Deirdre Cusack Kirkpatrick-Durham
Voluntary Work in Sri Lanka
For the last
eleven years I have lived in Sri Lanka , where my husband Julian has been building roads. A tropical paradise to most people, and
indeed it is a beautiful island, rich in culture and history. But there is a darker side to Sri Lanka , which I saw up close through the work I
did with a charity called Interplast UK .
Interplast funds teams of medical personnel from various first-world
countries (Britain, Australia, Germany, USA are some) to travel to third world
countries like Sri Lanka and perform reconstructive surgery on those people who
could not otherwise afford to have this surgery done.
Sri Lanka has a nationalised health care service,
as do most developing countries, but it is woefully under funded, and the
pressure on the service is severe. To
make the money go further patients are asked to fund their own medicines, to
bring in blood donors before planned surgery will be undertaken, to feed themselves, and to have relatives or friends to stay with
them and help with their care. A far cry from the all-inclusive NHS that we know. In addition, specialist surgical consultants
are few in number, and the need for them great, so
waiting lists are very long.
One area of
particular need is in reconstructive surgery, both to correct congenital
deformities, which seem more common in the third world, and to rectify acquired
deformities, primarily scarring and distortions from burns (kerosene lamps are
the most common form of lighting for the poor, and are the most common cause of
fires in the home), violence and trauma (Sri Lanka has been fighting a
terrorist war for the last 25 years) and from disease (Sri Lanka, along with
India, has one of the highest rates in the world of adult-onset diabetes).
Interplast UK is headed up by a retired reconstructive
surgeon, Mr Charles Viva, who is a Tamil of Sri Lankan origin, so the island is
dear to his heart. In total I joined
seven of his medical camps, or ‘Mercy Missions’ as the Sri Lankan media called
them, and it was an experience I wouldn’t have missed and was privileged to
share - emotionally and physically draining, but so stimulating and
uplifting. Charles is the most amazing
chap - by far and away the best plastic surgeon I’ve ever worked with, and I’ve
worked with a few in my time, but a really pleasant man too, and anyone who’s
ever worked in an operating theatre will tell you that that doesn’t necessarily
follow. In fact it very rarely
follows. From our 6am start until our often 10pm finish each day I never saw Charles
ruffled, upset or put out - he was calm, competent and in control all the time.
The first camp I
joined was at the beginning of 2002, when a change of government in Sri Lanka led to a ceasefire between the Government
forces and the Liberation Tigers of Tamil Eelam
(LTTE), the rebel forces who are fighting for a homeland in the north of the
island. The camp was held in Jaffna , the Government-held town at the tip of
the otherwise rebel-held northern peninsula.
The Sri Lankan Air Force flew us up and back on the trip, from Ratmalana military airport just to the south of Colombo to the military airstrip at Pallali, on the tip of the Jaffna peninsula. From there the Army bussed
us in to the Jaffna Teaching Hospital, where we were
based. The disembarkation procedure at Pallali was a real eye-opener. The plane landed, the tail ramp dropped,
everyone raced out at top speed and our bags were thrown out after us; the
troops waiting to embark then raced up the ramp, the tail lifted and the plane
sped off down the runway, up and away.
All this happened in the space of about five minutes. They’ve got it down to a fine art, as I
suppose they must, having been at war up there for so long and with Pallali periodically coming within artillery and mortar
range of the LTTE.
We really
struggled to keep up with the disembarkation.
Nobody told us what was going to happen until it happened, by which time
they were screaming at us-" RUN."
In the event, de-planing proved fairly easy, as gravity takes over. It was the return trip, at the end of the
camp, entering the aircraft up a steeply sloping ramp at a flat-out run, with
the engines blowing a gale of hot, kerosene-fumed, exhaust-laden wind at you was the difficult part. And carrying all the kit and supplies too,
but fortunately by the end of our two weeks both we and the supplies were much
lighter.
The drive in
from Pallali to Jaffna was distressing. Stretching out on either side of the road as
far as the eye could see are roofless farm homesteads, vegetation growing
through them, with bullet-pocked walls and surrounded by overgrown and
weed-infested fields of rich red earth.
I subsequently found out, through talking with the UNDP representative
in Jaffna , that the whole area is extensively mined,
with the LTTE having sown their mines in the most destructive way, such that it
will take a long time and much manpower to eradicate them. Some of their tricks are to mine the front doorstep
of the farmhouse, or the step at the farm well, or the land under the big
spreading tree where people gather to talk - but not at every farm of course,
so everyone is fearful to return to their land, even if there is a
ceasefire. Not that some people can ever
return - both the Muslim and the Sinhalese populations were expelled from Jaffna Province by the LTTE over the last years, and the
population is now entirely Tamil.
