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Surgeons Scope Magazine Issue 2 - 2023
A SURGEON IN PENANG
DR PRABHU RAMASAMY
There’s nowhere in the world that Dr Prabhu Ramasamy (FRCSI 2016) would rather live than Penang, and no more rewarding career, he says, than surgery. He recounts how medicine has inspired three generations of his family
I grew up and went to school on the beautiful island of Penang in Malaysia, where I live now. I am the youngest of three boys, my two brothers are doctors too and we are the second generation of doctors in my family. My brothers are in practice in Kuala Lumpur.
When I was in school my initial plan was to join the armed forces, but coming from a typical Tamil family that was not an acceptable profession. My parents wanted us to be professionals, so even though after high school people thought I might study engineering I was influenced by my brothers going to medical school and followed in their footsteps.
My father, Dr PK Ramasamy, was a paediatrician, my uncle an ophthalmologist and my aunt a gynaecologist. I grew up watching them serve the community and develop their practices. Everywhere they went people recognised them and they had status in the community. That influenced me, I thought medicine did not look like a bad career. Of course, I only saw the end result of doing medicine and getting to where they were; I did not see how incredibly hard they worked.
My father was a government servant and did his paediatrics training in the 1970s, working in different places around Malaysia. I was born on the east coast in the state of Kelantan. We came to Penang in 1979 when I was five and my mother, Saraswady, fell in love with this beautiful place and after that refused to move anywhere else. There are two parts to the state of Penang: the island and the part on the mainland. I grew up on the island and still live there. My father is 84 now, he worked until the age of 79; my parents still live on the island.
I graduated from Jawaharlal Nehru Medical College in Belgaum (Belagavi), India in 1998. Following a year of internship there, I returned to work in Malaysia. In 1999, I was assigned as a house officer at Hospital Pulau Pinang (Penang Hospital). I did obs and gynae, then general medicine and then surgery.
Upon completing my housemanship, I was transferred to Hospital Seberang Jaya in the state of Penang as a medical officer. The hospital covered all the basic specialties but had no sub-specialty units. At that time, the hospital faced a severe shortage of doctors. I became the third medical officer in the department of surgery, as we had no resident surgeon and relied on cover provided by visiting surgeons from Hospital Pulau Pinang, 20km away. Often they provided cover over the phone. The hospital was located close to the intersection of three major highways and we saw plenty of trauma, it was terrible. At that time I thought I wanted to do radiology, and that later I would do interventional radiology. I had no intention of pursuing a career in surgery.
But about a month after joining the department, Mr Khoo Boo Beng, who was to become my mentor, arrived. Working under his guidance was a source of great joy and inspiration. Under Mr Khoo the department grew and he and Mr Naga, the second surgeon posted to Seberang Jaya Hospital, encouraged me to pursue a career in general surgery.
After working for two and a half years at Seberang Jaya Hospital, I became eligible to apply for my Masters in Surgery. I applied to the same university where Mr Khoo had completed his training, based on his recommendation. In 2003, I enrolled in the Masters in General Surgery external programme at the University Kebangsaan Malaysia (National University of Malaysia).
My wife Shanty is a doctor too and she started her Masters in Medicine the same year. Our son, Hiresh had been born the previous year and our daughter, Raveena, during the second year of training. It was a very busy time and without the tremendous support of my mother and mother-in-law I don’t know how we would have coped.
Colorectal cancers had become the second most common type of cancer among Malaysians and the leading cancer among Malaysian males. There was a pressing need for expertise in colorectal surgery.
My training was gruelling. Surgery was not a popular specialty at the time and there was an acute shortage of surgeons. Over the next four years, I returned to the Department of Surgery at Hospital Pulau Pinang. Dato Dr Manjit Singh, Mr Premanth and Mr Tan Wee Jin played significant roles in my training as a general surgeon. During this period, I actively participated in the training of undergraduates from Penang Medical College (RSCI and UCD programmes), house officers, medical students, and fellow Masters students in the Department of Surgery.
I successfully completed my Masters in Surgery in 2007 and was then assigned back to Hospital Pulau Pinang. In 2009, I was accepted into the Fellowship in Colorectal Surgery under the Ministry of Health Malaysia. I underwent training under Professor Azmi at the International Islamic University (IIUM) in Kuantan, Malaysia. For the second year of my fellowship, I was posted under Dato Dr Wan Khamizar at Sultanah Bahiyah Hospital in Alor Setar, Kedah. My overseas attachment in colorectal surgery took place at Christian Medical College (CMC) Vellore in India.
During my Masters of Surgery training, a significant component of my curriculum involved teaching undergraduate students from the medical school. During that period, the Head of the Surgical Department at the medical school was Professor Peter William Ray Lee, a colorectal surgeon himself. I had the privilege of spending considerable time with him, and he later became my Master’s thesis supervisor.
