Ratnam, a small-built man who was known for being a smart dresser, was always unassuming. When conferred the title of Emeritus Professor at NUS in 1996, he said of his achievements, “I have been very lucky. God opened doors for me; I happened to be there.” Prof Ratnam, remembered today as a world leader in human reproduction research and the founder of the IVF programme in Singapore, received the Public Administration Medal (Gold) in 1977 and the Public Service Star in 1985.

References

“Administrative Manual,” Asia & Oceania Federation of Obstetrics & Gynaecology,
updated 2009, http://www.aofog.org/files/upload/AOFOG-Administrative-Manual.pdf

“AOFOG Newsletter,” AOFOG Young Gynaecologist Awardees Association, 1 (2005),
http://www.aofog.org/files/upload/YGA_2005.pdf

“‘Frozen Embryo’ Baby all Grown up,” The Straits Times, October 14, 2014.

Geoffrey Bishop, “Emeritus Professor S. Shan Ratnam, 1928-2001,” Journal of Obstetrics and Gynaecology 28, (2002).

Indrani Nadarajah, “Forum Marks Another Breakthrough for Ratnam,” The Straits Times, November 3, 1996.

“Medical Pioneer Ratnam Dies,” The Straits Times, August 7, 2001.

Renowned Asian Gynaecologist Ratnam Dies in Singapore,” AFP, August 7, 2001.

Salma Khalik, “Man of Vision, Mentor to Many,” The Straits Times, August 8, 2001.

Victor H H Goh, S S Ratnam, W F Tsoi, Cries from Within: Transexualism, Gender Confusion
and Sex Change (Singapore: Longman, 1991).

 

 

Prof S. S. Ratnam
Sri Lanka, 1928–2001