An adventure I've had:When I was 20 years old, I enrolled in Sea Semester based out of Woods Hole, Massachusetts. A 12-week program in oceanography and sailing, I spent 12 weeks with 22 other students in an Outward Bound-like experience. The first 6 weeks were spent on land and classroom work, and the final 6 weeks were spent on a 125 foot schooner named "Westward" putting our classroom learnings to work, sailing the vessel and carrying out oceanography experiments.
The experience was one of the greatest of my life; I gained a great deal of confidence as we were given progressive responsibility for ship handling, and learning to live with 35 other people (students and crew) on a 125 foot sailboat for 6 weeks was a once in a lifetime experience. I met one of my best friends on the trip, and 21 years later the adventure still holds some of my fondest memories.
I have also done some sailing since, having logged a trans-Caribbean trip, a trans-Atlantic trip, and trips on the U.S. Eastern Seaboard, the Western Mediterranean, and Northern Caribbean. One of my recent trips:While it may sound old-fashioned, it is true that one of the reasons I went into medicine, and ultimately into emergency medicine, was because of a deep desire to help in the time of crisis. Following the Tsunami disaster of December 2004, I was one of hundreds (perhaps thousands) of Kaiser Permanente physicians and staff who were looking for ways to help those who were suffering in South East Asia.
I was fortunate that our organization supported a relief effort, and more fortunate still that my schedule, my group, and my family supported my participation. I traveled with 3 other physicians from the Northern California Permanente Medical Group to Sri Lanka for 4 weeks of relief work in early 2005. The experience was gratifying, frustrating, and life-affirming all at once. What follows are some of my 'blogs' that I sent home.
Musings from Sri Lanka.
First day in camps today (Feb 24th), our 3rd full day in Sri Lanka. Feels good to do something after kicking around and traveling since our arrival. The camps are purported to be winding down now, but one of the three we went to still had over 400 families. This particular camp is located at one of the local schools (which is thus closed until the displaced families are out, apparently to the duress of local officials who want to get school restarted). The camp is located within the Batticaloa city limits and seems particularly sad. There is a high percentage of families who lost one or more members, not simply displaced from their homes. In fact when I asked one woman with abdominal pain if she might be pregnant she gave me a sad laugh. I thought it might be because she was in her mid-40's, but then she told my interpreter her husband had been killed in the Tsunami.
The story was the same for so many people there including a 12 year-old girl who lost both her parents and a man who lost his entire family of seven. For many there is depression and alcoholism as a result. We saw over 140 patients in less than 2 hours between the four of us, about 35 patients each, less than 4 minutes/patient. The complaints are mostly straight forward, many coughs and musculoskeletal problems. "Tsunami cough" is a common complaint, some bronchospasm as a result of aspiration. For some it is real, for other's probably a somatization response to the tragedy they've suffered. Nearly everyone adds 'fever' to their list, though I didn't document any fever at all (documentation being a very loose term, since we don't actually write anything down except the prescription).
This is actually a bit of a problem since few people have any idea what they've previously been diagnosed with or previously treated with, but now it's an ongoing problem and I don't want to repeat the mistakes of the past. A few patients had elevated blood pressure which could use some intervention, but we are very limited in our ability to treat anything chronic since there is great concern about starting patients on medications when we don't have any follow-up. Consequently we refer all such patients to the 'clinics', though I'm dubious that they actually go. The same approach is used for truly ill patients, since again our arsenal of interventions are very limited.
The best part of the day was probably giving out toys. Many people donated stuff to me, and I gave out only a small portion today. Never enough, but at the first and third camps which were relatively small (and the medical quickly taken care of) we were able to give out good handfuls and then play with the kids, which they loved: jump ropes, paddle ball, frisbies and stuffed animals were all very popular. In fact this morning while we were waiting to get our disbursements of medications for the camps we broke out a frisbie and immediately had a crowd of about 10 people playing and another 20 curiously watching. I had a cousin who used to travel Europe frequently, and I always remember him telling me how he used a frisbie wherever he went to make instant friends.
