Status of Healthcare in the Vanni

by a Sangam member; originally published December 14, 2003

Many of my friends and colleagues have traveled to NorthEast of the island of Sri Lanka since the ceasefire agreement was signed between the LTTE and the government of Sri Lanka. There have been extensive reports of the destruction of 20 years of war, but none to my knowledge has focused on the destruction to the health care division. Since I work in the healthcare sector I feel compelled to report on this aspect of destruction.

I left Sri Lanka in 1987 on completion of the G.C.E. (O/L) examination at St. John’s College. When I returned in 2002 and 2003, the day-to-day living of people has changed a lot, unfortunately for the worse. Twenty years of war has ruined the healthcare infrastructure of the NorthEast. For example, the infant mortality rate (IMR) is considered a good indicator of the level of health in a country. The IMR is defined as the number of deaths in the first year of life out of 1,000 live births. According to the WHO’s world health report and DHS survey, the IMR in 1985 in the country of Sri Lanka was 24.2 and in 2002 it has decreased to 15.6 per 1,000 live births. During the same time period, the IMR in the North-East has increased from 11 to 30 per 1,000 live births. I fear the real statistics may be worse. For comparison, the IMR in the USA is 6.7 per 1,000 live births.

From Colombo, I flew to Palay airport and then from Jaffna I traveled by road to Kilinochchi. The A9 is not a highway by western standards, but I hope that in the near future it will turn into one. At least it was free of landmines. However, there were landmines beyond the limits of the “highway.”

Kilinochchi is a busy, active town. If peace continues, in no time it will develop into a city. The dramatic difference between Kilinochchi and Jaffna is the absence of armed or military personnel in the roads or in any public places. According to current statistics, there are about 45,000 army personnel within the Jaffna peninsula – ratio of about 1 soldier per 11 civilians. An open prison camp indeed!

I am ashamed to say that I never visited Vanni during the first 17 years of my life. To tell you the truth, I was apprehensive visiting an “alien” region. I was not sure what to expect. I was pleasantly surprised to see a complete civil administration in place. The system in place is efficient, uncorrupt and friendly. I felt more at ease in Vanni than in Jaffna!

The Center for Health Care (CHC) is an NGO registered in Sri Lanka which has extensively studied the healthcare needs of the people of the NorthEast. They are working in partnership with all Tamil expatriate medical communities. The personnel from CHC took good care of us. We stayed at the overseas health professionals’ lodge built by THO-UK. A basic, but comfortable, place indeed. Whatever the lack of comfort is well compensated for by the Tamil hospitality. This lodge was built to provide accommodation to visiting healthcare professionals who are willing to provide service-based help to the local community.

First, I visited the Akkarayankulam hospital. Since Kilinochchi General Hospital was bombed and completely destroyed, it has been functioning from the Akkarayankulam hospital. The conditions are difficult to describe for an amateur writer like me. Wards are crowded with limited facilities. The labor room is being used as operating room. The radiology department is made up of one simple XRay machine. The entire lab is run from a single room which did not even have facilities to check renal function; No facilities to store blood products. There are no facilities to screen blood products for infection. And the list goes on.

Friends, this is the plight of a District General Hospital. You can imagine the level of healthcare in rural areas. Primary healthcare is the backbone of any healthcare system in the world. The secret to our excellent healthcare system in the past is due to dispensaries and the easy availability of AMP/RMP doctors. [AMP – Assistant Medical Practitioner, RMP – Registered Medical Practitioner] They provided excellent service to our community and maintained the health of our nation. Twenty years of war has destroyed this network of primary healthcare centers and unfortunately, the training of AMP doctors has been abandoned, too. Jaffna Medical College produces about 70 doctors in each batch. These young enthusiastic doctors travel to the South for further training and are unfortunately lost in the system. Unfortunately due to the prolonged war, the North-East has very little to offer for their further training and to stimulate their young minds. There are no training colleges available to train allied healthcare professionals either.

