Once we reached Kilinochchi we went straight to Nandavanam where visitors have to check in first. One of the girls’ uncle came to see us while we were waiting for our ride to Dharmapuram. He works for a construction company, Prime Engineering & Architecture, and currently is conducting a couple of projects in Kilinochchi. He showed us his office building and his apartment inside which is still under construction. The major objective of his company is to train the people here on using power tools and teach them new construction techniques. We then visited the construction site of a future major hospital in Kilinochchi. Overall, I noticed that Kilinochchi is a well-established town and growing very fast with a lot of construction projects in progress.

We were taken later then to Dharmapuram to Vaakesan’s Guesthouse. Our coordinator came that same night and met all of us. Few he already knew from prior visits. He talked about the things we need to expect here and have to adjust to, such as limited availability of electricity, insects, snakes and foremost the heat. He mentioned that tomorrow would be the first day of a five-day heat wave. He explained some of the house rules and gave us an idea on how our daily schedule is going to be.


Next morning, we met another coordinator who gave us our schedule for the upcoming weeks. Three in our group came here to learn Tamil, while the others and myself would be doing the medical project and teach English. To help the girls who were learning Tamil we all were told not to speak in English anymore and try to converse in Tamil. We left for Mullaitivu that morning. Close to Mullaitivu, we stopped at a relocation camp for 10 minutes where I was able to talk to some of the people residing there and asked them how they were doing. Except for the unbearable heat they said that they were doing well and were well taken care of.

Picture 1: Relocation Camp near Mullaitivu


Picture 2: Relocation Camp near Mullaitivu

As expected, Mullaitivu was a complete ghost town. Having seen the coverage on TV endless times I have gotten desensitized to the disaster. However, seeing the massive destruction with my own eyes, it evoked again the same feelings I had six months ago. It was still hard to believe that this town was a graveyard for so many lives. We got off the van and walked along the beach where our coordinator described his experience when he came to help out after the tsunami hit. After we left Mullaitivu we stopped in a small town to have lunch. One thing I immediately noticed in Kilinochchi and now in that town is that there are no beggars on the roadside or little kids selling things. When we walked by stores none of the employees tried to get our attention by loudly promoting their goods or directly asking us to come in. I haven’t been to many places in Sri Lanka but compared to the towns I have been, this was definitely a pleasant surprise. At the restaurant where we had lunch, our coordinator told us that it’s not allowed to tip the waiter here because this would prevent waiters to treat their customers differently. Once we reached our Guesthouse, we got together to discuss the medical project.

Picture 3: Mullaitivu

Project 4: Mullaitvivu ( notice the topless trees)

Medical Project- Prevalence Study at Dharmapuram Hospital

Our task was to study the prevalence of high blood pressure, depression and diabetes where the patients visiting the hospital are going to be our focus group. The initial plan was to do the study at Dr. Ponnambalam Memorial Hospital in Puthukudiyirupu, however, our coordinator felt that we should conduct it at Dharmapuram Hospital which is a very small and primitive village hospital and is not visited often by people coming from abroad. We were equipped with two sets of a blood pressure cuffs (sphygmomanometer) and stethoscopes and blood glucose meter testing kits including lancets and test strips. We were taught how to measure blood pressure and were given a brochure with guidelines provided by JAMA on how to report the data and determine high blood pressure. Our plan was to divide the task of asking questions and doing the tests and measurements within our group to accelerate the process and avoid any downtime. Because the blood cuff was adult size we decided not to include people in the study who are too skinny and agreed to an age group ranging from 21 and up. In our questionnaire we included questions to address risk factors associated with high blood pressure such as exercise and salt intake. We decided to measure patients only for blood sugar if their body mass index exceeded 25. Therefore, we included to measure their height and weight as part of the study. We were given a set of questions, which can be used as a first step to diagnose depression. We first would ask the patients two questions used to detect signs of depression and if they both are answered with a yes, we would proceed and ask a set of more specific questions. Once we prepared a draft of the questionnaire, we translated it in Tamil.

The next day we visited Dharmapuram hospital and met the staff. The hospital receives daily on an average about 150 patients and only one doctor on duty. They don’t have nurses, only trained volunteers who get compensated for their services by a local NGO. The most prevalent medical cases are fever, viral infections such as respiratory tract infections, snake and dog bites, asthma, diabetes, high blood pressure and diarrhea. The hospital has three wards and a total of 54 beds.

We were given a private room to conduct the study and the nurses helped us recruit patients for the interviews. First, we did few mock interviews with the patients, telling them beforehand our study’s objective and asking them for their feedback after the interview and tests. We were a little hesitant to ask the depression questions due its sensitive aspect. However, most of the patients told us that the questions didn’t seem intrusive or insensitive. Due to a team member getting sick and then the bulb missing for one of the blood pressure cuffs we ended up taking one patient at a time and couldn’t see as many patients as we wanted. The maximum we have seen the first week were 30 patients. The first few times we were definitely nervous doing the interviews and interacting with the patients and even though had assigned specific tasks to each person, still had trouble establishing a smooth routine. However, over time we were able to overcome those initial problems.

We interviewed more women than men and observed a difference in their behavior towards us. Most of the time, the women openly talked to us and felt more comfortable overall. They also didn’t show any reaction to the depression questions, whereas the men seemed more inhibited and answered the two screening questions mostly quickly with a no. Few patients would actually end up staying longer with us and telling us their whole life story. One of the depression questions asked if they feel unenthusiastic to do daily chores and most of the time patients would say how they do not like doing it but do still it because they just have to. They put the need to fulfill their duties and do what is asked before their own feelings and considering their financial situation they are not given any other choice. We, therefore, felt that the depression questions needed to be adjusted to this culture and way of life, however, due to our lack of background knowledge on this subject and no opportunity to do research on depression for this place, we did not do any changes to the questions and kept the original questions.

