Peter Connell - Medicine Electives in Sri Lanka
Why Sri Lanka?
My Elective placement was at Panadura Base Hospital, Panadura, Sri Lanka. I chose Sri Lanka as it provided an opportunity to witness tropical diseases that are not common in the UK. I was also interested to see how the medicine differed between a developing country like Sri Lanka and the UK.
The most striking difference between the two lies in their attitudes towards health. In Sri Lanka, the patients are extremely grateful for the doctor’s attention. Before the doctor arrives at their bed you can see the patient preparing themselves, taking their shirt off and sitting at the edge of the bed, waiting to be auscultated.
Consent doesn’t really happen here as it is assumed that what the doctor wants is the best thing. State provided health care is a luxury that many Sri Lankans are still very grateful for, especially those from lower socio-economic backgrounds, so they are very happy to have their blood taken for example.
My Elective Placement
Despite their attitudes towards health care, interestingly there are still many compliance issues. Alternative medicine plays a large role in Sri Lankan communities. There is also a lack of education meaning many patients don’t know how to take medication properly.
Whilst the Sri Lankan doctors are very highly clinically skilled, there is a lack of urgency about them and in general, life in Sri Lanka is very slow paced. The SHO informed me that if you are on time in Sri Lanka you are often called ‘an Englishman’ which was fitting as I was always 30 minutes earlier than everyone else for work commitments. I believe this culture is not beneficial for the patients, but it does add to the relaxing vibe of the country.
I was also very surprised by the amount of cirrhosis and drink related disease I came across. Very roughly, 1 in 6 patients on the general medical ward were affected. The alcohol consumed is often home made too. These were not old men either, they were often young.
I also came across some snake bites during my time there. As much as I felt bad for the patients, this was fascinating to me. England is perhaps the least tropical place on Earth so snake bites are a compete novelty. I learned that in certain hospitals they keep the animals in the hospitals to help provide vaccinations. Also Sri Lanka has the highest concentration of deaths caused by snakes in the world. This is meant to be related to the poor access to health care in rural areas. Fortunately, the patients I saw had been bitten by less venomous snakes. I actually had a near miss with a dark blue scorpion. Based on its color, I think it must have been a giant forest scorpion.
Probably more dangerous than the snakes and scorpions were the stray animals that roamed the street. It was not uncommon to find dogs and cats just strolling through the medical ward either, an infection control nightmare. They had a dedicated bay in the preliminary care unit just for rabies vaccinations. I thought it was strange how casual everyone was with these potentially rabid dogs around.
One weekend we went out into the community to take blood pressures and blood sugars of people who don’t regularly access health care. It was in a hot sweaty room, there were about 300 patients and we had limited time to complete the clinic. Funnily enough, this was the highlight of my trip. For one I am now an expert in blood sugars, but also it was just great fun meeting all the patients and I felt like I was genuinely helping.
I had a meeting with the organizers after the event and collaborated with them to try and organize these clinics more frequently. For very little effort on our part I feel we made an actual difference. This is a rare feeling as medical student. We diagnosed several new diabetics and also admitted a couple of patients who were particularly unwell. I also received many intense grillings from the senior doctor, as if it wasn’t hot enough.
My most memorable experience would have to be performing CPR on the second day of my placement. A 40 year old man had been brought in with shock and had a PMH of gastric carcinoma. The consensus at the time was that the carcinoma had begun to hemorrhage. Within a few minutes the patient became unresponsive and arrested. I was allowed to perform CPR after the senior team had become exhausted. Unfortunately the gentleman died, and it was particularly tough watching the wife receiving the news. It was perhaps the most vocal grieving process I have ever witnessed. Even more upsetting was that they had a new born baby and now the mother was alone with no work. As much as Sri Lanka is a developing country it is easy to forget that many people are still living in poverty.
In general I witnessed quite a lot of deaths whilst at the hospital. I think it was important for me to be exposed to this as it highlighted the stark reality of healthcare in countries which aren’t as developed as our own. It was certainly a humbling experience and I hope that I can recall these memories when I work as a doctor. One particular conversation with an owner of a beach hotel will definitely stick with me. He lost his business and 8 family members to the 2004 tsunami, including his mother and son. There were similar stories from other local people I met as well. The graveyards, visible from the train as you go along the coast were a constant reminder of that fatal natural disaster.
Sri Lankan people are amongst the friendliest I have ever met. I never felt in danger and always felt welcome and appreciated. The country is absolutely beautiful and very easy to travel round if you have some free time. The medicine is taught and discussed in English so there is a really great learning opportunity. I would highly recommend this as a destination for people considering locations for an elective.
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