The following table summarizes the shortage of healthcare professionals in the North-East:

In spite of the war, the Center for Health Care (CHC) has done an outstanding job in providing medical services to our community through primary healthcare centers called Thileepan Medical Centers and by running mobile clinics in rural areas. They have also restarted a training program for AMP students to staff these units.

Anyone can be proud of the achievements of the Thileepan Medical Centers. There are ten of these centers throughout the NorthEast, which are functioning from temporary, broken buildings and huts. They are open 24-hours a day, seven days a week and are staffed by a single, full-time healthcare professional and a few part-time volunteers. Each center sees about 350 patients per week. These centers have a wide-ranging role in improving the health of the local people:

Ø General medical, maternity, pediatric out-patient care.

Ø Emergency treatment of accidents, snake bites, dog bites, etc.

Ø Chronic disease management.

Ø Minor Surgery.

Ø Home visits.

Ø Local mobile clinics.

Ø Transfer of serious patients to District General Hospital.

Ø Health Education in schools and village centers.

Ø Public Health Initiatives.

Mobile clinics have done equally great service to the communities which are not able to access these primary healthcare centers. It is of great help to those who are old and feeble. There are many areas of Vanni that are still not accessible by road! The mobile clinic staffs see about 100-120 patients per visit. The common problems seen by the mobile clinic staff are:

¨ Acute Upper Respiratory Tract Infections

¨ Anemia

¨ Muscular pain

¨ Worm infestation

¨ Viral fever

¨ Gastritis/ Heart burn

¨ Wounds

The majority of the problems are as a result of:

§ Poverty

§ Poor sanitation & hygiene

§ Poor footware

§ Poor nutrition

§ Poor health education

To give you a sense of the impact these healthcare initiatives of the CHC has had on the community, malaria-related mortality in the Vanni region has decreased ten-fold from the period 1997 to 2001. And from my personal experience, I had fewer mosquito bites in Vanni than in Jaffna!

Armed with all this information in hand, we felt that the expatriate Tamil medical community needs to be organized to take on the huge task of nation-building. Yes, it is true! This huge responsibility of rebuilding the healthcare infrastructure of our nation has fallen on our able shoulders. Many Tamil medical experts have left home due to the war. And it is time that we help our brothers and sisters to rebuild the Tamil nation. We have a group of hardworking, uncorrupt young boys and girls anxiously waiting for our help. Let’s not miss this once-in-a-lifetime opportunity. So, how can we help?

v Provide clinical support by staffing healthcare centers and mobile clinics in the NorthEast of the island of Sri Lanka.

v Train the next generation of healthcare professionals to work in the NorthEast.

v Gather medical equipment and medicine to be sent to North-East.

v Fund-raising, including raising funds through pharmaceutical companies.

v Provide consultation and draft health care projects for the NorthEast.

Keeping all this in mind, the Tamils Health Organization, USA (THO-USA) was formed to rebuild the healthcare infrastructure of the NorthEast by:

– Assessing healthcare needs in the NorthEast of the island of Sri Lanka

– Highlighting the state of health in the NorthEast of the island of Sri Lanka

– Harness the expertise of the expatriate Tamil community

– Raise funds and channel resources to meet the identified needs

– Facilitate the education and training of healthcare professionals in the NorthEast of the Island of Sri Lanka.

As our first project, we are building a permanent building for the Thileepan Medical Center (TMC) in Iyankulam, Mullaitivu district at a cost of about US$ 42,500. The cost includes solar panels, too. The center will be made up of the following areas:

1. Waiting area

2. Office

3. Examination rooms x 2

4. Dispensary

5. Ward with 4 beds

6. Procedure or labor room

7. Toilet/Bathroom

8. Staff residence

Nationbuilding is obviously a daunting task for anybody to take on. For this reason, we, the international Tamil medical community, need to be organized to take on a challenge of this magnitude. As a first step, all expatriate Tamil medical and health organizations throughout the world need to meet up with the healthcare professionals from the NorthEast and have a workshop on rebuilding the healthcare infrastructure of the NorthEast. I hope that this happens sooner than later when the momentum to rebuild our nation is high.