In Memoriam Prof. Ponnampalam Balasubramaniam

Early life and career Professor Ponnampalam Balasubramaniam was born on 26 October 1929 in Sentul, Kuala Lumpur. He lost his father when he was twelve during the Japanese bombing of Singapore in the Second World War, and his mother later. Nevertheless, he put himself through medical school, graduating from the prestigious Ceylon Medical College in 1955. Love struck the same year when he met the love of his life in Galle, nurse Ratnavali De Silva and married her in 1962 after 7 long years, despite the attitude toward Tamil-Sinhalese mixed marriages at the time. Tragedy struck again while living and working in Malaysia. He developed radiation cataracts and his wife developed breast cancer. A devoted family man, he moved to Singapore in 1981 at his wife’s behest to spend more time with their daughter studying in Singapore, eventually losing his wife in 1983. A father and mother to his 3 children, he then raised them single-handedly while successfully juggling his time as an Orthopaedic Academic and Surgeon. Career 1958 marked the start of his Orthopedic traineeship in Colombo. Obtaining his FRCS (Eng) in 1965, he started work as a Lecturer in Orthopaedic Surgery at the University of Malaya in Kuala Lumpur in 1966. Having extensive training under notable surgeons such such as Dr Coventry (Mayo Clinic), and Prof Hodgson (Hong Kong), Prof Bala went on to become Professor and Head of Orthopaedic Surgery, University of Malaya in 1978, and quickly developed the sub-specialties of hand, microvascular surgery, paediatrics, spine, trauma and adult reconstruction there. The family moved to Singapore in 1981 where he was appointed Associate Professor at Singapore University Department of Orthopaedic Surgery. He became full Professor in 1984, Vice Dean of the Faculty of Medicine from 1985 to 1994, and Deputy Chairman of the Medical Board and Director of Medical Affairs from 1991 to 1994. He mentored and published numerous scientific articles during his tenure in Singapore, focusing on tendon healing, hip cartilage and morphology, spine fusion and scoliosis, paediatric elbow osteotomy, shoulder stability as well as the ‘Singapore Operation’ for peroneal tendons. Despite ‘retiring’ in October 1994, he continued as a Professorial Fellow in the Orthopaedic Department followed by an appointment as Professorial Fellow in the Dean’s Office, National University of Singapore. Between 2001 -2003 he was the foundation Petronas Chair in Sports Medicine in the University of Malaya. He was awarded the Singapore National Day Public Administration (Gold) medal in 1991. In Memoriam Prof. Ponnampalam Balasubramaniam 15 The Academy of Medicine Singapore honoured him as the 8th College of Surgeons Lecturer in 2013. As the SOA lecturer in 1994 and as Donald Gunn lecturer in 2003, he was similarly honoured by the Singapore Orthopaedic Association. His Lecture in 2002 at the 50th Anniversary Celebration of the University Department of Orthopaedics, 20 years ago aptly describes the situation of undergraduate medical education today – He was a true visionary! In recognition of his achievements, the Malaysian Orthopaedic Association has set up an annual P. Balasubramaniam Best Published Translational Medicine (Non-Clinical) Paper Award and the Singapore Orthopaedic Association similarly renamed the Young Investigator’s Award as the P Balasubramaniam Young Orthopaedic Investigator's Award, both since 2015. Beyond Malaysia and Singapore, Prof Bala contributed contributed to the development of Orthopaedic education in Indonesia such as undergraduate training at the Hassanudin University Makasar from 1978 and supported post-graduate training from 2003 through regular visits. He was also one of the founding members of the ASEAN orthopaedic association. Teacher It can be said Prof Bala delved into medical teaching with all his heart, mind and strength. As an educator Prof Bala has helped to shape 3 generations of Orthopedic Surgeons, contributing firstly in his role as a Professor of Orthopedic Surgery in the National University Hospital Department of Orthopedic Surgery, and then in his second career as a fount of Orthopedic knowledge, where over the course of 2 decades, batch after batch of Orthopedic trainees would make the pilgrimage to his house to be molded and prepared for the challenges of passing their postgraduate examinations. 16 examinations. A teacher with vast experiences in all the fields of Orthopaedics, he has painstakingly accrued a huge library of interesting or rare cases through his years as a clinician, educator and regional examiner. There is never boredom or mediocrity in his sessions and approach. He was a pioneer in teaching styles and methods, simulating postgraduate styles of examinations such as clinicals, vivas and even the written examinations. In practicality, this was meant to ensure everyone overcame the necessary hurdle, but more importantly to make us safe, well informed practitioners with breadth and depth. Prof taught for the love of teaching. He never expected any recognition or reward. While recognizing the impact of rapidly expanding fields on undergraduate teaching in Orthopaedic surgery, he also cautioned against changing priorities and fragmented training with increasing sub-specialization at the 50th Anniversary celebration of the Department of Orthopaedic Surgery, NUS in 2002. Mentor Not all teachers are mentors, but Prof Bala is one and even more, a friend. He did not hesitate to point out the shortcomings of his trainees, but this came from a heart of love and a desire to impart his knowledge skills and attitude to his trainee. His constant guidance extended beyond the training years, as the familiar ”Don’t worry, I am here” resounded in the memories of many a consultant scaling new challenges in their career. His preoperative planning approach to visualize ourselves doing the actual surgery, from the start, to the end helps to mentally plan for appropriate approaches, resources and anticipate anticipate challenges, an advice that has stood the test of time. Both Prof Wong and Prof Thambiah shared about how he would expect them to have clerked, examined and summarized his patients prior to surgery. This summary was not any ordinary summary, it had to be up to Prof Bala’s rigorous standards and had to include the trainees’ own opinion on what would be the most appropriate surgical plan before they were rewarded with the privilege of performing the surgery. Prof Joseph Thambiah remembers Prof Bala instructing him to draw by hand the vertebrae that he had operated on and colour in the areas that he had removed after every spine surgery. It made him a better surgeon and artist, too! Patient care did not end in the operating theatre for Prof Bala, and he always expected a phone call from the trainee after they had reviewed the patient once the patient had returned to the ward. Prof Bala was a man driven by principle; he treated his patients the same, whether they be prince or pauper, private or subsidized. A firm believer that the practice of Orthopaedics is both 17 both an Art and a Science, Prof remains a firm advocate of returning to gold standard treatments against new high tech medical management in an era of rapid technological advancements. Nor did he allow financial incentives to cloud his clinical judgement. Conclusion As we mourn the passing of a great surgeon, thinker and educator on March 22, 2022, we would also like to celebrate a life of service and giving. Perhaps one regret would be the lost opportunity for this bright spark to enkindle all the shining stars in Orthopaedics who are and yet to come. Nevertheless, the legacy of Prof P Balasubramaniam will live on forever, in service to our patients , and in duty to generations of students and young doctors looking to us for guidance. Joyce Koh Suang Bee Chair Asia Pacific Orthopaedic Research Society Singapore