Deirdre Cusack  Kirkpatrick-Durham

Voluntary Work in Sri Lanka  



For the last eleven years I have lived in Sri Lanka , where my husband Julian has been building roads.  A tropical paradise to most people, and indeed it is a beautiful island, rich in culture and history.  But there is a darker side to Sri Lanka , which I saw up close through the work I did with a charity called Interplast UK .  Interplast funds teams of medical personnel from various first-world countries (Britain, Australia, Germany, USA are some) to travel to third world countries like Sri Lanka and perform reconstructive surgery on those people who could not otherwise afford to have this surgery done.

Sri Lanka has a nationalised health care service, as do most developing countries, but it is woefully under funded, and the pressure on the service is severe.  To make the money go further patients are asked to fund their own medicines, to bring in blood donors before planned surgery will be undertaken, to feed themselves, and to have relatives or friends to stay with them and help with their care.  A far cry from the all-inclusive NHS that we know.  In addition, specialist surgical consultants are few in number, and the need for them great, so waiting lists are very long.

One area of particular need is in reconstructive surgery, both to correct congenital deformities, which seem more common in the third world, and to rectify acquired deformities, primarily scarring and distortions from burns (kerosene lamps are the most common form of lighting for the poor, and are the most common cause of fires in the home), violence and trauma (Sri Lanka has been fighting a terrorist war for the last 25 years) and from disease (Sri Lanka, along with India, has one of the highest rates in the world of adult-onset diabetes).

Interplast UK is headed up by a retired reconstructive surgeon, Mr Charles Viva, who is a Tamil of Sri Lankan origin, so the island is dear to his heart.  In total I joined seven of his medical camps, or ‘Mercy Missions’ as the Sri Lankan media called them, and it was an experience I wouldn’t have missed and was privileged to share - emotionally and physically draining, but so stimulating and uplifting.  Charles is the most amazing chap - by far and away the best plastic surgeon I’ve ever worked with, and I’ve worked with a few in my time, but a really pleasant man too, and anyone who’s ever worked in an operating theatre will tell you that that doesn’t necessarily follow.  In fact it very rarely follows.  From our 6am start until our often 10pm finish each day I never saw Charles ruffled, upset or put out - he was calm, competent and in control all the time.

The first camp I joined was at the beginning of 2002, when a change of government in Sri Lanka led to a ceasefire between the Government forces and the Liberation Tigers of Tamil Eelam (LTTE), the rebel forces who are fighting for a homeland in the north of the island.  The camp was held in Jaffna , the Government-held town at the tip of the otherwise rebel-held northern peninsula.  The Sri Lankan Air Force flew us up and back on the trip, from Ratmalana military airport just to the south of Colombo to the military airstrip at Pallali, on the tip of the Jaffna peninsula.  From there the Army bussed us in to the Jaffna Teaching Hospital, where we were based.  The disembarkation procedure at Pallali was a real eye-opener.  The plane landed, the tail ramp dropped, everyone raced out at top speed and our bags were thrown out after us; the troops waiting to embark then raced up the ramp, the tail lifted and the plane sped off down the runway, up and away.  All this happened in the space of about five minutes.  They’ve got it down to a fine art, as I suppose they must, having been at war up there for so long and with Pallali periodically coming within artillery and mortar range of the LTTE.

We really struggled to keep up with the disembarkation.  Nobody told us what was going to happen until it happened, by which time they were screaming at us-" RUN."  In the event, de-planing proved fairly easy, as gravity takes over.  It was the return trip, at the end of the camp, entering the aircraft up a steeply sloping ramp at a flat-out run, with the engines blowing a gale of hot, kerosene-fumed, exhaust-laden wind at you  was the difficult part.   And carrying all the kit and supplies too, but fortunately by the end of our two weeks both we and the supplies were much lighter.

The drive in from Pallali to Jaffna was distressing.  Stretching out on either side of the road as far as the eye could see are roofless farm homesteads, vegetation growing through them, with bullet-pocked walls and surrounded by overgrown and weed-infested fields of rich red earth.  I subsequently found out, through talking with the UNDP representative in Jaffna , that the whole area is extensively mined, with the LTTE having sown their mines in the most destructive way, such that it will take a long time and much manpower to eradicate them.  Some of their tricks are to mine the front doorstep of the farmhouse, or the step at the farm well, or the land under the big spreading tree where people gather to talk - but not at every farm of course, so everyone is fearful to return to their land, even if there is a ceasefire.  Not that some people can ever return - both the Muslim and the Sinhalese populations were expelled from Jaffna Province by the LTTE over the last years, and the population is now entirely Tamil.

