Note arising out of very short visit by Arjuna Aluwihare to Menik Farm camps and Chetticulum and Vavuniya hospitals 29 and 20 September 2009

Arjuna Aluwihare, …… This memo was written by Professor Arjuna Aluwihare for his own edification — then in early October 2009. As befits a scholar he presents hi impressions within the proviso that it was short visit. I have taken the liberty of highlighting some sentences. Web Editor… see  ** at END for bio-note

1. I was very well received by Dr Jayasinghe, Dr Safras, and all other medical and other personnel. Drs Jayasinghe and Safras had arranged for my driver and me to stay at the IOM accommodation in Zone 0- and we were fell fed and watered! It was a pleasure also to meet many young graduates from various faculties who have recently come as medical officers to the camps. I need to stress we were very well looked after. I am grateful to the Secretary Health for arranging this visit.

2. Health related matters

I had seen the statistics and data collected and collated by the IDP centre and Dr Herath and his staff, and was amazed at their detail and the trouble taken to understand the problems and deal with them. Having seen the camps it is easier to appreciate how much very hard work is reflected in the tables he had. I had also read the poems written by Dr Terence de Silva.

 Tent City in Zonal Camps – pix from Island, 13 May 2009

The Health situation on the whole seems well under control with now many doctors and others as well, and using IDP’s who are health trained (e.g. Nurses, Pharmacists etc) to the maximum and others as translators etc. Counselling is needed but the challenge is (as recognized by the staff) to give quality and also work hoping the camps will be semi-permanent and transient (The Director was considering asking my sister whom he knows from his Amparai work (Dr Nikapota- whom I telephoned while there) to help arrange counsellor training if need be.). It seems necessary to remember city slums, Muslim IDP camps in the west of Sri Lanka, Tsunami displaced etc. Several people of the IDPs working before in the North East are doing same job including nurses, hospital staff of all kinds- they get their government salary (THIS IS EXCELLENT)- this is very much appreciated. Similar to that lots of work done by the camp inmates is what they used to do. The translation for doctors is by ‘volunteers’. There are many doctors now with a night doctor in most if not all camps with a nurse (staying in A/c rooms in a modified container which also may have the laboratory) and Emergency Treatment Unit facilities. Dr Jayasinghe and Dr Safras have done and are doing a very good job. In Zone 4 they used kids drawings to identify those needing help. In Zone 4 there are 30 orphans and 160 single kids- may be with parents elsewhere. Some of these were child soldiers- who are going for rehabilitation bit by bit. Zone 4 has old peoples’ home, orphanage, kid’s hostel etc.

There are surgical clinics once/wk in camps by rotation- they are hoping that an orthopaedic registrar will join this. The patients are referred to Vavuniya and now hopefully to Chetticulum. There are  Gynaecology and Obstetric clinics and Paediatric and Medical clinics with Consultants several times/wk.  The College of Obstetricians seems to have done a lot. Zone 2, 4 1 have hospitals with ETU and several beds. All Zones have several places with outpatient facilities and a doctor(s) like a family practitioner with medications, IV fluids, nebulizers and beds to use this. The Docs are there 830 am to 430 pm with lunch break; in zone 2 and 6 OPD and other zones there are several doctors. Basically there was said to be no shortage of medicines. Some of the hospital tents are very hot as no top level ventilation- but there are attempts to resolve this (the school buildings with open sides and cadjan roofs are much cooler!). There are some mobile health services as well in the big camps.

 Medics at work in a field hospital, early May – pix by Manori Unambuwe

Hospitals outside the camps: Vavuniya hospital has a very heavy work load. Most of the camp work seems orthopaedic and wound infection based and requires repeated surgery; the more complex work involves treating many mal-united fractures- for which the instruments and equipment are not yet available. While I was there one soldier came in with leg blown off by a land mine while clearing- he and two colleagues had also foreign bodies in their eyes. The Orthopaedic Surgeon sent them to A’pura- partly considering security and other problems, some of which might have been felt to be staff related, at Vavuniya. Later the same day a medical SR was arrested for allegedly helping to send LTTE patients to Colombo on transfer allegedly to help them escape. One such patient was said to have been arrested in CMB and made a statement to this effect.(Are there any fears about the impartiality of medical and other hospital staff- in particular about harming or not harming patients of any particular ethnic group or other category deliberately or by withholding medication/treatment?)