Our schedule will be to work the camps on Tuesday, Thursday, and Saturday, rounds in the local hospital Wednesday and Friday, with Sunday generally off and Monday as a flex day. Needless to say, I'll know more about the hospital experience tomorrow.
I've felt the damage of the Tsunami much more than I've seen it, to this point. Nearly everyone you meet, even the taxi drivers in Colombo (the only truly large city in Sri Lanka, but on the Southwest side of the country and basically untouched by the waves) lost family or friends or at least know someone who did. More than 60,000 people confirmed dead so far, and they still expect the number to climb. Many more lost everything. The entire population is only 20 million. There is still a lot anxiety about the tsunami, and yesterday there was a rumor of a new wave coming which notched up everyone's fears. This is probably similar to hearing a plane overhead after being in New York for September 11th (an observation from Linda, one of my colleagues here who was in NYC for 9/11). Still, while I can see that we will be very busy for the few weeks that we are here, I believe the country is moving into a phase where the greatest need will be construction and construction financing. I'm watching people clear debris and build structures pretty much by hand, which will obviously be a slow process.
The people have been welcoming and appreciative of our efforts. They have a somewhat unnerving way of moving their head in a 'bobble head' manner while you talk to them that at first blush seems like a nod 'no', but in fact is more of 'OK'. Many of the women wear bright, colorful saris and parasols are common in the mid-day heat. The land is very beautiful, though with third world infrastructure people burn their trash daily leaving a lot of roadside debris and a regular output of smog (which blows clear of this island to impact the rest of us). Houses seem simple; cement slab flooring with run-off sinks and showers into drains that for the most part go to 'grey water'. I think many house have septic, though they get pumped and I'm not too certain where that goes. I'm told life expectancy here is in excess of 74 years, though I find that a little hard to believe; perhaps they exclude traumatic death, as the set up for injury seems high.
Roads are filled with bikes, scooters, motorcycles, motorized rickshaws, cars, buses, and trucks. Lanes are merely a suggestion, and everyone weaves in and out. Much of it looks like a video game with people zipping past on the right and left (in your lane), oncoming cars forcing you to the side, multiple 'vehicles' in the same lane, and all kinds of obstacles (including cows and elephants) jumping across your path at any time. It's not unusual to see 3 or 4 people riding on a motorcycle, often 2 kids, and if anyone has a helmet on, it's the adults. And I've not seen one bike helmet. Honestly, it's an organ donor's delight, though I would be surprised if they had much of a procurement program. If there were one program that might really be worth pursuing long-term, I think it might be a helmet-for-kids program.
I haven't seen too much of the island, but people here like to point out how close the land is to many descriptions of 'Eden'. Colombo was a busy, fairly crowded city that felt generally safe and relatively clean if not a bit unkempt. Flying in at night I was struck by the relatively low amount of light being generated by the city. Driving to Batticaloa we went into the mountains which were much lusher and were filled with many beautiful lakes and marsh patties. We have seen elephants, water buffalo, kites, and many other birds (and of course cows, dogs and other domestic animals). Batticaloa itself is a coastal city that is more or less an island, surrounded by lagoons. It is very pretty, especially along the waterways. The aforementioned trash is something of a blight, but just a little. Though the coastal homes were devastated, most of the city was actually physically unharmed. Houses are generally small and simple. Many have windows without any glass, but who needs glass with these temperatures? Even the hospital is mostly open. The weather is hot, but certainly tolerable. I'm getting used to it already, and I love tropical climates. Even during the afternoon peaks, it seems that if you are in large open spaces with good air flow, the shade is enough to make it very comfortable. The evenings, especially, are sultry and comfortable, perfect for sitting outside. So far the mosquitoes are not too bad.