Another crucial factor influencing my decision to specialise in colorectal surgery was the shortage of colorectal surgeons in Malaysia. Colorectal cancers had become the second most common type of cancer among Malaysians and the leading cancer among Malaysian males. There was a pressing need for expertise in colorectal surgery.
Seven years ago, I made the decision to move into private practice and I’m currently at Loh Guan Lye Hospital in George Town, Penang, where I serve as the Head of Surgery and also lead the OT (Operating Theatre) committee. Prior to the COVID-19 pandemic, I was actively involved in teaching, dedicating at least an hour each week to undergraduate students. I typically accept around five elective students annually.
Additionally, I allocate a day each month to engage with postgraduate students from Hospital Pulau Pinang and Hospital Seberang Jaya. I actively participate in workshops related to colorectal surgery for postgraduate and junior surgeons. Furthermore, I am a member of the Court of Examiners for the MRCS exams conducted by RCSI in Penang.
My work week typically spans six days, from Monday to Saturday, and most days I work between 10 and 12 hours per day. My schedule includes two days dedicated to surgical procedures, during which I have two operating lists. Additionally, I allocate 90-minute slots for endoscopy procedures from Monday to Friday. This rigorous work routine allows me to maintain a busy and fulfilling practice in the field of surgery and endoscopy.
My work week typically spans six days, from Monday to Saturday, and most days I work between 10 and 12 hours per day. My schedule includes two days dedicated to surgical procedures, during which I have two operating lists. Additionally, I allocate 90-minute slots for endoscopy procedures from Monday to Friday. This rigorous work routine allows me to maintain a busy and fulfilling practice in the field of surgery and endoscopy.
One of the specific challenges I encounter in my work in Penang, despite it being a relatively small city, is the escalating cost of healthcare. While the hospital I work in offers a range of multidisciplinary services, the increasing costs can pose difficulties, particularly for economically disadvantaged patients. Ensuring that quality healthcare remains accessible and affordable to all residents of Penang is an ongoing concern for me.
Government hospitals are very well-equipped but hugely overcrowded. While the ratio of doctors per head of population has improved in recent years and
When I left government employment, I was Head of Surgery at Hospital Pulau Pinang, and the principal motivation to move to private practice was financial. I wanted to be able to provide a good tertiary education for my children and could not do that on a government salary. The wage difference means that instead of Malaysia having a brain drain to other countries, there is a brain drain from the public to the private sector which threatens to paralyse the whole system.
Penang holds a special place in my heart, it is my lifelong home. The city’s liveability, renowned food, and the presence of family and friends, make it a cherished location for me. However, I do have concerns about excessive development that may be eroding the unique charm that Penang has long been known for. Sometimes I think developers are trying to make it like Singapore. Unfortunately, that has involved deforestation and it is much warmer now than it was when I was a child, and I don’t hear the birds as much as I used to. As the population has increased, the roads have become more congested. I live about 10km away from the hospital in a suburb called Green Lane. During the pandemic it used to take me only eight minutes to get to work, but now it takes 40.
Penang holds a special place in my heart, it is my lifelong home. The city’s liveability, renowned food, and the presence of family and friends, make it a cherished location for me. However, I do have concerns about excessive development that may be eroding the unique charm that Penang has long been known for. Sometimes I think developers are trying to make it like Singapore. Unfortunately, that has involved deforestation and it is much warmer now than it was when I was a child, and I don’t hear the birds as much as I used to. As the population has increased, the roads have become more congested. I live about 10km away from the hospital in a suburb called Green Lane. During the pandemic it used to take me only eight minutes to get to work, but now it takes 40.
Eating is a culture in Penang and we have the best food in the world. We are known for our street food, which is truly wonderful. Usually we eat at home during the week, but on Sundays we go out for lunch and try somewhere different each time. My son, Hiresh, is 21 and currently studying biomedical science at the University of Leeds. My daughter, Raveena, is 19 and a pre-med student at a private university in Kuala Lumpur. Shanty and I did not pressure them into choosing medicine as a career, we are trying to break with the old ways.
I used to play golf until I became a houseman but that and all my other hobbies fell by the wayside due to the pressures of work. Now, when I’m not working, I like to spend my time with my parents and family.
I have recently completed my term as the Chairman of the Malaysian Medical Association, Penang branch. In the short to medium term, my goals involve continuing my private practice and providing my children with the best education possible. I also intend to engage in more social services through the Malaysian Medical Association, with a focus on serving the public and advocating for the rights of doctors in Malaysia. Malaysian laws do not permit the formation of unions for doctors.
Looking a little further into the future, once the children are settled and I have paid off all the university fees, I hope to return to teaching, possibly on a full-time basis. I love teaching – that’s the reason I look forward to elective students coming to do classes with me. I find teaching rewards me more than it rewards the students, as the love for the subject comes back. I find it very enriching. I always try to convert my students, drag them over to the dark side, and encourage them to join and pursue a career