(Please note: I was not present for the whole study and therefore don’t have any data or a final report on the study. The previous information only includes the part I was involved in. The observations while doing the study are from the week I was there at Dharmapuram Hospital. My team members ended up also conducting the study at Dr. Ponnambalam Memorial Hospital.)

Picture 5: Dharmapuram Hospital

Picture 6: Medical Staff at Dharmapuram Hospital

English Lessons at Visuvamadu Library

In the evenings we were scheduled to teach English to students attending the Visuvamadu Library. The person who manages the library had picked out about ten students he felt would be benefit from getting lessons and hoped that they will get proficient enough later to teach other kids. First, we got introduced to the students and then divided the students among us. I chatted with the students assigned to me in Tamil and asked about what they felt they need most practice. Most answered that they need to learn how to differentiate the tenses and work on speaking English. I tried to converse in English with them several times, however, they felt very timid to talk back in English. All my students were in their early twenties and have had English in school. However, they told me how their teacher would teach English in Tamil and when giving homework also supplies the answers right away giving no opportunity to learn. Their teacher would barely do reading exercises and call up only the best students in the class to read. All my students on their own have been trying to improve their English since they have finished school. Therefore, their motivation and attention during the class was remarkable and definitely helped accelerate the lessons. I used the books that were in the library to create lesson plans and noticed the need of more updated books. The supervisor of the library pointed out that they need also up-to-date engineering and other science books. Currently, a computer center is getting build right next to the library where classes are going to be held on using Microsoft Office, Windows, etc. I did see improvements in my students after couple of lessons when practicing tenses and sentence structure. However, there is for sure more work and time needed to make them proficient enough to teach others. Especially the speaking part, their lack of resources such as English learning tapes or software and having no opportunity to practice speaking English will make it very difficult for them to learn the right pronunciation and sentence structure on their own. Another thing I think is needed is structured lesson plans that can help visitors from abroad pick up where prior visitors have left off which would help the person teaching and the student as well.

Other places we visited

Besides the medical project at Dharmapuram Hospital and teaching at Visuvamadu library we had the opportunity to visit a lot of places. We went to Iniya Vazhu Illam, a school and hostel for children who are hearing and vision impaired. We went a couple of times to Navum Arivu Kudam where injured veteran soldiers reside and go to school. There we had the opportunity to interact with the women for some hours. I remember being amazed that their injuries didn’t hurt their attitude. They all had this positive spirit. It made you forget for a moment that these women were soldier who have fought and faced death daily in the battlefield. They were just like us. We chatted about how to take care of your hair or maintain your weight and just giggled and teased each other. But I do remember feeling so guilty when I was with them and felt that anything I have accomplished in life was so meaningless to the sacrifices these women have done for us.

We visited Kallaru, a relocation camp near Dharmapuram, where everyone in our group was placed with a group of people. I met a lady whose parents and one of her daughters were killed by the tsunami and she showed me their obituaries. I asked her and her other daughter staying with her about their living conditions and she told me how they get food stamps and are still depended on donations. Only few at the camp are actually employed. I talked to the daughter as well and she told me that she was able to continue her schoolwork here. Overall, they seem to do well. I asked more people at the camp about their experience when the tsunami hit. They obviously had been asked it so many times that when talking about it they were completely unemotional.

There is work going on to establish a permanent village for the residents next to the camp. The road leading to the camp from Dharmapuram is also getting worked on. I met another lady who is part of the village committee that deals with projects related to the camp. She told me how there is a need for transportation, especially for medical emergencies. The nearest hospital is Dharmapuram hospital, which for them is 10 km away and Dharmapuram does not even a 24-hour emergency service, so an emergency during off-hours would require even further travel. A cancer patient died on his way to the hospital when he was transported by a tractor. Older and disabled people who want to go see a doctor have to arrange for transportation, which is most of the time not possible. And the local pharmacy just gives them aspirin for every sickness they have. There are also a lot of adults and kids who want to learn English and have access to computers. However, getting to Visuvamadu library is again a problem due to no transportation.

Reflection – Some final words

Born and grown up in Germany and now living in the USA, I was dealing with some sort of an identity crisis. Constantly balancing three different cultures and languages made me wonder where I fit in and always long for a place to call home. I would jokingly refer to myself as a German-Born-Confused-Lankan (GBCL). Having lived abroad all my life these few weeks in Tamil Ealam were for sure a unique experience for me. It was my first time in the North-East (when I was two years old I have visited Jaffna but I can't really count that.). I have always felt like a tourist when I came to Colombo. Even though I was with enough people who shared my background, I never felt that I belonged there. Therefore, I was surprised that I didn’t feel like a stranger during my stay in Tami Eelam. Although I had a hard time adjusting to some customs there and my snake phobia was for sure always with me in the back of my mind, I fell in love immediately with the simple way of living and became more comfortable meeting new people. This trip made me realize how thankful I am for my parents for having kept me close to my roots by instilling Tamil values in me and teaching me Tamil. Because of that I was able to connect with the people I have met and they also felt at ease opening up to me.

Before, helping the people of Tamil Eelam was more an option for me, now I know it is my duty to help them as much as I am capable of. I owe it to my homeland and to my people. Until now, I have never felt so much pride, never understood the true meaning, and most likely never really deserved it when I say I’m Tamil.

Final, final words
I would like to thank the IMHO and NTYO for have given me this great opportunity.

One of my favorite moments- being stuck behind them for about a mile.