Many of my friends and colleagues have traveled to North-East of the island of Sri Lanka since the peace agreement was signed between the LTTE and the government of Sri Lanka. There have been extensive reports on the destruction of 20 years of war but none to my knowledge has focussed on the destruction to the healthcare division. Since I work in the healthcare sector, I felt compelled to report on this aspect of destruction.

I left Sri Lanka in 1987 on completion of G.C.E. (O/L) examination at the St. John’s College. When I returned in 2002 and 2003, the day-to-day living of people has changed a lot, unfortunately for the worse. Twenty years of war has ruined the healthcare infrastructure of the North-East. For example, the infant mortality rate (IMR) is considered a good indicator of level of health in a country. IMR is defined as the number of deaths in the first year of life out of 1,000 live births. According to world health report and DHS survey, the IMR in 1985 in the country of Sri Lanka was 24.2 and in 2002 it has decreased to 15.6 per 1,000 live births. During the same time period, the IMR in the North-East has increased from 11 to 30 per 1,000 live births. I fear the real statistics may be worse. For comparison, IMR in USA is 6.7 per 1,000 live births.

From Colombo, I flew to Palaly airport and then from Jaffna I traveled by road to Kilinochi. A9 is not a highway by western standards but I hope that in the near future it will turn into one. At least it was free of land mines. However, it is not true beyond the limits of the “highway.”

Kilinochi is a busy, active town. If peace continues, in no time it will develop into a city. The dramatic difference between Kilinochi and Jaffna is the absence of armed or military personnel in the roads or in any public places. According to current statistics, there are about 45,000 army personnel within the Jaffna peninsula. A ratio of about 1 army per 11 civilians. An open prison camp indeed!

I am ashamed to say that I have never visited Vanni during the first 17 years of my life. To tell you the truth, I was apprehensive visiting an “alien” region. I was not sure what to expect. I was pleasantly surprised to see a complete civil administration in place. The system in place is efficient, uncorrupt and friendly. I felt more at ease in Vanni than in Jaffna!

Center for Health Care (CHC) is a NGO registered in Sri Lanka, which has extensively studied the healthcare needs of the people of the North-East. They are working in partnership with all Tamil expatriate medical communities. The personnel from CHC took good care of us. We stayed at the overseas health professional lodge built by THO-UK. A basic but comfortable place indeed. Whatever the lack of comfort is well compensated by the Tamil hospitality. This lodge was built to provide accommodation to visiting healthcare professionals who are willing to provide service-based help to the local community.

First, I visited the Akkarayankulam hospital. Since Kilinochi General Hospital was bombed and completely destroyed, it has been functioning from the Akkarayankulam hospital. The conditions are difficult to describe for an amateur writer like me. Wards are crowded with limited facilities; Labor room being used as operating room; Radiology department is made up of one simple X-Ray machine; Entire lab is run from a single room which did not even have facilities to check renal function; No facilities to store blood products; No facilities to screen blood products for infection; And the list goes on.

Friends, this is the plight of a District General Hospital. You can imagine the level of healthcare in rural areas. Primary healthcare is the backbone of any healthcare system in the world. Secret to our excellent healthcare system in the past is due to dispensaries and the easy availability of AMP/RMP doctors. They provided excellent service to our community and maintained the health of our nation. Twenty years of war has destroyed this network of primary healthcare centers and unfortunately, the training of AMP doctors has been abandoned too. Jaffna Medical College produces about 70 doctors in each batch. These young enthusiastic doctors travel to South for further training and unfortunately lost in the system. Unfortunately due to the prolonged war, North-East has very little to offer for their further training and to stimulate their young minds. And there are no training colleges available to train allied healthcare professionals either.