Since I started writing this we've actually been to the hospital for a day and back to the camps. Tomorrow is a day off, so we're going to take a drive south to some other areas very hard hit by the disaster. I'm going to send this tonight, but I'll write more later. Hope you are all well. Thinking of everyone and glad that you are safe. I am, too.
jbw
1 March 2005
We took Sunday "off" and drove several hours south to visit an orphanage. This particular orphanage is for boys who were left without families as a result of the civil war here. Now they’ve been hit a second time with the loss of one of their ‘brothers’, 3 of their instructors (who gave their lives saving the boys), all their belongings and their home - 3 good sized buildings right on the beach. (By the way, they way, they estimate their losses at about $180,000 US, so I guess three large buildings on the beach doesn’t quite fetch the same prices as California). The director of the program showed us around, and he showed us where his wife’s family lost 4 members. Later he showed photo albums of his niece’s 14th birthday party from less than a year ago. It was unsettling, to say the least, but just one of so many tragic stories we hear daily.
Anyway, the drive down was quite dramatic as there was a tremendous amount of physical damage including felled bridges, damaged roads, upturned cemeteries, downed trees, and of course demolished homes. One thing I have noticed, however, that as much rubble and destruction exists, almost all of the clutter that I’ve seen in photos of the area immediately following the Tsunami seems to have been more or less cleaned up. Where it has gone I’m uncertain, because as I’ve mentioned they have no real sanitation system here.
Sunday night was the send-off dinner for Lali and Mary, the two physicians from the proceeding group who are now on their way back to Colombo and then back to the U.S. Lali actually grew up in Sri Lanka and trained in medicine here. She also dodged bullets in the streets due to the civil war. I know she had strong feelings about being able to participate in this project. Mary is another emergency physician from our organization and she had some great insights into what we can and cannot do during a project like this; the romantic notion that you’re going to swoop in and make dramatic changes (especially the mind-set of the emergency physician) and the reality that nothing is going to change overnight, that while the people here are generally accepting and appreciative of our offers of help, they have managed and would continue to manage without us, and that there is great power in touching a person, listening for a few minutes, coaxing a smile from a child and giving them some hope. In the long term perhaps we can affect some changes, though this will likely come about from our organizational efforts rather than one person.
Yesterday (Monday) was a day back in the camps. We saw about 150 patients in two camps. These camps were true ‘camps’, with tents set up for individual families. They’ve already been living like this for 2 months, and often there is no near term solution in sight. The government will not allow anyone to return or rebuild within 200 meters of the beach, but many are fisherman whose only livelihood exits in the ocean. Are they to be sent to resettle inland? For whatever reason we did seem to see a bit more pathology on Monday than previously: an ill infant who needed to go to the hospital and several patients who described fairly classic angina symptoms without a previous diagnosis. Despite those cases, however, most of the cases were coughs and colds, yet the work continues to be very gratifying.
Perhaps ironically, however, our work in the camps is going through a significant shift. The local health officials want to encourage people living near regular health clinics and hospitals to return to using those systems, and mobile clinics are more convenient. Since the population of the clinics has dwindled form more than 60 thousand to about 20 thousand now, the mobile clinics are being decentralized and will now only offer care at outlying camps. The process is being turned back over to the local Minister of Health (MOH). We spent today connecting with her and trying to confirm which camps we would now be covering, how we will obtain needed medications, and how we can obtain certain needed help (like nurses). The MOH was accepting of our offer of help, but things are not too well organized at this point, and we will probably spend some more time this week righting this ship. In the meantime I’m also working on a project handed over from the proceeding teams helping to get the hospital lab some much needed chemical reagents so that they can run some very routine tests they’ve been going without for a long time. This is an example of the long term impact we can and do have.
