Sri Lanka’s Neglected Population

IMC's mobile clinics bring health care to those who need it most By Sonia Walia

In recent years, the coastal region of Trincomalee in eastern Sri Lanka has been buffeted by civil war and natural disaster. A long-standing conflict between the Liberation Tigers of Tamil Eelam (LTTE), the Sri Lankan Army, and the paramilitary group, Karuna, has created a persistent climate of fear and instability. The violence has driven thousands of people to abandon their villages and seek security in camps. When the tsunami struck the coast in December of 2004, thousands more were displaced. As the population struggled to recover, violence erupted once again, throwing the region’s recovery efforts into reverse.

Photo by Gareth Price-Jones

IMC staff register incoming patients at a mobile clinic set up at one of several shifting sites, all of them accessible to the displaced camps in Trincomalee.

The combination of violence and natural disaster has created a health care crisis. Trincomalee's camps are teeming with people crowded into tin barracks. Illnesses such as acute respiratory infection and diarrhea proliferate in the cramped, unsanitary conditions. Before International Medical Corps set up mobile clinics in Trincomalee, Sri Lanka, in November of 2006, there were only two doctors serving all of their needs; the conflict had prompted most qualified health professionals to flee the region for more stable working environments. The shortage meant that the doctors who remained were seeing as many as 150 patients a day; internationally accepted SPHERE standards for humanitarian relief recommend that doctors see no more than 50 patients per day.

Sri Lankans seeking medical treatment had to travel for up to four hours, passing through several military checkpoints, before reaching the nearest hospital. Once there, they waited for hours before being seen by a doctor, who was often too overburdened to provide more than a cursory one-minute exam.

Photo by Gareth Price-Jones

Dr. Mandula, a Sri Lankan doctor, and Dr. Jojo, an expatriate doctor, discuss the most effective drug regimen for one of their patients.

In Trincomalee's volatile environment, travel also carries with it the risk of abduction by armed men. Those who disappear may never be heard from again. With medical care such an inaccessible and dangerous proposition, many people stopped seeking it altogether. The result: numerous Sri Lankans have died en route to medical facilities. Some have been held up at checkpoints when they needed urgent medical care; others, too intimidated to make the journey, have delayed treatment until it was too late. It’s no coincidence that Trincomalee has the highest maternal mortality rate in the country.

When IMC launched a mobile clinic project in Trincomalee in November of 2006, thousands of displaced citizens gained safe, reliable access to medical care. Today, IMC operates two teams of health care professionals who set up clinics at various locations within easy walking distance of the camps. The location shifts daily: some days, IMC sets up in a school, fitting consultation times around the children’s classes. Other days, IMC takes over a bombed-out hospital. Pregnant women visit the clinics to receive antenatal care. Mothers bring their children when they are suffering with dysentery or acute respiratory infection. In addition to running clinics, IMC doctors support the few government staff still manning the hospitals, and provide health education to both medical professionals and community members. IMC helps deepen local doctors’ knowledge on subjects such as effective drug use, and offer basic health training to community volunteers, who can play a critical role in helping prevent the spread of disease.

Photo by Gareth Price-Jones.

Trained dispensers issue medications and explain drug regimens to patients.

The danger now for these people is that funding for IMC’s mobile clinics ends in September. Without IMC’s mobile clinics, many people would probably forego medical care altogether, rather than endure the military checkpoints, the endless waits, the risk of abduction. Left untreated, curable ailments such as diarrhea and acute respiratory infections can become fatal. If the residents of these camps are left once again with one functioning hospital and two overworked doctors, eminently treatable illnesses will go untreated, and inevitably, lives that could easily have been saved will be lost.

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