In November 2012, four young second generation British Sri Lankan doctors travelled to Sri Lanka [6] to learn about healthcare issues on the island. The trip was part of International Alert’s diaspora project, which is funded by the British High Commission in Colombo [7]. During their trip, they met many interesting and inspirational people and returned to the UK having gained an understanding of the complex issues facing post-war Sri Lanka.
Here, Malathi Gunaratne (pictured below) shares her thoughts on the group’s journey as well as the next steps in continuing to engage the UK-Sri Lankan healthcare community and initiating projects in Sri Lanka.
Initially a group of strangers, the only things unifying us were the label ‘doctor’ and the fact that we all shared Sri Lankan heritage. It soon became evident that we all felt privileged to have been given this opportunity and that we had a common interest in Sri Lanka’s changing healthcare issues as well as a desire to see a peaceful future for Sri Lanka’s communities – one in which all would have a stake and which the diaspora could positively contribute towards.
Our eight-day visit took us to Galle, Jaffna, Batticaloa and Colombo. Hours on the road travelling between destinations gave us time to get to know each other. We discussed healthcare, politics and the deep-rooted ethnic tensions. Being of Sinhalese heritage, I was curious to find out the ‘Tamil take’ on the conflict between diaspora groups in the UK. I felt our group dynamic had developed into one which allowed frank discussion of our thoughts and opinions on the matter. The nature of our trip provided a rare neutral platform for the discussion of otherwise uncomfortable topics which are often avoided.
On the road
During our medical visits, being with Tamil group members made me acutely aware of how healthcare within a predominantly Sinhala region (e.g. Colombo or Galle) may be experienced by a Tamil patient. Small cultural insensitivities such as the omission of a Hindu statue next to a Buddhist one on a ward, often overlooked, could make the difference to a Tamil patient on their journey through the healthcare system. This would not be an issue if ill-health respected ethnic and geographic boundaries.
However, this is a very real problem for minority patients in a given community and is made worse when patients have to travel outside of their home areas to receive specialist care due to specialist services not being available across the island. For example, at the time of our visit, a patient with a neurosurgical or cardiothoracic problem in Jaffna would have to travel to the nearest centre able to provide this specialist care – in Kandy. Imagine a place where all the signs are in a language you cannot read, people are speaking a language you cannot understand, you are ill, vulnerable and afraid, and there is nothing familiar in the environment to comfort you. Although these patients are in the minority, it is our role as healthcare professionals to affirm worth and preserve the dignity of all of our patients.
Another healthcare area where this geographical divide poses a real problem is within mental health. A largely centralised mental health service means that vulnerable patients of all ethnicities with a mental health disorder may need to be treated as inpatients at large centres many miles from home. As such, they are removed from their families, friends and familiar en
vironment. This is particularly pertinent to Sri Lanka as a post-war nation, where exposure to conflict has made people more vulnerable to developing mental disorders.
Many other healthcare issues were highlighted to us during this trip. Some of these are problems specific to a post-war nation. Others are problems faced by a country undergoing rapid economic development and facing a transition from communicable to non-communicable or chronic health problems. For example, the stigma associated with mental illness, sexual health and sex education, and gender-based violence, can act as major barriers to accessing healthcare. The lack of training of allied health professionals whose role is paramount in the management of chronic disease was another recurring topic discussed in detail.
One thing became very clear to us from our discussions within our group as well as with those we met on our trip. There are many boundaries between the different ethnic groups that live in Sri Lanka and abroad, from where different ethnic groups live and where they socialise, to the language they are taught at school, the university they choose to go to and the people they feel comfortable having as friends. There are boundaries within people’s minds. Worse still, there is an undercurrent of apathy to breaking down these barriers. It is important to feel safe, accepted and included in society. Such feelings promote wellbeing. Health should be defined as the promotion of wellbeing and not the mere absence of disease. Bearing this in mind, the current situation cannot be good for the health and wellbeing of Sri Lankans.
Thankfully, there are forward-looking individuals and institutions that see the importance for Sri Lanka of developing inclusive processes. The Eastern University medical faculty [8] is leading the way as a medical school which has a more proportional mixture of Sinhala, Tamil and Muslim medical students, and teaches ‘Peace Medicine’ and ‘Conflict Resolution’ as part of its undergraduate curriculum. Also in the east, the Butterfly Peace Garden [9] is a charitable organisation that works in Batticaloa with children affected by the conflict in a way which promotes understanding and inclusiveness between different ethnic groups.
Sharing our experience with diaspora communities
In December 2012, we presented our main findings from the trip to individuals and institutions from the UK-Sri Lankan medical community and civil society. We also provided a forum to discuss how UK-based health professionals from the Tamil, Muslim, Sinhalese and Burgher communities can work together with each other and their colleagues in Sri Lanka to support positive health outcomes across the island.
The group discussed several tangible ideas for improving health outcomes and promoting reconciliation, including an exchange programme for British and Sri Lankan medical students, in partnership with medical faculties in Sri Lanka. The programme should encourage British Tamil students to spend part of their exchange in the south and west of Sri Lanka and British Sinhalese students to spend part of their exchange in the north and east.
We hope that by working together in this way, the group will also serve as a platform for dialogue and support the development of understanding between different Sri Lankan ethnic groups, both in Sri Lanka and here in the UK. As a member of diaspora, it is easy to feel disconnected from one’s ancestral home, to grapple with one’s identity and to feel a desperate desire to be able to relate to and give something back to the community at home. We all went to Sri Lanka not knowing what to expect and came back not only aware of the healthcare challenges facing Sri Lanka but enthused and excited about making a small difference.
The group is eager to engage as many healthcare professionals, associations and individuals as possible from across the diaspora communities. If you would like to get involved, please email Meera Chindooroy at mchindooroy@international-alert.org [10]
Find out more about International Alert's work in Sri Lanka here. [11]