The Orthopaedic Surgeon at Vavuniya is hoping to get equipment from MSF to deal with the mal-united fractures-. He wishes ministry was more polite to staff (!)- His family is in Negombo. One new General surgeon was said to have already left the country from Vavuniya.

Chetticulum hospital has a new Operating Theatre and only one anaesthetist-  foreign at consultant level. There is a new General Surgeon whose 6 surgical beds are in the medical ward. The patients are 90% orthopaedic – the residue of wounds and fractures and pellets (and metal war residue); with much infection of bone and sinuses. They hope to treat more of the elective problems in the camps soon- they had planned a hernias list but did not get the patients in time.There is a plan to try to get an orthopaedic Senior Registrar to help. They do a weekly Thursday clinic in the camps on rotation and all patients from any camp are sent to this. Maternity patient transfer from camps to maternity ward is with a midwife- patients going a week early and staying 2/52 later (used to be go two weeks early and stay back 4 weeks- to reduce maternal mortality). It would be good if hospital patients, especially pregnant mothers could communicate with relatives in camps as to how they are and how is the new baby. There is generally no contact with family in the camp till the patient returns. Many mothers have to leave a young kid alone in camp even if there are relatives in Vavuniya or nearby.

The Medicine Sans Frontier hospital is behind the coordinating centre. It is well set up and I saw reasonable theatre facilities in twin tents with a capable surgeon and anaesthetist- but no jelly to lubricate catheter or do PR! They were kind enough to invite me in to watch and operation on a strangulated hernia. No good cooperation between this and the camps for reasons of medical politics. The MSF feel underused- but they get patients from around the area now as well. Their wards are large cadjaned tents like structures- well set out. The General surgeon and orthopaedic surgeon (young) and lady Obstetrician are all different nationalities (I presume some competent body is allowed to check the credentials of the foreign staff who operate on Sri Lankan Patients?). They may leave soon- it is a pity they feel they are not used to maximum- I can see they may not be able to or want to be strict about security, and may be used as escape conduit- is that a worry? Also they feel some of them have been a bit superior and arrogant.

Comment:  The Doctors are unanimous about desiring a quick release of IDPs to avoid recurrence of problems, and also on humanitarian grounds, and also favour family reunification. Some feel forces and government are dragging their feet- may be some powerful ones may oppose the President even!

The general health situation considering the magnitude of the problem seems to be good and I really feel all are trying to and are doing their best –locally and in Colombo! Government could well recognize that release and reunification of families even if within camps also will help health including nutrition. These camps may be better off physical health wise than some other areas of the country- but there is no free movement.

 3. General layout matters: The camps are very dusty (this is hardly surprising) and IDPs and the medical staff are really worried about flooding with the rains. The roads are higher than the ground with tents, and the drains are not very deep or extensive. So with a heavy shower it is likely that a shallow lake could develop between roads and the depth from road surface to drain bottom is greater than camp surface to drain bottom. This had happened with the last heavy showers.

Zone 2- has the fairly low ICRC tents with a family or two / tent. Very crowded and perhaps worst water queues at the pumps. The big hospital (which has walls, OPDs, male and female wards, ETU, laboratory etc.) is very hot as there was almost no ventilation-they are trying to improve this.

Zone 1 Tin sheds- a bedroom and outer room and kitchen behind. The toilets are outside -male and female separately. If it rains bad flooding is feared as here also roads are raised and thus basic earth level is lower. There are few drains cut.

Zone 4– This has the best hospital. This zone has most of the last people to leave with perhaps more high up LTTE cadres’ relatives; probably the richest camp. Banks have had a lot to do but several still have their gold and cash in bags.

Zone 0 Tin huts. Seemed less congested than Zone 2

There are lots of shops- sathosas, and small shops- selling everything (clothes, fruit, various kinds of food) but at higher price. I got a 500ml ginger beer for Rs 80. There are banks, a Keels, coin operated telephone booths.