Over the weekend we also met a German pediatrician practicing in the UK. He came to the camps with us on Monday and some of us (yours truly included) will round with him tomorrow AM as he is established as an autonomous practitioner here despite his similarly short stay to ours. This is a nice ‘in’ to some of the hospital goings on and I’m looking forward to it. As I’m becoming more comfortable in the hospital, I might also wander down to the Emergency Department tomorrow. As I think I’ve mentioned before, the ED here does not function anything like an ED in the US, so my plan is to simply observe. Emergency Physicians sometimes jokingly refer to ourselves as ‘triage docs’ (and I suppose some of our non-Emergency MD brethren may think of us that way), but we actually manage a wide variety of ailments through complex courses. However, whereas a busy shift for me might be 2.5-3 patients an hour, here they routinely see 10 patients an hour or more (at least so I’m told). To a much greater extent they appear to be triaging a high volume of patients just to get them through. Hopefully I’ll know more tomorrow.
We are exploring around town a bit here and there. A fun way to get around is a three-wheeled motorized ‘rickshaw’. You can get to a destination several miles away for the equivalent of about 50 cents to $1.00. We went out to dinner the other night. Dinner for 5 with beverages for about 6 bucks – including tip! And it was really tasty, too.
Well the witching hour is fast approaching and I need to be on my toes for rounds tomorrow, so I’m going to turn in. Keep your eyes glued to your screens for more riveting reports!
Thinking of everyone back home,
Joshua
Batticaloa ‘Blog’ # 3 – 3 March 2005
Today was a nice day. I’m beginning to feel comfortable driving around (we’re being driven, as I wouldn’t dare try to get behind the wheel of a motor vehicle around here as I’m sure it’d be bumper car madness from the get go). I like the sights that are now becoming familiar – funky traffic, school children in waves on bicycles, street vendors, working cattle, strolling cattle, goats, dogs, shops, colorful clothing, and the daily bustle that is Batticaloa. We are still working on putting together the new phase of mobile clinics for the camps, so we are unable to go back until Saturday (hopefully). So today I rounded on the cardiac care ward, ICU, poison ward, and medicine ward – about 70 patients. The fascinating thing is that the attending for all of these wards is the same person – Dr. Vivekanandarajah (try saying that three times fast. Or even once slowly!) In the US each ward would have its own attending, often more than one (especially for larger wards like medicine).
Dr. V (much easier) has been at this hospital since the 1970’s. He says that in the 60’s it was actually a pretty good place to practice, with plenty of staffing and a new facility. However with the civil war it has been neglected and physician staffing gradually left. For a time he was the only physician for the entire hospital! Now he feels it’s about 40 years behind the times. Though it’s better now than a few years ago, it would still be much easier for him to practice in the capital (Colombo) or even in the UK. However he is so dedicated to the people of this area that he has stuck it out for all these years. To me he embodies what I would like to bring to the table as a physician and a person. I’m even told that officially he is retired, and yet he continues to practice. And trust me, it isn’t about the money.
And speaking of economics, I’m still trying to wrap my mind around that topic. I hung out for a bit in the emergency dept today, and the doctor there told me he makes the equivalent of about $250/month. They only get two days off/month – every other Sunday. Of course they only work 6 hour shifts so it still averages out to a 40 hr work week, but still….I’m told that if they want extra money they can pull some additional hours – for about $1.05/hour! And nurses make about 40% of that. Now I know the cost of living is much lower here than what I’m used to, but I always put things in terms of hours worked. Dinner at the local diner here goes for a little over a buck – so about 1 to 1.5 hrs work for the ED doctor. A nicer diner is $5-6, or a shift. Need a new 256 mb jump drive for your computer? That’s a week’s work. I have no idea how they afford the whole computer much less a house or a car? Of course people here are much less materialist than we are in the US.
I did watch a really tough case in the ED today: A women came in with really bad asthma and collapsed. The doctor intubated her (put a tube down her throat to take over her breathing), but they are not allowed to use paralytics in the ED here (only by anesthesiologist in the OR suite), drugs that carry some risk but greatly facilitate the intubation process. The procedure became difficult and there were some complications. Of course they didn’t have the correct tubing for the oxygen, so they cut off some nasal cannula tubing and stuck it down the endotracheal tubing. If you don’t understand much medicine, just take my word when I say this isn’t ideal and certainly not how they do it on “ER". Now they needed a chest x-ray, but their portable x-ray machine has been broken for several weeks, so they took her off all monitors and trucked her down to x-ray. By the way, they don’t have much by way of sheets here, so most people are laying on uncovered gurney pads which means no easy way of sliding them over – just lift and hope not to hurt your back (I’m guessing they don’t have much of a workman’s comp program).
