In my third week at Karapitiya Hospital I was introduced to Dr. Kumara, senior lecturer in Surgery. Participating in various surgical cases was what I was most looking forward to on my rotation in Sri Lanka. Walking into the OT I noticed it was quite a different set up from the operating rooms back in the states. Patients were lined up on a bench right outside of the open theater doors with their medical chart in hand.
Death and dying are never easy to deal with as a physician. However, that process is different in Africa. Morbidity and mortality are more commonplace and seem to be accepted. Religion is pervasive in all aspects of healthcare: the Wednesday morning chapel service, the preoperative prayers, and the prayers after meetings.
In my third week at Karapitiya Hospital I was introduced to Dr. Kumara, senior lecturer in Surgery. Participating in various surgical cases was what I was most looking forward to on my rotation in Sri Lanka. Walking into the OT I noticed it was quite a different set up from the operating rooms back in the states. Patients were lined up on a bench right outside of the open theater doors with their medical chart in hand. Some patients were even curious enough to stand and watch the ongoing procedures from the doorway. On the other side of the patient bench was a make-shift PACU where the post-operative patients were still coming out of their anesthesia. Inside the operating theater, there were multiple procedures going on at the same time. In one corner of the room, a woman was having a lumpectomy under local anesthesia. In the center of the room, a man was under general anesthesia having an open cholecystectomy. Finally, off to the side of the room a woman was getting a carpal tunnel release.
I wasn’t sure what to expect when I arrived at Mahamodara Maternity Hospital. The tuk tuk dropped us off outside of what appeared to be fortress walls. We were met by our Duke coordinator and led through the gate, past a building that was in disrepair and dilapidated. We traversed through a labyrinth of crumbling plaster and boarded up windows. There was a smell of mildew lingering in the air. I thought to myself, “Women come here to give birth”? Once we rounded a corner, I noticed an area to my right which looked as if it should have been full of expectant women, but was eerily vacant. It was then I realized what I was seeing was the shell of the Mahamodara which stood during the 2004 tsunami. I stared into the ward, and could imagine this area full of pregnant women and newborns on that day, and could almost feel their terror. I was told the hospital was hit by 3 waves. The first wave destroyed the “fortress” walls that I had seen earlier, but these barriers had lessened the impact to the building. It flooded the first level and knocked out the electricity. The doctors and staff evacuated the mothers and infants, some to higher ground, and others to Karapitiya Hospital. The second wave was estimated between 20-30 feet high. There are many stories of heroic men and women from that day, including one physician who calmly completed a Cesarean section by flashlight after the first wave hit. He then safely evacuated the mother and child. Due to lack of funds to demolish the building, it now stands as a temporary memorial.

Huffington Post

POSTED ON FEBRUARY 3, 2012, AT 9:47 AM

This post is part of a series on childhood poverty in the United States in partnership with Save the Children and Julianne Moore. Moore leads the organization’s Valentine’s Day campaign, through which cards are sold to support the fight against poverty in the U.S. To learn more or to purchase the cards, click here.

More than one in five American children lives in poverty. In my home state Tennessee it is an astounding one in four.

And it’s only getting worse. Less than four years ago, the national number was one in six children. Childhood poverty has increased 18% since 2000, as 2.5 million more children live in poverty today. But those are just cold, hard numbers. It’s what happens to kids who happen to be born into poverty that matters.

Childhood poverty does not just mean a family of four makes below $23,050 a year (it’s estimated that a family needs over twice that income to actually meet basic needs). No, childhood poverty limits access to the simplest, most basic things such as healthy foods, books, the Internet, and a secure place to play, exercise, or even sleep.

It means poor children,nearly half of whom are overweight, grow up with worse health.

It means at the age of four, poor children are already 18 months behind developmentally.

It means without early education programs, poorer children struggle and are 25% more likely to drop out of high school.

It means they are more likely to become teen parents, commit a violent crime, and be unemployed as adults.

It is a sad fact that at birth, one in five Americans today is well behind in the pursuit of happiness. The evidence increasingly points to the fact that once a child falls behind in the crucial early years, they may never catch up.

As a doctor, I focus on the devastating, long-lasting impact poverty has on a child’s health. Simply put, on average, the lower on the “socio-economic ladder” a child falls, the shorter life he will live. Americans in the lowest income category are more than three times more likely to die before the age of 65 than those in the highest income bracket.

For a child, a healthy body, a strong heart, normal development, and progressive learning all require adequate and balanced nutrition. But poor families too often don’t have access to nearby, affordable healthy foods. This stands as a major reason that debilitating chronic conditions like obesity and diabetes disproportionately afflict these impoverished youths.

