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Paediatrics in Sri Lanka
The
main industries are the processing of rubber, tea, coconuts, and other
agricultural commodities; clothing, cement, petroleum refining,
textiles, tobacco are also major exports. Singhalese is the main
During my elective I hoped to see what being a doctor meant in a developing country and the different disease patterns and methods of treatment when finances were even more limited than in the NHS! My choice of country also meant that I could explore a new culture, history and hopefully ensure a healthy brown tan. I feel I achieved all of these objectives. I
spent 8 weeks at the Lady
Ridgeway Hospital in Colombo; this is a paediatric
hospital with 1100 beds in 15 wards, which cover medical, surgical,
ENT, cardiology, rheumatology and a burns unit. The occupancy rate is
reported to be 90% but from my experience and seeing various patients
sleeping on mattresses on the floor, I think this may have been an
under-estimate. The daily average admission rate is up to 200
patients. During this time, I mainly attended ward rounds for several
hours each morning. 20 medical students attended the 1st round and 10
doctors all crowding round one cot plus a bewildered mother. There
were also bedside teaching sessions and several tutorials, which were
led by the registrars and covered what ever we wanted teaching on. The
quality of teaching was very go
Sri
Lankan public transport is interesting and not the fastest. This
limited what we could do and see as we only had the weekends free.
There are several ancient cities, which are well preserved and very
impressive. We may have been a bit naive to think that the 7months
after the tsunami most things would be back to normal. We visited the
beaches and coastlines and normality was not the case. For miles all
that was left of villages were the concrete foundations and a lot of
people were still living in temporary accommodation. Speaking to the
locals it
I would have been better prepared if I had read and learned a bit about tropical medicine and the kinds of diseases that we would likely be experiencing. However, the consultants were very good at explaining and taking the time to help us understand the various pathology and disease patterns. I would recommend Sri Lanka as an elective destination to anyone who wants to experience a completely different culture and way of practising medicine. Hopefully by next year the tourist industry will be back to normal making traveling around much easier and the award winning beaches and coastal areas will be back to their former glory! |
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For more information on the hospitals/organisations
above check out The Medic's Guide to Work and Electives Around the World
Medics Travel
is for doctors, nurses, medical/nursing
students and other health professionals wanting to plan work and electives with hospitals,
NGOs and charities overseas. It also lists government and
recruitment agencies and has updates for the ultimate guide - The
Medics Guide to Work and Electives Around the World - good luck in
your travels...and please update this site when you come back!!! |
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Sri
Lanka is an island off the south coast of India and is 65,525 sq km in
size (roughly the same size as Ireland) but with roughly the same
population as Australia, estimated at 19.8 million people. The average
yearly income is the equivalent of £494 in Sri Lankan Rupees. Sri
Lanka's history can be dated back to 543 BC and has endured centuries
of invasions by the Portuguese, Dutch and British until 1948 when
Ceylon was given its independence and became Sri Lanka. 
language but to go to school you have to speak English. Despite its
poverty, Sri Lanka has one of the highest literacy rates at 91.8%.
There are several ethnic and religious mixes: culturally there are the
Singhalese- 74 per cent; Tamil- 18 per cent and Muslim -7 per cent;
Religiously, 70% follow Buddhism; Hinduism- 16 per cent; Christianity-
7 per cent and Islam-7 per cent.
The
total health expenditure per capita is £74.50 and the healthcare
budget is only 3.7% of the total budget. In Sri Lanka, from experience
it would seem that if you could afford it, you would go private and
not use the heavily burdened and under-financed public system. In 2001
the leading causes of deaths were ischaemic heart disease followed by
gastro-intestinal disease, cerebro-vascular disease and pulmonary
disease. With malnutrition, malaria and tuberculosis being major
burdens on the healthcare system. Life expectancy is 68 years for
males and 78 years for females. Traditional medicine (ayurveda) is
still an important part of the health system in Sri Lanka, although it
is not practised in the hospitals. The basis of traditional medicine
is the theory of "three humors" (tridhatu), corresponding to
elements that make up the human body: air appears as wind, fire as
bile, and water as phlegm. Imbalances among the humors (tridosha)
cause various diseases. 
od
although sometimes I felt that it was a bit advanced as we were with
several final year students. We were also able to visit many of the
clinics, which included ENT, dermatology, cardiology and the burns
unit.The common medical conditions included a lot of congenital heart
disease, dengue fever, leprosy, typhoid, several cases of meningitis,
chromosomal abnormalities such as in Turner's and Downs syndromes,
renal failure and tubular sclerosis. More than 40% of children are
born with some medical problem. The main problem being congenital
heart defects. Due to the lack of ultrasound scanning and antenatal
screening most abnormalities are not picked up until after the first
year of life when the child will present with heart failure, clubbing
and even liver failure. The signs that these children present with
should hopefully never been seen in a western country.
The
experience I gained from this elective was invaluable and has taught
me many things. Not only do I now know something about tropical
diseases, increased my knowledge about common problems in paediatrics
but also the personal and social experiences in the hospital seem as
or more important than this knowledge. Sri Lankan medicine is practiced
very differently to the UK. The doctors speak English and in the
public hospitals most patients and relatives do not speak English (in
our time I think I met two mothers who could speak English). At the
start of the ward round all of the mothers of the children stand to
attention by the bedside and wait for the much revered consultant to
come and examine their child. If the mother were late then she would
betold off. Often the doctors would not even communicate with the
mother and if they did it was only to clarify a point in the history.
If it were felt that the mother was uneducated or would be unable to
understand the diagnosis then often she would not be told especially
if they suspected a poor prognosis and didn't want to make a
scene! 
seems
that the money from the international - tsunami appeal has yet to
reach many affected areas! Consequently the beaches and thriving
tourist areas resemble ghost towns with much of the debris still on
the once prized beaches. Colombo, itself, is majorly polluted and it
seems that most tourists sensibly only see Colombo as they go to and
from the airport. The beach doubles up as the local sewage plant
making swimming and walks a gamble with disease. However most of the
hotels will let you use their swimming pools and sun lounges for
around a pound.
There
were no major problems with this elective except for a slightly
unhelpful medical secretary one morning. We always realised that
communication with the patients and relatives would be limited but not
to such a degree. We were informed that there would be other local
medical students around to translate for us if need be - however, we
picked the time when there was exam leave and consequently there were
no students and so no translators. This just made us appreciate the
importance of communication. All the children and relatives were happy
for us, after a bit of gesturing, to examine them. The children were
ideal to practise paediatrics on, as most of them were so stunned to
see a white person with blonde hair that they hardly ever cried or
resisted.
