A growing number of expatriate healthcare professionals (physicians, dentists, nurses, technicians, etc.) are visiting North-East of Sri Lanka to help with the medical care of the people in this region. Both, the visitors and the people in the region find these visits to be mutually beneficial. The ‘visitors’ have found these trips to be a ‘wonderful experience’; many have returned for two or more visits and all have promised to return. Patients in the region have benefited immensely from the services provided and have expressed profound gratitude. The International Medical Health Organization (IMHO), an interconnected group of organizations of healthcare professionals in various countries around the world [Est. 2003], welcomes this trend and wishes to encourage more expatriates to do the same.

The IMHO has acquired considerable experience with its members having visited the region in the past. It wishes to help streamline future visits to optimize the benefits.

This information is intended to help those healthcare professionals who plan to visit in the future. This advisory manual is divided into two sections – what to expect when you go and what you need to do before you go.

WHAT TO EXPECT WHEN YOU GO

Healthcare Systems:
Northeast Sri Lanka is currently under two administrations – Government held areas and LTTE areas. The healthcare systems in the two areas are different.

The government held areas have two teaching hospitals (Batticaloa and Jaffna) and nine base hospitals in addition to smaller district hospitals, peripheral units, dispensaries and maternity homes. The LTTE controlled areas have only district hospitals, peripheral units and dispensaries and maternity homes. There are no teaching, provincial or base hospitals in this area. Both areas have private hospitals. The Tamil Eelam Health Services (TEHS) has also setup twelve primary care centers (Thileepan Medical Centers) both in the LTTE and Government controlled areas.

Manpower shortage is severe in both areas and both areas could benefit from visiting healthcare professionals. However, the manpower shortage is most grave in the LTTE held areas. There are no medical specialists at all in the LTTE held areas, and the shortage of generalists and para-medical personnel is also more severe.

Center for Health Care (CHC), a non-governmental organization, oversees the healthcare in the Northeast of Sri Lanka. The IMHO works in close collaboration with the CHC in arranging visits by expatriate healthcare professionals. The following applies to the regions serviced by the CHC and the IMHO.

Transportation:
A variety of conveyances are available from Colombo to the different parts of the northeast province – air, public and private hire vans.

The IMHO can arrange transportation by private hire vans to areas it services. If you are traveling by road expect minor delays at the border crossings between the government and LTTE held areas. Sri Lankan armed forces inspect the identity papers (passport), the vehicle and personal belongings of the travelers. On the LTTE side permits are issued for a fee of US$ 10.00 (SLRs. 1,000).

Accommodation:
A limited amount of comfortable accommodation is available free of charge for visiting health professionals. The rooms are clean with comfortable bedding and mosquito nets. Bathrooms are clean with sitting, water-sealed and flushing, commodes. Bathroom floors are wet however. The rooms and common areas are fitted with fans. Air-conditioning is provided on a limited basis.

Food:
Wholesome and tasty meals are provided free of charge at the lodgings. There are also several clean and very affordable private restaurants in the area. Tipping is frowned upon.

Amenities:
Telephone services are limited but improving. International and intra-island calls can be made from a private kiosk in Kilinochchi, very inexpensively. Urgent calls can be made from TRO and IMHO offices. Cell-phones work in the government held areas, but not in the LTTE held areas. Internet access is available at a private internet-café in Kilinochchi for one US dollar (SL Rs. 100) per hour. Foreign currency and travelers checks can be cashed at competitive rates.

Safety:
A recent visiting doctor observed “Vanni is the safest place on this planet.” Crime is limited to petty disputes among locals, and the Thamileelam Police Service is reliable. There are no beggars in the LTTE controlled areas.

Healthcare Facilities:
Visiting healthcare personnel can provide services at the Thileepan Medical Centers, private hospitals and at the government hospitals.

There are twelve Thileepan Medical Centers in the northeast. These are primary care centers, where visiting professionals can see patients, identify needs and train the staff.

In the Vanni there are two private (cooperative) hospitals – Ponnambalam Memorial Hospitals. They are satisfactorily equipped to provide modern medical care. Consultation and exam rooms are ample to conduct clinics. Laboratory and X-ray facilities, including ultrasound, are modest but sufficient. Equipments for cardiology, gastrointestinal, Eye, ENT and gynecology exams and procedures are available. Well-equipped operating rooms with competent anesthetic service are also available. Common medications are on hand in modest amounts.

Visiting specialists however need to contact the facilities in advance to determine if equipment and supplies they need are available. The IMHO can coordinate this activity.

Teaching:
Two sets of healthcare providers are being trained by the CHC at the Physicians Assistant (PA) level. The curriculum is the same as the one used for medical student teaching at the Jaffna Medical School. The students are English educated, quite bright and eager to learn. Both didactic and bedside teachings are welcome. Classrooms with projectors are available. Those who wish to teach at the Jaffna or Batticaloa medical schools need to contact the deans at these medical schools in advance. IMHO-USA will try to help coordinate these activities too but the visiting healthcare professional needs to have academic background.

Other Services:
Healthcare services are needed at other institutions also. Physical Medicine and Rehabilitation specialist and Physical Therapist services are needed at the several homes for the disabled. Psychiatrists, Psychologists and Psychiatric Social Workers can provide services at the homes for the mentally ill. In all areas training local volunteers to provide ongoing care would be valuable.

WHAT YOU NEED TO DO BEFORE YOU GO

	Contact the IMHO. In the US the contact person is Dr. Gnanam Thambipillai.E-mail
	Tell us your intended date of travel, how long you plan to stay, and whether you need transportation from Colombo, accommodation, etc. It would be helpful if you can be flexible about the dates, as it would help us stagger visits by the many healthcare professionals from around the world. The facilities are limited and it is best not to over-stretch the system.
	Tell us your area of medical expertise. If you are specialist we also need to know if you require specialized equipment and/or supplies for your field of expertise.
	Fill out the credentialing form attached. This is to prevent unqualified personnel from endangering patient welfare. We apologize for any inconvenience in this regard.
	We recommend malaria prophylaxis, although the incidence of malaria is on the decline in the area. It is also recommended that you take mosquito repellents such as ‘Dheet’ and/or ‘skin-so-soft’.
	Take loose cotton clothing, as the climate is hot and moderately humid. Sneakers are best to walk around in. Rubber slippers are recommended for indoor use and in bathrooms.
	Other useful items include flashlights and extra batteries, umbrellas and raincoats.
	Anti-diarrheal medications, an anti-biotic and an analgesic/anti-pyretic that works well for you are also useful. These medications are available locally, but the choice is limited.

Taking Medical Equipment:
We encourage you to take medical equipment, which you may need during your visit, with you. It would also be helpful if you could leave them behind for use by others who may follow you. In this regard please consider the following:

	Sophisticated medical devices can breakdown easily, and service for the different brands is not readily available. Used/old equipments have a greater chance of failure.
	Many modern medical devices are available for purchase in Colombo, generally at a lower cost than in the west. Further, most equipments purchased in Sri Lanka can be serviced locally.
	If you wish to purchase any medical equipments in Colombo, the IMHO and the CHC can assist you with this. If you need it for your use during your visit, several weeks’ advance notice is required for us to be able have it ready before you arrive.

The International Medical Health Organization urges you to go even for a short period. Your expertise is sorely needed in the northeast Sri Lanka. For you, it will be an unforgettable, meaningful and truly gratifying experience.