And
so to work. Jaffna Teaching
Hospital is a large, spread out network of buildings, interlinked by covered
walkways. It has 1,015 beds, miles of
sprawling corridors, a multitude of Nightingale wards,
an intensive care unit, a coronary care unit, a four-roomed operating theatre
suite, acres of outpatient clinics, a mortuary, a teaching block, nurses’
training school - and all of it so shabby, unloved and uncared for. A lot of the depressing neglect and
unloveliness could be altered with a bucket of soap and water and an
application of willpower and elbow grease.
In a word, the place was dirty.
Of course, after so many years under siege and at war, morale was low,
and it is very hard to motivate demoralised people. With the advent of peace one day the
recruitment problem will ease, and new staff will bring change. We can but pray for this.
That said, there were really dedicated, hard-working and admirable
doctors and nurses in the hospital, who are doing what they can to hold the
place together in the face of old, broken, worn-out equipment, a non-existent
maintenance department and sporadic and incomplete supplies and
deliveries. They do get given donations
of equipment and supplies from charitable organisations and countries (while we
were there an American Aid donation of monitoring equipment arrived) but the
big problem is that there seems to be no co-ordination of all these gifts, so
that whilst one group gives, for example, Hewlett Packard electronic equipment,
the next group gives 3M equipment, and so on.
Of course the software and consumables are not interchangeable between
the various types, creating a logistical headache. Add to that the fact that there is no service
backup in Jaffna , and a very limited and erratic electrical
supply, so when things break down there are no technicians to fix them. And with no in-house training in the use of
the new equipment, the staff just muddle through
somehow, and of course equipment is inevitably abused and misused.
The day we
arrived we had an outpatient department full of hopeful faces, waiting to see
the surgeons to be assessed for the lists of those most in need and most likely
to benefit from surgery. Inevitably some
were turned away. With over a 1000
people wanting surgery, and only two weeks in which to operate, it was a
heartbreaking scenario. But by the end
of our time in Jaffna we had done some 160 operations
in 12 days, of which 88 were repair of cleft lips and/or palates, 23 were
release of burns contractures with or without skin grafting, 5 excision of
cancerous growths with grafting, and 44 assorted others, such as scar
revisions, repair of facial congenital anomalies, excision of leg ulcers with
grafting, and so on. Impressive really,
and the most cases that the team had ever done in any two-week camp, they
said. All the disposable supplies that
we used were brought with us, donated by the generous British public and by
medical companies, and we had enough to leave behind some £6,000 of supplies
for use by Jaffna Hospital .
Following this
camp I worked with the Interplast UK team for the next few years at various hospitals
around Sri Lanka and in Bangladesh .
In each town the picture was much the same, maybe not the war-damage
that Jaffna has sustained, but always old buildings,
largely in need of upkeep, and strained to capacity by the pressure of patient
numbers, too full and too busy to be kept clean and neat, and always staffed by
tired but, for the most part, willing workers.
The one exception to this picture was the trip that took us into the
LTTE-held heartland, to run a four-day camp in one of their field
hospitals. Here was a very different
story. The hospital, much of it under
canvas, was clean, neat, disciplined and cared for in a very military way. The LTTE may be a rebel and terrorist army,
but like armies the world over they are run on regimented, hierarchical and
disciplined lines, which makes for a very orderly environment.
Whilst working
there we saw need and damage just as distressing as that found in the
Government hospitals to the south. One case as an example.
A young woman, an LTTE cadre, probably 24 or 25 years old, with lovely
shining black hair, and perfect, soft smooth skin, and wonderful eyes - except
that the whole of the bottom half of her face had been blown away by a bullet,
leaving a gaping, salivating hole where her nose and mouth should have been. We spent the better part of a day
reconstructing that young girl’s face, first a tracheotomy, then taking a bone
graft from her rib and wiring it in to where her jaw had been, and then
patching and grafting soft tissue over, and reconstructing her nose and lips
with silastic implants and soft tissue flaps.
Provided she heals cleanly she will have a functioning face; she’s never
going to win any beauty prizes, but at least she’ll be able to eat and drink
more or less normally. She’s never going
to get married and have babies either.
Who would want to marry her in a country where arranged marriages are
the norm? A complete
and completely avoidable tragedy.
On a lighter
note, we had a free afternoon at the end of that camp, and were taken out into Mullaitivu Bay by the so-called “Sea Tigers”, the
maritime arm of the LTTE, in two extremely fast boats. They showed us what they could do – racing at
extreme speed from headland to headland, shooting up very accurately an old
wreck, and finally landing us back on the beach by racing in without letup, so
that we planed across the sand to the high water mark. This last show-off prank had both us and the
young LTTE nurses who had escorted us shrieking and laughing with alarm, at one
in our excitement and fear. Then we lay
on the sand drinking cool drinks, eating a delicious pudding dish, and watching
the sun go down and the stars come out.
It was peaceful and lovely, and a world away from hatred, bullets and
war.
28 July 2008