Food- free fixed quantities but they have to cook now- there are fights over firewood. Some persons still get meals. I had a camp lunch. Rice and parippu and vegetable and and egg. The quantity was more than I wanted but less than for the usual Sri Lankan male

Vegetable- some IDPs are growing their own maize and greens etc (seen in Zones, 2, 1, 4 and 0)

There are schools in the camps but a shortage of teachers. Some kids are in school uniforms with UNICEF back packs. Several parents commented children have missed various public exams or the study for these (not just because of the camps but due the whole complex situation over the last many months before and after April.) Others have children in schools and/or university outside the camps- including SJP.

Water- very short, queues of bottles, they puncture pipes to get water in dug holes and then extract it; drink from dirty stream, drains contaminated with faeces, orderly queues with numbered bottles. About 20L/day for a tent for all purposes.

Showering/ bathing are very difficult- there is a shortage of places and water and privacy. The toilets are variable.

Tents- low; huts with tin roofs; cooking area at back.

In my very short visit there were no complaints of abuse of females or males or children by IDPs or forces.

There were several NGOs around. In particular in Zone 2 near the entrance where the checking goes on there was one with tents and the workers said they were there to befriend the IDPs (I presume someone checks on the credibility and history of these various NGOs?)

If there is a main ‘grouse’ it is related to the wish to be able to be with relatives or family and move around freely

4. Security and release matters

Relatives- it is very difficult to get relatives out or to meet or to communicate if one is in hosp even after a baby.

There are many Jaffna Tamils and displaced estate Tamils who came north in 1978 or 1983

There are LTTE people there but many of them and those with money have got out. There are said to be various illegal packages- delivery to Vavuniya hospital or to Colombo or to the airport. (Apparently airport was Rs700000, Vavuniya hospital is 100000?)  The CID is in mufti in camps and then LTTE identify these and then sometimes point out innocents for arrest on personal vendetta grounds alleging terrorist connections.

Lots of families have lost kids or others in shelling in bunkers and fighting, and taken by LTTE to fight, and killed by LTTE while trying to leave. IDPs say in last days untrained (including older kids) were given 3-5 days training and sent to fight. The stories many have to tell are really tragic.

The people are angry with LTTE and some with government anyway, but are generally pleased to be away from LTTE and fighting but are getting fed up with being locked in. Some are willing to go back even to basic facilities rather than being in the camp. There are land mines only in some areas and not in most (so IDPs say) as LTTE did not know where the army was coming from and also when retreating had no time to lay mines. Other issues they feel are- houses damaged and no infrastructure at or near home; there may be a fear of leaking information or of distorted talking to media or media distortion of what is said about the last part of the ‘war’; the government may be waiting for all hidden munitions to be found (should there be a public or there may already be a secret OFFER of a REWARD FOR INFORMATION ABOUT THESE CACHES?). (Comment by me -The so called International community has to establish its credibility in this situation by its willingness to look at all sides of the problem and also by tackling manifestations and links with the LTTE in various countries of this ‘International’ community. The Government also needs not to be paranoid, and like Don Quixote it must not ‘tilt at windmills’; parliament as a whole must depoliticise these issues.)

Release seems very slow- the checking and screening must be very difficult but one would hope maximum resources are available for this! Some expressed a fear that their reading of the available ‘forms’ to be filled suggested that if they were taken by their relatives who are in say Colombo or Kandy, then they have to forgo any compensation for damage to or loss of business or home that they might otherwise have got-            this NEEDS CHECKING and if it is a false rumour needs refuting (of which apparently there are many spread for various reasons- could be reduced with good newspapers, radio, TV centres I note the form in the newspapers of Tuesday 13^th inviting applications from relatives). Also some NGOs may not fund return to closer to home transits even (gated or ungated) not realising that IDPs may have to be near home to clean and rebuild homes/ businesses before reoccupying them.

The Chetticulum paediatrician has a sister and brother in two separate camps and can’t get them out (needs checking). There are families split up as well in several camps.

Doctors unanimous about quick release of IDPs to avoid recurrence and also on humanitarian grounds and also for family reunification. They feel forces and government are dragging their feet- may be sections within government even between the President and others opposing each other on this!