Fortunately she was light. After x-ray she was taken on to the ICU. The x-ray didn’t show much except maybe the tube was in a bit too far. No one seemed to pull it back. While the team was getting her set on the ventilatory machine a nurse was manually ‘bagging’ her to breath for her. Again, I don’t expect that many of you reading this have too much medical background, but one of the effects of asthma is that it is hard to exhale – that is you have a prolonged expiratory phase during breathing. If inhalation takes you 1 second and exhalation takes you 3 seconds, than you’re not going to be able to breathe more than 15 times/min. Meanwhile the nurse is bagging her at a rate of about 30-45 times a minute, or ‘stacking breaths’. Sooner or later if you’re not careful in those situations the lungs overfill and can ‘pop’ (big complication).
So about this time the patient’s blood pressure dropped and her neck veins are filling up, probably due to venous congestion from increased thoracic pressure. I’m sitting on my hands just observing through all this because, after all, in this setting I’m not a practitioner. It’s also complicated because I’m not sure who’s who amongst the two physicians who are there. Are they interns, junior house officers, or senior house officers? Do they want advice or will I offend them? And the fact of the matter is I don’t really understand most of what’s being said, so maybe the doctors are ordering breathing treatments, sedatives, steroids, and some of the other medications that you might throw at someone in respiratory extremis.
Finally I just had to say something and suggested that maybe the nurse was bagging too fast. They told me it was ok, they would slow down the rate after she was on the vent. Fortunately her lungs did not appear to pop, they finally got her on the vent and slowed down her rate. Within a few minutes her blood pressure came back up and her neck veins went down. She still had a long way to go. They won’t be able to check blood gases (basic to managing people on ventilators) ‘cause the machine has been broken for several months, but I still think that there’s a good chance she’ll do ok.
Despite such difficulties and lack of what seems to me even the most basic resources, the staff here do seem to take quite good care of patients. And I guess compared to some places (like parts of Sudan where they don’t even have functioning hospitals, I’m told), what they have here is pretty good. It made me think a bit about the US, and how we like to think that nothing like that goes on in our country, yet I know that there are so many underprivileged areas that are probably ignored for the most part. Maybe they need to get hit by a natural disaster.
That’s the irony here, of course. Tons of resources are being brought in now. Maybe if they were here earlier fewer people would have died. No way of knowing, but people here speculate. Certainly over the years patients have suffered due to the hospital neglect. So the Tsunami was a bad thing, but clearly for the survivors and generations to follow, there is hope that things will be better. That’s why we’re here.
So that’s my news for today. Keep in touch. Keep in touch with each other. Be glad for the things you have (is it Cheryl Crowe who says “it’s not having what you want, it’s wanting what you have"?).
Best,
Joshua
You’ll be happy to know that the woman I reported on in the last installment was doing fine the next morning. She had been extubated (breathing tube removed from her throat) a few hours earlier, and was resting comfortably. She probably went home that afternoon. And by the way, they were checking blood gases Friday morning on their new blood gas machine right there in the ICU! Of course they don’t have the needles to draw properly, but they can get around that.
It occurs to me that I probably haven’t described the actual hospital much. The ICU consists of 5 beds, two in one room separated by a wall, and 3 in another room. Temperature is simply ambient, and remember it’s pretty hot here. Windows are open and flies are in and out. I don’t want to give the impression that it’s not clean because that’s not the case at all, it’s just not the hospital ‘cold sterile’ that we are accustomed to and that used to freak me out as a kid (probably still does as an adult, but just seems normal to me now). All the beds have monitoring equipment, but some of it is pieced together from various sources. Ventilators are available for intubated patients, but most of them are archaic and taped together in several places. The cardiac care unit and the poison ward are both 5 bed units without so much as a curtain separating the beds. Privacy isn’t the issue it is back home. The CCU at least has some temperature control, so it’s pretty comfortable. No TV’s anywhere, and I don’t see much reading material. Visiting hours are pretty restricted (primarily to meal times, Cathy observed, encouraging your family to feed you so the hospital doesn’t have to). I’m not sure what they do to keep entertained, but maybe that’s why they don’t have private room or curtains!