And so to work.  Jaffna Teaching Hospital is a large, spread out network of buildings, interlinked by covered walkways.  It has 1,015 beds, miles of sprawling corridors, a multitude of Nightingale wards, an intensive care unit, a coronary care unit, a four-roomed operating theatre suite, acres of outpatient clinics, a mortuary, a teaching block, nurses’ training school - and all of it so shabby, unloved and uncared for.  A lot of the depressing neglect and unloveliness could be altered with a bucket of soap and water and an application of willpower and elbow grease.  In a word, the place was dirty.  Of course, after so many years under siege and at war, morale was low, and it is very hard to motivate demoralised people.  With the advent of peace one day the recruitment problem will ease, and new staff will bring change.  We can but pray for this.

That said, there were really dedicated, hard-working and admirable doctors and nurses in the hospital, who are doing what they can to hold the place together in the face of old, broken, worn-out equipment, a non-existent maintenance department and sporadic and incomplete supplies and deliveries.  They do get given donations of equipment and supplies from charitable organisations and countries (while we were there an American Aid donation of monitoring equipment arrived) but the big problem is that there seems to be no co-ordination of all these gifts, so that whilst one group gives, for example, Hewlett Packard electronic equipment, the next group gives 3M equipment, and so on.  Of course the software and consumables are not interchangeable between the various types, creating a logistical headache.  Add to that the fact that there is no service backup in Jaffna , and a very limited and erratic electrical supply, so when things break down there are no technicians to fix them.  And with no in-house training in the use of the new equipment, the staff just muddle through somehow, and of course equipment is inevitably abused and misused.

The day we arrived we had an outpatient department full of hopeful faces, waiting to see the surgeons to be assessed for the lists of those most in need and most likely to benefit from surgery.  Inevitably some were turned away.  With over a 1000 people wanting surgery, and only two weeks in which to operate, it was a heartbreaking scenario.  But by the end of our time in Jaffna we had done some 160 operations in 12 days, of which 88 were repair of cleft lips and/or palates, 23 were release of burns contractures with or without skin grafting, 5 excision of cancerous growths with grafting, and 44 assorted others, such as scar revisions, repair of facial congenital anomalies, excision of leg ulcers with grafting, and so on.  Impressive really, and the most cases that the team had ever done in any two-week camp, they said.  All the disposable supplies that we used were brought with us, donated by the generous British public and by medical companies, and we had enough to leave behind some £6,000 of supplies for use by Jaffna Hospital .

Following this camp I worked with the Interplast UK team for the next few years at various  hospitals around Sri Lanka and in Bangladesh .  In each town the picture was much the same, maybe not the war-damage that Jaffna has sustained, but always old buildings, largely in need of upkeep, and strained to capacity by the pressure of patient numbers, too full and too busy to be kept clean and neat, and always staffed by tired but, for the most part, willing workers.  The one exception to this picture was the trip that took us into the LTTE-held heartland, to run a four-day camp in one of their field hospitals.  Here was a very different story.  The hospital, much of it under canvas, was clean, neat, disciplined and cared for in a very military way.  The LTTE may be a rebel and terrorist army, but like armies the world over they are run on regimented, hierarchical and disciplined lines, which makes for a very orderly environment. 

Whilst working there we saw need and damage just as distressing as that found in the Government hospitals to the south.  One case as an example.  A young woman, an LTTE cadre, probably 24 or 25 years old, with lovely shining black hair, and perfect, soft smooth skin, and wonderful eyes - except that the whole of the bottom half of her face had been blown away by a bullet, leaving a gaping, salivating hole where her nose and mouth should have been.  We spent the better part of a day reconstructing that young girl’s face, first a tracheotomy, then taking a bone graft from her rib and wiring it in to where her jaw had been, and then patching and grafting soft tissue over, and reconstructing her nose and lips with silastic implants and soft tissue flaps.  Provided she heals cleanly she will have a functioning face; she’s never going to win any beauty prizes, but at least she’ll be able to eat and drink more or less normally.  She’s never going to get married and have babies either.  Who would want to marry her in a country where arranged marriages are the norm?  A complete and completely avoidable tragedy.

On a lighter note, we had a free afternoon at the end of that camp, and were taken out into Mullaitivu Bay by the so-called “Sea Tigers”, the maritime arm of the LTTE, in two extremely fast boats.  They showed us what they could do – racing at extreme speed from headland to headland, shooting up very accurately an old wreck, and finally landing us back on the beach by racing in without letup, so that we planed across the sand to the high water mark.  This last show-off prank had both us and the young LTTE nurses who had escorted us shrieking and laughing with alarm, at one in our excitement and fear.  Then we lay on the sand drinking cool drinks, eating a delicious pudding dish, and watching the sun go down and the stars come out.  It was peaceful and lovely, and a world away from hatred, bullets and war.


28 July 2008