In 1981, the medical profession in this country and the local Anaesthetic fraternity in particular lost a true pioneering stalwart unexpectedly with the sudden demise of Dato’ Dr T Sachithanandan at only age 49. He underwent an elective coronary bypass operation at London’s Harley Street Clinic under the knife of the world renowned leading British heart surgeon, Mr Donald Ross. Tragically, unlike our then Malaysian Prime Minister, Tun Hussein Onn whom Mr Ross had similarly operated on just several months earlier, Dr Sachithanandan did not survive the bypass procedure. Considerable advances have been made in the techniques and safety of both anaesthesia and cardiac surgery since this early era and coronary surgery today is widely performed throughout Malaysia with excellent outcomes obviating the need to seek specialist treatment overseas.

Awareness and an appreciation of the heritage of any organisation or specialty, and the sacrifices and pioneering effort of the doctors involved is fundamentally important to better understand and, thus, improve contemporary practices as historically much progress in medicine is made standing on the shoulders of giants. This brief article is a poignant remembrance of the defining work of the pioneering Anaesthesiologist, the late Dato’ Dr T Sachithanandan, 30 years since his untimely passing.

The First Intensive Care Unit

As both Johor state Anaesthesiologist and President of the Johor Baru Junior Chamber International (JCIJaycees), a state level global charitable foundation, Dr T Sachithanandan was highly instrumental in establishing the first intensive care unit (ICU) in a Ministry of Health (MOH) government hospital in 1969. This historic ICU was only just preceeded by the unit at University Hospital, Kuala Lumpur. Funding for the Johor Baru ICU was derived from three principal sources, namely the MOH, Johor state government and charitable public donations via Jaycees fund-raising. Dr Sachithanandan’s vision and determination to set up this first public sector ICU was reflected in how he skillfully negotiated unprecedented government funding which matched ‘dollar-to-dollar’ the Jaycees charity funds. Fund-raising commenced in 1965 and this pioneering ICU was built and finally declared open on 3rd February 1969 by HRH Sultan Ismail of Johor. The ICU ‘project’ won the best project award at the National Jaycees Convention that year (1969) and received a personal commendation from then Prime Minister Tunku Abdul Rahman Putra as a benchmark for future NGO work. The monumental challenge and success of establishing this first ICU at Johor Baru General Hospital (GH) cannot be overstated as it became the template model on which subsequent ICU’s were designed and built in virtually all the other state general hospitals in Malaysia.

Academic Training and Accreditation

The Faculty of Anaesthesiologists, College of Surgeons of Malaysia was established in April 1975. Over time, the faculty evolved into an independent College of Anaesthesiologists within the Academy of Medicine of Malaysia. As the inaugural Vice-Dean of the Faculty (1975/76) and subsequently as Anaesthesia Dean in 1976/77, Dr Sachithanandan was a major driving force in the impetus to develop local academic training in the specialty. With fellow pioneering contemporaries, Prof A E Delilkan and Dr Lim Say Wan initially, and later Prof Abdul Hamid bin Hj Abdul Rahman and Dr Antony Manavalan, Dr Sachithanandan was very involved in organising a curriculum, structured training programme and preparatory courses leading up to a local postgraduate certification in Anaesthesiology. This landmark effort from the Faculty of Anaesthesiologists formed the basis for the eventual curriculum and format used by Universiti Kebangsaan Malaysia (UKM) (in 1985) and University Malaya (UM) (in 1987). To put this effort in perspective, one should know that in 1976 there were a total of only 36 qualified Anaesthesiologists in Malaysia. From the 1950s till 1965, aspiring Anaesthetists went abroad for their final phase of training and fellowship exams. The Australasian Primary and Final fellowship exams were first held in KL in 1973 and 1975 respectively. As of 2008, 461 specialists have obtained a local Masters degree in Anaesthesia from UKM, UM and University Sains Malaysia (USM) collectively. However, it is not only contemporary practicing Anaesthesiogists in Malaysia who owe much to an earlier generation as most advances in Malaysian surgery too, would not be sustainable without a sufficient pool of trained and competent Anaesthesiologists.

