2004 Tsunami Opens Door to a Decade of Collaboration in Sri Lanka

Rubber_Tapper

Rubber tapper on Watawala Rubber Plantation in Galle, Sri Lanka. Photo by Kayla Stankevitz.

Published February 10, 2015, last updated on March 25, 2015 under Research News

As Duke Global Health Institute (DGHI) faculty and students reflect on the 10-year anniversary of the tsunami that obliterated coastal areas of Sri Lanka, they can take comfort in all that has come from the collaboration with colleagues at the University of Ruhuna, located in the southern city of Galle. 

That partnership, begun during the relief phase following the tsunami, has resulted in numerous joint faculty research projects and publications, and Sri Lanka has proven to be a fruitful research and education location for DGHI masters students as well as medical students, residents and doctoral scholars. In addition, two Sri Lankan post-doctoral scholars have spent a year each at Duke, working with colleagues here on their research.

Duke’s Response Focused on Research and Education Collaboration

As the devastation wrought by the tsunami caught the world’s attention, Victor Dzau, then-chancellor of Duke Medicine, led a fundraising effort and gathered colleagues to formulate Duke’s response. According to DGHI professor Chris Woods, the team quickly determined that the best way to contribute to the rebuilding in Sri Lanka was to establish research and education collaborations focused on projects of interest to peers there. 

Woods and DGHI professor Truls Ostbye traveled to Galle and conducted a needs assessment of the University of Ruhuna’s research capacity and interests. Based on this assessment, they suggested a number of joint projects, including research about how a large referral hospital in the area where the tsunami hit recovers from a disaster of this magnitude, health of teens and the elderly, occupational health of vulnerable workers and an evaluation of the causes of febrile illness. 

Education for the purposes of capacity building has led to bi-directional exchanges of faculty and students at all levels. The robust nature of DGHI’s partnership with the University of Ruhuna has made Sri Lanka one of the institute’s Priority Partnership Locations

“We’ve been able to do a lot with limited resources,” said Ostbye. “This is a reflection of the interest and energy of our partners at Ruhuna.”

Woods has been impressed with how the country has rebounded since the tsunami. “It has been remarkable, and I feel privileged to be in a position to witness the progress Sri Lanka has made since the tsunami,” said Woods. “We continue to collaborate with our colleagues there and that will ultimately pay a significant health dividend in that country.”

Sri Lankan Global Health Fellow Returns to Homeland to Research Flu and Antibiotic Use

Back in 2004, native Sri Lankan Gayani Tillekeratne had no idea that her homeland would draw her back in ways that continue to shape her career as a physician and researcher. The day the tsunami struck Sri Lanka, Tillekeratne was a Duke medical student at home in Ohio celebrating the holidays. She remembers feeling powerless to help, but upon returning to campus, she helped send medical supplies and equipment to Sri Lanka, in an effort spearheaded by another Sri Lankan medical student.

Fast forward a decade—during which Tillekeratne completed medical school—to today. As an alumna of DGHI’s master of science in global health program, she’s wrapping up her global health fellowship and working as an infectious disease physician at the Veterans Administration Hospital in Durham. 

“I came back to Durham because of the global health fellowship and master’s program,” she said. Her master’s research in 2013 took her to Sri Lanka, where, under the guidance of Chris Woods, she spent a year researching fever, patterns of influenza, and antibiotic use and antimicrobial resistance at Teaching Hospital Karapitiya, the 1,500-bed hospital affiliated with Ruhuna Medical Faculty. She continues that work today, motivated by the fact that inappropriate antibiotic use has become a major global health concern.

Tillekeratne was in Sri Lanka this past December and witnessed some of the tsunami tenth anniversary observances. “It’s amazing that the country has rebounded and rebuilt to this extent,” she said. 

Tillekeratne will give a lecture on antibiotic resistance this Thursday, February 12.

Research Partners Make Significant Impact on Rubber Tapping Community

Ten years after Duke faculty arrived in Sri Lanka to explore ways to offer relief following the tsunami, students Kayla Stankevitz, a DGHI master’s student, and Hemajith Tharindra, a master’s student at the University of Ruhuna, are wrapping up a joint research project as part of the twinning program between DGHI and Ruhuna, which pairs students and faculty mentors from both institutions. 

Under the mentorship of Vijitha DeSilva at Ruhuna, Ostbye at DGHI and Ashley Schoenfisch in Occupational and Environmental Health at Duke, Stankevitz and Tharinda conducted first-of-its-kind research of Sri Lankan rubber tappers from August to December of last year. Nearly one-third of Sri Lankans worked in agriculture in 2014, and rubber is one of Sri Lanka’s top three exports. 

Stankevitz used her biomedical engineering background to look at the musculoskeletal issues faced by the rubber tappers as a result of the lack of eye protection and even shoes, carrying heavy buckets of natural latex on their head, using sharp knives to make cuts in up to 600 trees each day, and working in rough, snake-infested terrain. 

Tharinda, who has a background in counseling as well as peace and development studies, focused his research on the rubber tappers’ psychosocial condition. In addition to harsh working conditions, rubber tappers also endure long periods of unemployment and poverty during Sri Lanka’s rainy season, which is not conducive to rubber tapping. 

Together, Stankevitz and Tharinda developed an extensive questionnaire and worked with plantation owners to engage with the workers. The plantation owners granted broad access to the student researchers because they had a vested interest in preventing injury and lost work days. In addition, says Stankevitz, “Owners see their plantation as a community and are interested in improving the health of their workers.” The owners also have had limited resources to implement health and safety measures, according to Tharindra.

The students are in the midst of analyzing their data, which reflects interviews with 300 rubber tappers, and they hope to publish two joint papers as a result of their work together. Both recognize how their contributions to the project are highly complementary: “Hemamjith is an expert in all things Sri Lanka and has many contacts that proved helpful,” said Stankevitz. “Having a research partner who could also manage the day-to-day logistics was invaluable.” Tharinda echoes her enthusiasm: “Kayla’s expertise in data collection and analysis helped make the project possible.”

Initial results from their research project are not surprising: Sri Lanka’s rubber tappers experience a high rate of injury and mental duress. Their research led to a number of recommendations that have been embraced by the two large plantations where their research took place:

  • At Tharinda’s suggestion and under his direction, plantation owners are establishing on-site first aid programs. 
  • Tharinda worked with local organizations to provide eye screening and eye glasses to some of the workers. 
  • A program is being developed to teach the workers to save money to alleviate the poverty they experience during periods of unemployment. 
  • Plantation owners are landscaping their grounds better in order to prevent injury and rid the properties of pests. 

Stankevitz and Tharinda also recommend greater government oversight of working conditions and worker health, especially on privately owned plantations. Sri Lanka’s equivalent of the U.S. Occupational Safety and Health Administration doesn’t provide oversight of plantations, and they believe that it should. 

The research project garnered a lot of local attention, so much so that Stankevitz was a featured speaker at the annual plantation owners meeting in Galle recently. And owners of plantations with other major agricultural products have been requesting additional research on workers and working conditions. 

View Stankevitz’s and Tharinda’s recent presentation on their work at DGHI.

Learn more about DGHI’s work in Sri Lanka.

We’ve been able to do a lot with limited resources. This is a reflection of the interest and energy of our partners at Ruhuna.

Truls Ostbye, DGHI professor

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