My Experience with Healthcare in Sri Lanka

Hi. I’m Niri, a buzzing second year medic. I’m excited to take you through a snapshot of my medic trip to Sri Lanka exactly two months after the Easter bombings. I know what you are all thinking, why did you go?

Why Sri Lanka?

This was a trip I had been wanting to do for many reasons. My late aunt had founded a clinical practice to provide free care for local citizens, but sadly before expanding it into a larger hospital she passed away from Dengue Fever. I was left wanting to see the amazing work she had done. I was also keen to explore the health issues affecting people from my mother’s homeland in the aftermath of the civil war between the Tamils and the Sinhalese. A final reason for this trip was to spend time with my mother. I care for her as she has several chronic illnesses and is in deteriorating health but we have always wanted to visit her old school. I wanted to take my mother and ensure that she could tick this off her bucket list, absorb plenty of Vitamin D and be exposed to the warmer climate of her youth, which might improve her health.

My trip to Sri Lanka was entirely possible due to being awarded a travel grant by the university, so thank you Leeds! At this point you really just want to hear about what I did, right?

What I was doing in Sri Lanka

I volunteered in a rural hospital named Tellippalai Base Hospital for two weeks and a teaching hospital for a further week meaning I had a varied experience of clinical practice in Sri Lanka.  I am going to focus on moments of my time at the rural hospital.

Upon arriving at the hospital, I was told to meet the Superintendent, who I was informed was Sinhalese. I was scared as I only knew a couple of phrases in Sinhalese. However, I somehow made him understand that I was a medical student who was going to be supervised by the visiting physician (VP); the consultant in charge of the hospital in terms of general adult medicine. To my dismay, the VP was not present this day as he had unfortunately ill and thus I was handed the files and told to see and assess the patients. I did not know what to do and panicked inside…

A few minutes later, I plucked up some courage and went to speak to one patient in Tamil, who had COPD and performed a chest auscultation to listen for telltale signs of COPD. I was then taught by a medical officer, who is similar in ranking to a senior house officer in the UK, how to ask for patient consent in a way that patients in Sri Lanka could understand. As I was speaking to one patient, all the patients wanted to talk to me and within a couple of hours I had gathered the histories of every patient on the female and male general medical wards. I then went to A&E and was able to able to practice performing chest and heart auscultations. I saw a vast amount and learnt how each condition was managed from TB, typhoid, dengue, bilateral polio, and various mental health conditions, such as schizophrenia. I was shocked to see the variety of ways patients had attempted to commit suicide; by scorpion sting, snake bite (including the infamous Russell’s Viper), colonies of wasps or stray dogs.

Seeing this I wanted to better understand how these conditions affected patients, so I asked to interview a patient with schizophrenia. A medical officer kindly took me to the psychiatric ward where I was handed a basic assessment form and told that I could talk to the patients. The patient I focused on believed that spirits had possessed her and that they were talking to her. She was also having visionary hallucinations. Seeing how culture affects a patient’s presentation was interesting as in Sri Lankan, belief in ghosts is common and if a person sees spirits they are believed to be possessed by one and so cursed. This means it is difficult to get a sense of a patients mental wellbeing as they believe they are cursed instead of unwell, which affects how they can be assessed and treated.

What did I gain?

It was a life changing experience – I went in with western ideologies, being fixated on the GMC guidelines but in the end I had realised that I had to adapt to the views and practices of the Sri Lankan healthcare system so that I could do the greatest good for the local citizens whilst not losing sight of my moral or ethical values.

Niralini Thayaparan