Medicine & Healthcare, Physiotherapy in Sri Lanka by Tom Goom
The Good the Bad and the Muddy
October the 1st, packed and ready to leave at Heathrow, it dawned on me I had no idea what to expect of my time in Sri Lanka. So it was with some intrepidation that I boarded the plane and started my journey, heading to Karapitiya for four months volunteering abroad, working as a physiotherapist.
One month on and I'm very pleased to report that I have loved my placement here. My host family is great, the people I live with have been really nice and my work in the physiotherapy department is challenging but very rewarding. A particular highlight has been how friendly everyone is - I've been fed all sorts of delicacies, taken out for drinks and even invited to a wedding. I've eaten strange brown things and smiled politely while wondering if I can spit it out without anyone noticing, I've drunk tea that is nearly 90% sugar and tried things so spicy I wondered if I'd ever be able to taste anything again. But it's all good and despite a burning tongue you have to smile and say, "Stuh-tee" (thank you) while searching for something to cool your mouth.
The friendliness of the staff and patients makes all the difference at work, it means that despite not speaking any Sinhalese, and my patients not speaking English, that somehow we manage to get by. I spend much of my day miming, pointing and frantically gesticulating to illustrate what I mean. I now do a very passable impression of someone falling over when I ask the question "did you trip or injure yourself?" I feel I have been very lucky here, I am doing exactly what I wanted to do, treating patients, training staff and using my skills and experience. I've treated tiny babies with sore necks, elderly people with arthritis and one young boy who keeps getting me to make him balloon models (I made him a balloon sword to encourage him to use his arm after a fracture) and all is going well.
There have been a few challenges, mainly in approaching the senior staff. Some of them have been working here for longer than I've been alive, how do I tell them that sitting every patient under a red light bulb for 30 minutes and calling it "heat treatment" is not likely to be effective? The answer seems to be in a gradual "exchange of information" rather than "training". I'm doing presentations 2 or 3 times a week and just trying to get them to question their approach a little. I don't expect to be able to revolutionize the department but if I can improve the treatment just a little that would be fantastic.
To give you an example, in England we usually treat patients 6 to 10 times, that is normally sufficient to manage most conditions. Here they can treat 40 or 50 times, I've even seen patients that have had over 100 treatments! When you consider the time cost to the department, and the fact that some of the patients travel 30 miles or more to get here, it's a huge waste of the their time and money. So that gives me something to work on, a goal to reduce the average number of treatments to between 6 and 10. Time will tell on that one.
During my time here in Sri Lanka I have discovered that it is very much a country of contrasts, even on a brief drive down the Galle Road they are clear, the beauty of the sandy beaches on one side of the road, palm trees swaying in the cool breeze, the desolation of a house reduced to rubble and covered in dirt on the other side. This theme has continued throughout my time here, good and bad, poverty and wealth, health and illness and no more so is this difference noted than within the hospital itself. Some very good things happen in Karapitiya hospital - people are treated quickly with short waiting lists, they have access to consultants and physiotherapists much quicker than we do in the UK, and yet the standard of care can be ineffective at best. Come with a stomach ache and you'll leave with 7 different pills and the hope that one of them will work. But this isn't always the case; there are some very good staff and some.not so good.
At the end of each working week though, the hospital is far from my mind when we get together for some fun and to explore Sri Lanka. Each weekend has been excellent, from getting sunburned while water skiing in Bentota (I checked my skin colour on a B&Q paint chart and it matched "crispy bacon,") to sinking in muddy water at World's End (it seems flip-flops are not the best available walking shoe). We've had a beach party in Unawatuna and yet more mud, climbing Adam's Peak in torrential rain (which was actually much more fun that it sounds). But even at the weekends you see more of the contrasts here, different ends of a broad spectrum, on one road we past a school next to a rubbish tip and a little further on stylish hotel. At Nuwara Eliya we had to fight tooth and nail not to be conned by a less than helpful hotel owner, and just when I was beginning to lose my faith in my belief that all Sri Lankan people were lovely, I arrived home five hours late to find my wonderful host family still up at midnight just to check I got home safe!
So in conclusion, it's been an eventful month, I've just about scrubbed the dirt off my flip-flops, it's been an eye-opening time and I'm learning to embrace all that Sri Lanka has to offer, the good, the bad and the muddy.
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