5. Final Comment made with humility especially about health/ food situation after a VERY SHORT visit

I think a lot has been done under very difficult circumstances – fighting, end of a war, residual terrorists, hot climate and now rains, chronic nutritional and other health problems, latent epidemics, resource shortages, mass movements of old, young pregnant, and mentally and physically injured peoples, unjustified, ill informed, and may be malicious criticisms (from inside and outside the country), etc etc. and many need to be complimented and feel pleased with what they have achieved (Sri Lankans and international helpers). This is not say there is not more to do!

***** ** Professor Arjuna Aluwihare, Emeritus Professor of Surgery at the University of
Peradeniya. Apart from an illustrious career as a surgeon, he has been
the Vice Chancellor of his University, Chairman of the University Grants
Commission, and Chairman of the Board of Study in Surgery of the
Postgraduate Institute of Medicine in Colombo, overseeing Surgical
Training in the whole country. He is Ex President of the National
Academy of Sciences of Sri Lanka, bears several prestigious fellowships
from Sri Lanka and abroad and has written widely inclduing a Chapter in
the recent Oxford Textbook of Surgery.

PLEASE TAKE NOTE OF THESE ESSAYS OVER THE YEARS IN THIS SITE

Michael Roberts,“Omanthai! Omanthai! Succour for the Tamil Thousands,” 9 August 2010,  http://thuppahis.com/2010/08/09/omanthai-omanthai-succour-for-the-tamil-thousands/

Michael Roberts, “Relief Work in Aid of Mothers and Babies among the IDPs in 2009: Myrna Setunga’s Reports to Her Donor Pals THEN in 2009,” 28 September 2012, http://thuppahis.com/2012/09/28/relief-work-in-aid-of-mothers-and-babies-among-the-idps-in-2009-myrna-setungas-reports-to-her-donor-pals-then-in-2009/

Myrna Setunga, “Vavuniya Adventure: Setunga I,” 15 May 2009, 15 May 2009, http://thuppahis.com/2012/09/28/vavuniya-adeventure-setunga-i-15-may-2009/

Myrna Setunga, “Second trip to Vavuniya, 1st June to 5th June 2009: Setunga II, circa. 6 June 2009,” http://thuppahis.com/2012/09/30/second-trip-to-vavuniya-1st-june-to-5th-june-2009-setunga-ii/#more-7193

Myrna Setunga, “Third Trip to Vavuniya, 11-13 June 2009, Setunga III,” http://thuppahis.com/2012/09/30/third-trip-to-vavuniya-11-13-june-2009setunga-iii/

Myrna Setunga, “Fourth Trip to Vavuniya, 8-12 July: Setunga IV,” 13 July 2009, http://thuppahis.com/wp-admin/post.php?post=7209&action=edit&message=6&postpost=v2

Myrna Setunga, “An Overview: Setunga V,” 2 July 2009 22 July 2009, http://thuppahis.com/2012/10/01/an-overview-setunga-v-22-july-2009/

Susiri Weerasekera, “Fitting Artificial Limbs for the IDPs and ex-Tigers, July 2009 to March 2010 —FINS at the frontline,” 23 September 2012, http://thuppahis.com/2012/09/23/7108/

Michael Roberts, “Mental Health Facilities for the Tamils at the IDP Camps and Now for Those Being Resettled … Reports from Manori Unambuwe,” 9 September 2011, http://thuppahis.com/2011/09/09/mental-health-facilities-for-the-tamils-at-the-idp-camps-and-now-for-those-being-resettled-%e2%80%a6-reports-from-manori-unambuwe/

Q and A, “From Tsunami Medical Logistics to IDP Camp Medical Aid, 2004-09; Q and A with Dr Herath,” 14 September2011, https://thuppahis.com/2011/09/14/from-tsunami-medical-logistics-to-idp-camp-medical-aid-2004-09-q-and-a-with-dr-herath/

ALSO Manori Unambuwe, “The Fallacy of Concentration Camps,” The Island, 3 May 2009,  http://www.island.lk/2009/05/03/features7.html