The First Postgraduate Medical Centre

Further evidence of the late Dato’ Dr Sachithanandan’s commitment towards developing and raising standards of postgraduate training in Malaysia, not only for Anaesthetists but all medical specialists was exemplified by his active involvement in establishing the first postgraduate medical centre in the country, again at Johor Baru GH in 1969, with two like minded colleagues; eminent pioneering physician Dato’ Dr Lim Kee Jin and the late Datuk Dr Sam Abraham (paediatrician).Their objective was to develop a comprehensive programme directed towards the continuing education of the doctor in an era long before CME was fashionable or deemed necessary. Dato’ T Sachithanandan went on to further establish another such centre, the first in the state of Perak at Hospital Ipoh in 1977.

Malaysian Medical Association

Historically, Anaesthesia as a specialty has often been in the shadows of surgery which perhaps was erroneously perceived to be more glamorous. Dato’ Dr T Sachithanandan’s election to the Presidency of the Malaysian Medical Association in 1972 brought prestige and prominence to the Anaesthetic fraternity. He was the first Anaesthesiologist to become MMA President, a feat only twice repeated in the subsequent 40 years (the late Dato’ Dr Lim Say Wan in 1982/83, and our incumbent and first ever lady President, Dr Mary Cardosa in 2011/12, have done so since).

As MMA President, he authoritatively articulated concerns of the profession and challenged the political hierarchy and policy-makers of the day on a variety of wide ranging issues, from ensuring all doctors in general were appropriately and fairly remunerated by the SOCSO authorities, to bravely challenging (albeit unsuccessfully) the ministerial decision requiring public sector doctors at government hospitals to “clock in”, a policy that showed little appreciation for the complex pattern and intensity of work undertaken by hospital specialists in contrast to the more predictable work practice of other civil servants.

Dr Sachithanandan and several MMA past presidents (the late Datuk Dr Keshmahinder Singh, Datuk Dr Syed Mohammed and Dato’ Dr R P Pillay) were however, more successful in lobbying the then Health minister to jettison the Ministry’s intention to register unqualified medical practitioners, an evidently retrograde and unsafe step, in the interests of public safety and quality assurance. His presidency also oversaw the establishment of the MMA House at Jalan Pahang where the MMA secretariat still actively functions today. Dr Sachithanandan was a champion of the ‘young doctor’ strongly advocating for the more junior MMA members to be given a ‘voice’ and formal representation on the influential MMA council, and the opportunity to contribute as evinced by his valedictory address in 1973.

Malaysian Society of Anaesthesiologists and Health Ministry Government Service

The late Dato’ Sachithanandan was one of the few founding members of the Malaysian Society of Anaesthesiologists (MSA) in 1964 along with contemporary pioneers Drs Frank Bhupalan, Antony Manavalan, M C Poopathy and Law Gim Teik. The MSA today boasts a healthy membership of approximately 600 specialists nationally and is undoubtly one of the more proactive and dynamic specialist organisations. Dr Sachithanandan became MSA President in 1968 and personally helped forge good relations with sister organisations in Australia and Singapore. His personal qualities of impeccable integrity, selfless ambition and visionary leadership coupled with a highly charismatic and naturally charming personality not surprisingly inspired many junior doctors to take up Anaesthesia when it was perhaps then a less established and less desired specialty. However, first and foremost, Dato’ Dr Sachithanandan should be remembered for the exceptionally competent and efficient Anaesthesiologist he was, and for being largely responsible for the early development (including the training of many junior specialists) and provision of a first class Anaesthesia service in the two large Malaysian states of Johor and Perak.

The First Private KPJ Hospital

Three decades on, Dato’ Dr T Sachithanandan’s contributions still remain impressive, relevant and undiminished. One of his final contributions was his active involvement in the clinical design of the Johor Specialist Hospital (JSH) in 1980, the state’s first private hospital. This was the very first Kumpulan Perubatan Johor (KPJ) hospital in the country and yet again became a template for the establishment of many more future lucrative KPJ hospitals nationwide. Sadly, he never got the opportunity to work at the JSH.

In retrospect, his achievements were remarkably exceptional given that he did not even live to celebrate a 50th birthday. Heritage awareness facilitates an understanding and genuine appreciation of the pioneering work of our eminent predecessors. This is important for rarely do advances in medicine occur in isolation, more often progress is made by standing on the shoulders of giants. Dato’ Dr T Sachithanandan was one such individual.