Ayubowan.

Sarah Lombardo (featuring Lauren Beaudry)

Where has the time gone?  Somehow, in the blink of an eye, 7 weeks of my Sri Lankan adventure has gone zipping past.  I have to admit that the first 2 weeks were a bit on the slow side – I think this is often the case when things are just starting to gear up and one is learning to manage life in a new country.

But now I always look right rather than left when crossing the street (actually, I look all directions, because those motorbikes and tuktuks will come from anywhere!), I remember to turn on the hot water heater before I want to take my shower, and I can sufficiently pronounce “Karapitiya,” “Mahamodara,” and “Ramesh Pathirana” so that the bus conductors understand where I’m trying to get to (two hospitals and the name of the former minister of education whose house is well known enough and close enough to Leijay to be a reliable reference point).  

And those daring salamanders hardly make me jump and yell anymore… well, rarely.

[Photo: Dancing in the street during the June poya in Kandy.]

 The last month has been sufficiently busy that I’ve also rarely had time to jump online, let alone post a blog entry.  Which is really too bad because Lauren (another Duke MSc Global Health student who is studying elderly care facilities) and I have seen and done quite a number of interesting things.  Here’s a quick recap: You probably don’t remember this, but June 15^thwas a Wednesday this year.

The date is significant in Sri Lanka because it marks the anniversary of when Buddhism arrived in the country from its northern neighbor (India, for those of you without maps) way back in 306 BC.  It is one of the bigger holidays in the country, perhaps only surpassed by the mid-April Sinhalese New Year and the Esala Perahera in July/August (celebrating the tooth of Buddha relic, which is kept very safe at a site in Kandy). 

[Photo: Mighty Sigriya rock."][/caption] Knowing that the week would be largely a bust in terms of work thanks to this mid-week holiday, Lauren and I seized an opportunity to travel northward to the many cultural highlights that this little teardrop-shaped island has to offer.  It’s too laborious to go into all of the details of the trip, but I’ll throw in a few of my favorite pictures with some tags.  If you’re ever lucky enough to visit Sri Lanka I would highly, highly recommend visiting Kandy, Dambulla, Sigriya, and Polonnaruwa.  Anuradhapura, the most ancient capital and home to a direct descendent of the original Bodhi tree under which the Buddha gained enlightenment, is also supposed to be amazing, but sadly we did not have the time to travel that far north. 

[Photo: Cave temples at Dambulla."]

Arriving back at Leijay refreshed and ready for action, I started a month-long series of rotations through the Ruhuna Medical School.  My first week in community medicine had me out in the clinics.  Though the facilities and equipment were modest, the numbers were nothing less than impressive.  The antenatal clinic easily handled 25+ patients an hour, while the immunization and pediatric clinic probably saw even more (which is probably how they achieve their inspiring 98% vaccination coverage).  I also spent one day at two elderly care homes (for which Lauren tagged along), and another visiting an amazing, charming orphanage.  Unfortunately the day dedicated to school inspections was cancelled due to a manpower need in the Ministry of Health.  The dengue epidemic is underway and it’s shaping up to be a record-breaking year. 

To counter the surge the MOH has been organizing dengue awareness campaigns whereby health officials visit local sites and provide information regarding the disease and mosquito control. 

[Photo: Lauren talking with a manager of an elderly care home]

The second week rotation in ob/gyn found me at Mahamodara Hospital, just off the coastal highway linking Galle to Colombo.  The hospital itself was heavily damaged by the 2004 tsunami, leaving large parts of the facility abandoned.  It appears as though they are rebuilding it at the moment, but I’ve also heard some whispers of the entire hospital being relocated a distance inland and closer to Karapitiya.  Most my week was spent on the labor ward, where a dozen or so women on nearly bare cots with zero privacy would deliver the most beautiful little babies. 

Nothing quite like my experience back in the States.  Maternal mortality, however, is impressively low in Sri Lanka (39/100,000 - the lowest in the Asian region), no doubt thanks to the amazing public health system.  All women receive free care with regular visits at the community medicine antenatal clinics, with 99% having at least 1 prenatal visit during their pregnancy.  If there is any problem or concern the women are referred to Mahamodara for further investigations. 

[Photo: A gaggle of medical students gathering around for a breech twin delivery.]

This past week was spent on the medicine wards at Karapitiya, where I saw a cornucopia of various illness and diseases.  Cardiovascular diseases – myocardial infarctions, strokes, etc. – are quite common, as are diabetes mellitus (often with complications such as chronic kidney disease) and alcoholic liver disease.  Moving to the more rare and exotic, we had several dengue patients (thankfully none with the hemorrhagic form), a leptospirosis, one patient with miliary TB and a compression fracture of his vertebra due to Potts disease (TB infection of the spine), and even carpal tunnel (okay, so that’s not so exotic or exciting. 

But I found it interesting that classic carpal tunnel bought the guy an admission to a medicine ward). [Photo: Nurse at community antenatal health clinic.] The evenings here have been largely filled with working on the analysis and research papers (both for Lauren and myself), and on the weekends we put on our tourist hats (or sunglasses to be accurate) and engage in some very vigorous window shopping.  Sri Lanka is well known for its precious and semi-precious gems, chief among them the sapphire.  But as two doubly poor graduate students (both of us are simultaneously doing the MSc and are in grad school for a health profession – nursing for Lauren and medicine for me), we can’t actually afford to buy any of those pretty, shiny things.  Oh well, maybe next time! [slideshow]