The medicine wards are large areas, about 30 beds each. There are some half walls separating the spaces into areas of 6-8 beds, but there is absolutely no privacy. Again, no temperature control except fans overhead and open windows. Ravens tend to alight on window sills and I’m not sure if that’s a good or a bad omen to have a raven watching over you during your illness.
Peds wards are similar, though the two wards encircle a courtyard with the interior of the wards completely open to the courtyard. If it were a hotel you’d love that open air tropical feel. Mosquito netting hangs over each cot, though at this time none is being used. There is a play area. Until recently the kids were restricted to one hour of playtime/day, but a visiting pediatrician convinced them to extend the time.
Meanwhile we’ve been working hard to reorganize our efforts in the camps now that the operations have been decentralized. I’m not sure if I mentioned the changes earlier, but the government efforts have now been turned back over to the local health ministries and there is some chaos associated with the reorganization – sort of a right hand isn’t sure what the left is doing. We spent much of the week arranging a supply of medications so we can continue to serve the camps. These meds were previously being supplied by BDHeaRT, which has been disbanded. BDHeaRT told us to go to the Minister of Health for further direction, but the MOH isn’t giving us much direction, and she tells us she’s waiting for BDHeaRT to give her meds. You get the picture. We did manage enough of a supply to return to the camps Saturday, and the people there were happy to see us.
One of the challenges there is a lack of record keeping. It’s a blessing if you’re seeing someone without a past history since you don’t have to write much down, but can be tough when a patient has a track record you’d like to know about. One older woman I saw told me she had been having a problem for several weeks. I asked her if she had been seen, and if she were on any meds. “Yes", she told me (via an interpreter), “I saw you last week". Oops! (I’ve only seen a few hundred patients). Now I’m back peddling, trying to remember what I thought was going on then, what I tried, and what else I might try now. Of course she couldn’t tell me what meds she was on, but I know what I usually do, so when I showed her some pills that I might have given her she confirmed that that was what she was taking. I figured she might be unhappy with our failure to make her better so far, but instead she seemed genuinely pleased that I was willing to try something different. I’m pretty confident that we’re on the right track, now (which isn’t to say I was on the wrong track before, just didn’t get to where I wanted to go!)
Meanwhile, we got some rain Saturday. In fact it is raining as I write. Rain in the tropics is always so refreshing – breaks the heat and the humidity. You don’t even mind getting wet. It doesn’t seem to last long, at least not this time of the year. But it is coming down in sheets right now with some good lightening, to boot. Come to think of it, I believe the raining season here ends in Dec. so they may not have had any rain since the Tsunami. The downpour is already abating, but I wonder how the camps are holding up? As if these people don’t have enough hardship already.
I’m remembering to look right-left-right now when crossing the street (they drive on the left), just another sign of the transition as I feel less like a stranger and more like a long term visitor. Oftentimes it feels like people know me, and since there are only a handful of white people here (despite all the foreign aid workers of the last few months), they probably do recognize me. There are even a few places we like to frequent, so we might be seen as regulars. Might be causing them to jack up their prices, but it’s nice to feel welcomed, so I don’t mind. I’m still not used to the heat, but I’m managing and at least I’m not getting too many mosquito bites!
More later. Take care.
jbw
Sri Lanka update # 5
The new team arrived Wednesday night which means this will likely be my last update. Hard to believe our time is up already. We spent Thursday in the camps, and Friday in the hospital, then a half day in the camps Saturday before starting a somewhat leisurely trek back to Colombo via Kandy (apparently on the list of 1000 places to see before you die) and ultimately 26 hours of flights home.
