Alright so lets start from Monday last week where I left
off…
On Monday, we had a journal club about nephrotic syndrome. I
presented the US guidelines for management while the registrars presented the
Sri Lankan guidelines. It was different from American journal club meeting
because we were told to mainly use review articles rather than critically
analyzing one article. But it was an interesting discussion, and I learned a
lot about nephrotic syndrome which I have not previously managed.
On Tuesday and Wednesday, I participated in the community
rotation. It is supposed to be more structured and longer than two days but
that is when medical students are there too. Without medical students there is
less formal learning involved. But it was still a great experience. I don’t
think I have previously explained Sri Lanka’s health system so let me start
there…
So Sri Lanka has free, universal health care. There are some
recent private hospitals popping up but most everyone goes to the
public hospitals and only the public hospitals have an emergency room and
trauma area. Every testing, medication, and surgeries available at the public
hospital are free. This includes things like MRIs, chemotherapy, and open heart
surgery. And the smartest, most trained physicians are at these public
hospitals. So despite how some of them look, it is the best care available in
Sri Lanka and it is quite complete. What it lacks (for free but is available if
willing to pay) are certain medications (for example ceftriaxone is not
available for free but cefotaxime is), specialized lab testing (like gene
testing), and certain surgeries (like bone marrow transplant). The doctors told
me that if they or their children were sick then they would take them to take a
public hospital, which I think speaks volumes, and is not something other
countries like India can boast. With
this system they have an infant mortality rate equal to many developed
countries. It also helps that >90% of the country is
literate thanks to their free public school system that basically everyone goes
to. Private schools are rare and many public schools are better than private. I
also think that’s very impressive!
Part of this system is a great rural health care structure.
Areas in each state are divided into MOH areas that one doctor (the MOH)
supervises. Within these MOH areas are multiple small clinics spread out
throughout the community that different medical officers (called Demonstrators)
visit each day for different clnics. For example, one day it is the antenatal
and immunization clinic and another day it is a children’s clinic. This allows
the locals nearly daily access to doctors without going too far. It also
ensures that everyone is cared for and looked after on a regular basis. There
are also smaller hospitals for about every 2-3 MOH areas. Parents can be transferred
from these hospitals to one of the five or six larger tertiary care hospitals
in the country if needed for free.
Seeing how much the US has struggled in controlling health care costs, I am impressed with how the Sri Lankan system works. There is a deficiency in quality and often delays in testing, but they have the same eventual outcomes. The Sri Lankan government wants healthcare to become more privatized because they feel they are spending too much money on healthcare. I have had many discussions with the doctors here on the future of Sri Lankan healthcare. They feel excited about privatization, but I am wary of the discrepancy in care that will develop-- not just in the quality of hospitals but the doctors who work there. Right now the government doctors (which is most of them) must move to different hospitals every 4 years with doctors who are more senior having priority over where they end up. This is a way to ensure that there are doctors in rural areas. It is less than ideal for the doctors many of whom must move hours away from their family but great for the patients. It's an interesting, never ending discussion so let me go back to my community medicine rotation...
I went to a couple of the clinics, seeing primarily
antenatal patients but also going into the immunization area where kids were
getting necessary vaccines and having their weight and head circumference
checked. It was interesting because they don’t have dopplers to listen to the
fetus’s heart beat. Instead they use something called a pinard. I had a really
hard time hearing anything with it and probably only heard fetal heart tones
twice. Here is a picture of what they look like: http://en.wikipedia.org/wiki/Pinard_horn
One of the clinics was held at an orphanage created by an
Austrian doctor. It was a very well developed and maintained orphanage. They gave me tour of the place. Most
of the kids are actually there due to court sanctions to get away from abusive
parents, which is super sad. But the children looked very happy and content
there! Unfortunately I did not have my camera but this is the website for the
orphanage: http://soschildrensvillages.lk/
On Friday, I presented a case at their Clinical Lecture
Discussion. The CLD is their version of Morning Report that they have once a
week. But it is much more intense because only the pediatric registrars
participate. They are ones on the “hot seat” and ask all the questions and form a
differential. I presented the case I presented at Chair’s Conference: the girl
with Hemophagocytic Lymphohistiocytosis. It was a hard case, but they got pretty
close!
This past weekend, I spent time doing some final souvenir
shopping and attending a peace concert! It was held at a Japanese Buddhist
temple and featured people from Europe, India, Japan, and of course Sri Lanka.
The point of the concert was to promote peace and understanding through music.
The Japanese Ambassador was there too! It was nicely executed in a beautiful area. Here are some pictures from the event:
A sitar player from India
The crowd in the area
A view of the beautiful sunset we watched there
The pagoda light up at night!
Speaking of going tourist shopping, let me tell you about
experiencing what I call the “Tourist Tax”. When traveling to a developing
country, foreigners often pay more than locals for many different reasons,
primarily being that the locals charge more knowing the foreigners will pay. I
have been charged more for that reason but can often haggle it down to a
reasonable rate that is still more than
the local rate. But I have not had people jack up the price so much as when I
am traveling with Anna, our new Japanese friend! I actually met some rude Sri Lankans for the first time when trying to negotiate a bus fare!
Relatedly, I may have mentioned that people are very curious
about me being Indian and enjoy talking to me. But I don’t actually stand out
too much usually unless I start talking, especially now that I have gotten
darker. Most people here assume I am Sri Lankan! And I really enjoy not getting
unnecessary attention. But walking around with Anna, people are constantly
staring and commenting! I feel like I am experiencing a different part of Sri
Lanka being around her. The Japanese government has put in a lot of money into the Sri Lanka infrastructure so they are very well respected here.
I wrote this blog post while going to pick up Dhaval from the airport on Wednesday but unfortunately am just getting around to posting it now. Pictures take so long to upload! I will provide details of the rest of the week in a different post!
This post had a lot of writing so let me end with pictures of different Sri Lankan fruit and food that I tried:
Hopper and Egg Hoppers. Super yummy and cheap. It is basically a South Indian Dosa made in a small skillet. So the edges are very crispy while the center is thicker and softer. The egg hopper just has an egg broken in the middle. It is super yummy especially with their different chutneys.
Wood apple. I really didn't like this. I thought it would be more like an apple but the name only describes the appearance. The taste is not so bad; it is very tangy. But the smell and appearance prevented me from being able to eat it.
Our version of High Tea! We meant to go to the Fort to have high tea but kept forgetting/not getting time together. But we bought amazing tea in Hikkaduwa and some local cake and made our own high tea!. The little brown things in the back are another fruit that is also very tangy. Sorry I don't remember the name of it!
