Report
Health Care Projects in Wanni so far... and what
next...
S.V.Bernardshaw
Dept. of Gastrosurgery, Ulleval University Hospital, Oslo,
Norway
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Background:This opinion piece, based on the experiences
of the author, outlines the planning for a short term-assignment.
With growing demand for humanitarian health care assistance
to north-east Sri Lanka, a framework for organizing
short-term trips to such area would be beneficial
to trip organizers.
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 The
Team Members
With the help from the THO we were
able to comprise a team including an experienced
anaesthesiologist and general surgeon from UK, and
two junior resident doctors from Australia (Figure
1). We could plan a day which was in accordance
with our usual summer holydays. The aim of our mission
was to select and treat patients with general surgical
problems, problems related to the gastrointestinal
tract, endoscopies and evening classes for the staff.
The accommodation and the food were excellent. We
choose the OPD as the basic area to select the patients
for operations. The communication between local
staff and patients were remarkably well. The staff
is experienced with medical terms and in English,
thus reducing the communication barrier further
down. Although the average length of stay was about
a week, our team was able to care for more than
100 patients (25% surgery). The people living in
the clinic areas welcomed us warmly and graciously.
Never once did we feel like outsiders.
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Discussion:Humanitarian
organizations have called upon by devolping countries
to assist in providing basic health needs to resource-limited
communities. Although the goal is to reduce the
disparity between populations, the ability to develope
a global perspective remains a challenge. The developed
countries have the responsibility of crossing political
and cultural barriors to assure that all are afforded
the same level of care. This challenge focuses health
systems on delivering a limited number of interrventions
producing the greatest impact in reducing the disease1
. According to the recent study2, "approximately
90% of the global health resources are concentrated
on 10% of the world`s population ”.
A fram ework! Do we need
it or not? ..well.. consider the area (including
the East) and its population. How did the previous
groups organize? With the proper guidance, the members
of the team will return with posistive experiences
and the community will benefit from their expertise.
The focus of the mission should be clearly defined,
dependant upon the expertise of the interested participants.
Conclusions: A
team with few members during a short period of time
may reduce the patient-workload to the local staff.
There are enough expertice within the overseas tamil
communitiy. With proper communication and means
both parties harvest benifits and satisfaction.
There is a kind of framework exists amoung various
teams visiting the north-east. The fascilties at
the operation theatre and endoscopy unit in Puthukudyiruppu
could handle major surgical cases without referring
to the higher centres.
Some thoughts in the future...
What we know is that there is a younger generation
which is being educated and sooner they will be
employed in the north- east health sector.
Are we prepared to provide
sufficient knowledge to those in the future?
The endoscopy unit |
The endoscopy unit
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Some thoughts in the future...
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Planning,
devolopem ent, and execution of an interprovincial
programme in m inimally invasive surgery.
In the late 1980s, minimally invasive surgery
experienced unprecedented growth.
Centers appeared worldwide, providing a variety
of training opportunities and laboratory experiences.
There is a possibility to gather a group of experts
among the multispecialty surgicalstaff in the
devoloped country to design a programme with multidiciplinary
course for the younger medical generation in the
Eelam. The purpose would be to provide credential
and training from the t echnician level through
the inst ructer surgeon level.
A (workshop) model template
Education and credentialling in minimally invasive
surgery would be accomplished by executing a programme
of basic science and clinical training for physicians,
technicians and nurses. The programme, for example,
could cover general surgery, urology, gynecology
and thoracic surgery (Video assist ed thoracoscopy).
The programme should also be able to identify
and select one or two persons who could serve
as future instruct ors, to maintian the continuity.
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Clinical
research unit with evidence-based reproductive
healthcare
`Information poverty`has been identified as substantial
impediment to better
healthcare in developing countries and even as
a form of mental starvation3. Typically, in the
developing medical libraries are equippped with
few worn books and dated journals. Currently there
a re few updated books scattered in local hospitals
in Wanni.
Evidence-based medicine is the now common currency
of medical education, research and clinical practice
in the developed countries, and the concept, is
appreciated internationally.
From our experience we know that the “hunger“
to t echnology and knowledge is
tremendous in Eelam. As I mentioned earlier there
is a new batch newly qualified
medicalstaff is in due course.
May be we should spot some (2 or 3 is enough to
start with) staffs and organize a
Research Forum.
References:
1. George M. Rich Century Poor results. Nursing
Standard 1999:14;14-15.
2. Bunyavanich S, Walkup RB. US Public Health
Leaders Shift Toward a New Paradigm of Global
Health. Am J Pub Health 2001:91;1556-58.
3. Lown B, Bukachi F, Xavier R. Health information
in the developing world. Lancet
1998;352:SII34-SII38.
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