The arrival of the new team for me is reminiscent of the end of my internship (first) year of my residency; you really have no idea how much you’ve learned until you see yourself through a fresh set of eyes that is exactly where you were a short time ago. The members of the new team are looking at us expectedly and maybe slightly anxiously, and I know exactly how they feel. Two and a half weeks ago we were trying to glean as much info as possible from the outgoing team, hoping they could stay just a little longer to help us with the transition. It cannot be that we’ve learned much in our short time here, yet through the new people I can see just how far we have come.
This has been my first experience in relief medicine and I’ve learned a lot. Speaking with Dr. Vivekandarajah this morning, he talked about how bringing manpower for 6 months, or a year or even 2 years was well and good, but what about when we leave? Equipment is good, and it has helped. But what will be the long term impact? We are working on some projects that might help, now. Obtaining some new ultrasound equipment may be feasible, and bringing in someone to teach echocardiography would save them from having to routinely transfer patients to the capitol in Colombo, a 6-8 hour drive or more. Helping to install some computers and software for digital/on-line medical resources would add lasting value. These are some of the things we’re looking into now that the new team and those that follow will really work on.
So for me, the role has felt transitional. I am very happy to have been a part of the process, but I’ve likely gained more than I’ve given. I have been part of a cultural exchange that feels very positive. And I’ve gained some perspective that I’m still integrating and expect I will continue to do over the next few weeks as I dive right back into work, then take a trip with the kids down to Disney Land over spring break. We are a country of excess but I’m a part of it and it’s the life I live, have always lived, and will likely continue to live. And that’s really ok. I just hope I have many more opportunities abroad, but also at home, to help a little, lend a hand a little.
Wow, that’s some heavy stuff. Or at least so I’d like to think. We did get to take a little trip last week to Polonnurawa and Sigiriya, the ancient cities of Sri Lanka. Polonnurawa was the 2nd capitol of Sri Lanka, built during the 12th century and ultimately inhabited by ‘three great kings’ (per our guide) of the many that ruled who added and upgraded. The whole area was rich with agriculture because of an elaborate system of canals built that rivals the aqueducts of Rome. Sigiriya was built even earlier, around the 5th century, 400 acres of land with a mountain top palace fortress. I’ve not been to Machu Pichu, but have to imagine these sites rival any in the world. Climbing to the top was brutal due to the heat, but worth it. I was soaked in sweat, but got a chance to jump into a pool. The sad thing was that within a minute of being out of the pool I was sweating again. Oh well. It’s was nice to see other parts of the island that were so beautiful and in most ways spared by the Tsunami, though there has been great financial impact, as tourism is way down. It’s a long way to travel, but these places would be worth putting on a ‘to visit’ list.
On the down side, I had kind of hoped that this trip would be a good opportunity to lose a few pounds and even drop under 150. Alas the food has been plentiful and pretty good, and everyone is very hospitable. We are frequently invited into homes and offered drinks, and it’s difficult to find a diet soda around here. Of course it would be rude to refuse, so I’m picking up an extra thousand calories or so a day just being a good guest!
Unfortunately, as we are preparing to leave there has been increasing political unrest here. It’s not clear what this will mean for the future of this project or particularly for the people of Sri Lanka, and especially the North/East coast. I can only hope things work out.
Looking forward to touching bases with most of you from a local time zone.
Don’t know that correct spelling, but Tamil for good-bye (“I will go and return") is ‘poi-too-varum’, so that seems a good way to sign off!
Joshua
|
Travel Photos:
The Research Vessel Westward Trip Photos:
Clinic pharmacy 
More Tsunami destruction 
Children waiting for clinic 
Tsunami destruction 
Looking for lost family 
Making friends with the children in camp 
Examining a pediatric patient at camp 
The Batticaloa General Emergency Department 
Some of the camp children with toys we brought 
Having my palm read 
Batti General Peds Ward |