“Food deserts” are those all too frequent regions of a city or rural areas, wherever poverty may exist, where affordable, healthy, fresh and nutritious foods are nowhere to be found. A 2011 Food Trust Report found that nearly one million Tennesseans, including 200,000 children, live in communities underserved by healthy food-providing supermarkets.

Across America 23.5 million live in areas that lack stores selling affordable, nutritious food. Without access to healthy foods, the cheap, fried, over-processed foods that accelerate the path to obesity become the mainstay diet. And the cause of early death.

This can be fixed. And an effective way to do so is for enterprising grocery retailers to partner with others in the private sector.

For example, just this year the Partnership for a Healthier America secured commitments from seven leading grocery companies to build new stores in areas where they’re needed most. All told, these commitments will bring fresh, affordable foods to ten million people!

Calhoun Enterprises alone will be building ten new stores in Alabama and Tennessee, creating 500 new jobs while figuratively bringing water to these deserts. And forward-thinking companies are increasingly learning that such “social partnering” not only helps the health and welfare of millions of Americans, but it also improves their own bottom lines.

And our government can also be a lot smarter. For many impoverished children, the majority of their meals, breakfast, lunch and even an afternoon snack, come from their schools. In 2010, almost half of all Tennessee students received government-subsidized school lunches. However, for longer life and better learning, we as tax-paying parents and citizens must insist on trading out pizza and tater tots for more whole grains, fresh fruit and vegetables.

Tennessee has recently started on this process. In June of last year, Tennessee, along with Kentucky and Illinois, joined a USDA pilot program for the “Community Eligibility Option,” allowing kids in low-income areas to skip the applications and red tape and receive the benefits of a free, healthy breakfast and lunch at their schools.

Nationally, last month the Obama administration overhauled the school lunch program for the first time in 15 years. Overall the menu will include items with less sodium, more whole grains and a greater selection of fruits and vegetables. Don’t worry, pizza will still be on the menu, but made with better ingredients.

Partnerships that focus on health and nutrition between the public and private sector, and between faith-based and secular nonprofits, will help lift children from the dire consequences of poverty.

America is the wealthiest nation in the world. The most technologically advanced. The most generous and accepting. We are the fastest car on the fastest track. We cannot afford to leave more than a fifth of our children behind.

We arrived on the pediatrics ward this Monday, a little less naive and much less shell-shocked. I had grown accustomed to hearing only the whirring of ceiling fans, barking dogs, and the quiet chatter of Sinhalese in place of the traditional mind-numbing beeps and alarms of our medical equipment. I was pleased to see protective screening over the open air hallways, to keep the children from tumbling two stories, and to keep out the birds. It was surprising to see the number of children waiting to be evaluated for possible admission. Nearly all the beds were full, and it seemed as though they were in the habit of converting previous storage closets, consultant lounges, and any available space into treatment areas. The need for even more space remains evident.
We arrived safely in Nairobi and stayed at the Mennonite Guest House. The next morning we ate breakfast with missionaries from all over the world in different stages of their calling around Africa. Kijabe’s reputation is well known and they wished as well as we were picked up and driven to Kijabe via a road that had terrible slums juxtaposed with sweeping views of the Rift Valley.
I had plenty of time to contemplate all that I had seen during 12 hours of travel back home from a medical mission trip to Georgetown, Guyana. I had just spent three weeks working in the Accident & Emergency (A&E) department at Georgetown Public Hospital and using my training as an Emergency Medicine resident in the United States to help teach new ER doctors core material such as EKG reading, airway management, and the approach to shortness of breath and chest pain. I had not realized when I arrived how much of my time would be dedicated to sitting in the metaphorical trenches and caring directly for patients coming to the A&E. I was prepared for a foreign experience in a distant land, but instead I found myself right in my element.
We arrived on the pediatrics ward this Monday, a little less naive and much less shell-shocked. I had grown accustomed to hearing only the whirring of ceiling fans, barking dogs, and the quiet chatter of Sinhalese in place of the traditional mind-numbing beeps and alarms of our medical equipment. I was pleased to see protective screening over the open air hallways, to keep the children from tumbling two stories, and to keep out the birds. It was surprising to see the number of children waiting to be evaluated for possible admission. Nearly all the beds were full, and it seemed as though they were in the habit of converting previous storage closets, consultant lounges, and any available space into treatment areas. The need for even more space remains evident.

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