µWhat do sick people do in Sri Lanka? Anyone can see a doctor free of charge.
If they go to the hospital, they will be seen. Any required medication is provided free. Repeat medications can be obtained from the hospital.
There is no general practice as we know it and some rural patients are a long way from their nearest hospital. Of course, you could rely on folk medicine…
Hospitals in Sri Lanka
Sri Lanka has many hospitals but the rural ones lack facilities. Patients are referred to more specialist hospitals when necessary. As yet there is no transplant surgery and facilities for renal dialysis are limited but there are neurosurgical surgery centres and cancer surgery is very advanced.
Doctors aspire to posts in the large hospitals in cities, as this gives them better access to private practice as well as a better equipped hospital.
Sri Lanka is well off for medical schools which admit only the best performing A level students.
The course is based on the British model of 5 years training with the first and second year devoted to preclinical subjects. After qualifying the junior doctors begin specialist training.
Those with the best grades are offered jobs in the teaching hospital and after a few years will be granted time to go abroad for further training. The others go where directed by the government. Every three years or so, they are moved to a new post.
Doctors are well paid, about £1000 per month. They also have perks such as a tax free car. They can engage in private practice after the hospital hours are done. Their fees are only about 1/20th of those charged in UK.
What is Ayurvedic Medicine?
There is a great tradition of Ayurvedic Medicine, a folk medicine consisting of the use of herbs, infusions, incantations, rituals and the like.
Each village has its Ayurvedic practitioner. Ayurvedic medicine is offered to the tourists who can take advantage of massages with oils and mystic rituals. It is becoming big business with companies producing ‘natural’ remedies.
Security guard’s story: Does chanting really work?
“I was bitten on the foot by a cobra and a woman from the jungle saved my life. She took my foot and cut through the bite to make it bleed. Then she squeezed lime juice on it and bound a piece of lime onto the wound. I could feel the pain rising up my body and I could not open my eyes. She began chanting. I do not know what she said but the pain began to go down immediately. Next day she opened the wound and black stuff like engine oil came out. She chanted over me 3 times in all and then I was well again.
Even the doctors allow her into the hospital to chant over the patients. They are very impressed with her.”
The security guard told me of a man he knew who was bitten and went to hospital without the chanting woman – he died.
Doctors are contracted to work 8-4pm and then they go to their private clinics. The juniors provide out of hours care. The private hospitals in cities can be very large and comprehensive but some are small and others not well run. Many are just a collection of consulting rooms providing out-patient care only.
How are the diseases different in Sri Lanka?
The diseases in Sri Lanka are different. Malaria is now rare except in the north but Dengue, a viral disease also spread by mosquitoes, is becoming prevalent. It can be fatal.
There are several infectious and parasitic diseases not seen in Europe. Rabies exists among the feral dogs and bats. A few cases are seen each year in humans; rabies has a 100% mortality. Vaccination is available and works if given quickly enough after infection.
Kala Azar (Leishmaniasis), a parasite causing skin ulcers, fever, anaemia and liver damage is becoming more common. It has spread into the north from south India across the Palk Strait during the civil war.
Insecticide poisoning, as part of a suicide attempt, and snake envenoming are big problems and so is a kidney disease affecting adults in the dry zone, possibly due to toxins in the water supply.
There is the burden of young men left disabled by gunshot and shrapnel wounds after the war. Oral cancer is a terrible disfiguring disease attributable to the habit of chewing tobacco and betel nut.
Health risks of obesity
Then there are the diseases of civilisation with which we are familiar: obesity, diabetes, blood pressure and circulatory diseases including heart disease. These are increasing as people move from rural villages where they live on a diet of rice, vegetables and fruit to the towns where factory food is available: pizzas, burgers, cake, sugary drinks and increasingly fatty foods.
Essential: grasping the basics of medicine
In the UK we trained many Sri Lankan doctors and we were aware that, when they returned home, they would have to practice a different sort of medicine. They would not have access to high tech scanners, diagnostic tests, sophisticated x-rays etc.
The basics were important. Listen to the patient and question him or her carefully, enquire about the family history and social circumstances. Then examine him in detail for evidence of disease. Finally make a diagnosis and apply treatment.
How application of basic clinical skills leads to medical discovery
The application of these very basic clinical skills was exploited fully by one of the first trainees we had in Southampton General Hospital, Dr Nimal Senanayake.
On his return to Sri Lanka he saw several young girls with wrist drop and hand weakness. He quickly realised that an epidemic was developing affecting Tamil girls who had reached adolescence and who were tea pickers from Nuwara Eliya region. It was the custom for Tamil girls, at the time of their first period, to undergo a week long ceremony involving drinking and anointing with Gingili Oil (made from sesame seeds.)
A batch of Gingili oil contaminated with motor oil was discovered. Motor oil, contains tricresyl phosphate, a known neuro-toxin. The doctor’s prompt action meant that only 20 cases occurred. Nearly all of them recovered enough to return to work.
The doctor concerned had a successful career and became a Professor and Dean of the Medical School. For this and other seminal research work he received many honours and became well-known internationally.
Schizophrenia, psychosis, depression and anxiety are just as common in Sri Lanka as here in the UK. People do not have a concept of depression but regard it as a ‘bad time’ or ‘evil spirits’. Families band together to support people with depression and anxiety but even so, suicide is still seen.
There is child abuse, misogyny, alcohol and drug abuse just as here but less overt. Being drunk is considered a personal disgrace rather than a normal state for a Friday night.
Now there are so many bureaucratic hurdles to immigration that very few Sri Lankan doctors come to the UK for training. Australia benefits from them instead.
Post Series: Dispatches from Sri Lanka, by Mike Sedgwick:
- Dispatches From Sri Lanka
- Kandy Lake vs Chandler’s Ford Lakes
- Self-Employment In Sri Lanka
- Sri Lankan Wedding
- Sri Lankan Food
- There’s Some Corner Of A Foreign Field
- The Cultural Triangle of Sri Lanka
- This Is the Record Of John
- Tuk-tuk: My Transport Of Delight
- Life On The Road
- Commonwealth Games In Kandy
- A Temple For A Tooth?
- Dawn Train Down The Mountain To Colombo
- Traditional And Modern Medicine in Sri Lanka
- Ancient Vedda Tribe Becoming Extinct