Our team along with some local doctors and medical students visited ten camps during our short stay. Batticaloa has approximately 50 camps total. We visited 8 camps that were located in the government-controlled areas and 2 camps in the LTTE controlled areas. I averaged about 60 patients a day.

My observations:

• Patients were mostly females (males were out at jobs or seeking employment).
• Anemia (based on clinical diagnosis) was prevalent with common causes being nutritional deficiency and worm infestations.
• Noted presence of other nutritional deficiencies such as vitamin A deficiency i.e. bitots spots. (I am sure that other deficiencies existed but did not have the clinical acumen to identify!)
• Musculoskeletal symptoms were one of the most prevalent presenting complaints. This I believe is partly due to their lifestyle of hard labor, trying living conditions and partly due to somatization.

  I was glad to double up as a Rheumatologist and treat a fair amount of DJD, tendonitis and myofascial pain. I was able to give several joint and tendon injections.

  The few cases of Rheumatoid Arthritis that I saw were poorly managed or not managed at all due to lack of lab facilities, medications and proper follow up.

• I saw a great need for screening of some common problems such as Hypertension, Diabetes Mellitus, Hyperlipidemia and Coronary Heart Disease.
• I consider the lack of continuity of care being a significant problem. CHC could look into rotating volunteer physicians to these camps so that some continuity is maintained.
• Asthma and respiratory problems were widespread. The lack of nebulizers, MDI’s and injectable steroids in the management of asthma further compounded this problem.
• Widespread presence of nonspecific symptoms such as headache, lightheadedness, loss of appetite, arthralgia, and fatigue were noted.
• I saw a fair share of acute respiratory infections and skin infections.
• Poor dentition and the need for visual exams were two other universal problems.
• There is a tremendous need for grass roots health education in awareness of 1) communicable disease and preventable disease, 2) nutritional enhancement, 3) general hygiene and dental care to name a few.

Health Care Delivery

To put it in a nutshell the health care system was in shambles even compared to the system as I knew it to exist in the South about 14 years ago. We do not have to stretch our imagination too much to realize why this is so!

The hierarchy of the General Hospital, District Hospital, Base Hospital, Central Dispensary and the Public Health Inspector was nonexistent. Basic care such as ambulance transport, injectable antibiotics, other emergency drugs, oxygen supply and nebulizers to name a few.

Primary Care Centers

In light of the above situation I was happy to observe the functioning of a Primary Care Centre in Panchennai in the LTTE controlled territory.

IMHO should be congratulated in its vision of helping to set up similar primary care centers, which are an excellent source of first contact for patients in remote areas.

I was glad to see the work in progress towards the building of a bigger better-equipped facility at Panchennai. (I would like to state here that the community in Oneida rallied after the Tsunami to raise money and $50,000 was donated to finance this building and furnish this Centre).

I did find the LTTE trained physician who is currently manning the Centre to be well versed in the health problems of the area and seemed to have some solid ideas to improve the health care for these people. We (my partners, Daniel and Renza, and I) are looking forward to collaborating with this Centre in the future.

Logistics

Overall there was good co-ordination between CHC Colombo and Batticaloa under very trying conditions, except for some minor glitches like getting us to the camps on time!

I think getting a head start and starting on time would enable us to be more efficient and give us a chance to see more patients.

The staff at CHC Batticaloa was excellent, always trying to make sure that all our needs were met, at times even bending over backwards for us. Thank you CHC!

IMHO Volunteers

As in many similar situations some bad apples can spoil the whole crop! Such was the case with some volunteers who were rude, demanding and “seeing Patients” was not their priority.

IMHO should endeavor to come up with a better way of screening individuals and setting up some guidelines to prevent these types of volunteers from going over.

Personal Note

The realization dawned on me that practicing medicine in a developing country is very different and that I was ill equipped at first…

Kind of lost… but got a better handle on the situation towards the latter part. I believe an extended stay would have helped me to be more productive.

This trip did rekindle something in me and if circumstances permit, would definitely go back in a heartbeat.

PS: I have attached the graphic depiction of some prevalent presenting symptoms of patients seen by me. Hopefully this may be useful for future volunteers. Detailed data on all symptoms are available with me and at the CHC office in Colombo. The Pediatrician was collecting data on maternal-child welfare.