Friday, July 23, 2010

Layover in Doha

When I was on my way back from Colombo to London via Qatar, I had a lot of questions concerning the stopover there, most of which I was unable to find answers to online. So now that I've done it, I'm putting a bit of what I learned out there so hopefully others will be helped in the future.

I flew, not surprisingly, Qatar Airways, which was a reasonably nice airline. On the way over I had a very short connection, but they not only held the plane when we were late but managed to get my luggage transferred.

On the way back I had almost 6 hours on the layover, so I debated trying to go out and see some of Doha. The rule is that if your layover is 8 hours or more, Qatar Airways will sponsor a visa for you, otherwise you have to buy one. The good news is that it's extremely easy and fast to buy one (at least with a US passport) -- you can pay with your credit card, and it's only US$28. I had read online that the airport in Doha is awful and you shouldn't spend any time there - it's not THAT bad... I've definitely seen worse. The ground floor is a huge duty free store with everything you could imagine, and there is a pretty pathetic food court upstairs.

But then again, the airport is 10 minutes from the city center, so there's no real reason not to leave. My plan was to take a taxi to the Sheraton, which is at the far end of the Corniche (the walkway next to the ocean that everyone advises you to walk down as part of your tour) and to walk back. The taxi was easy to get and cost me 30 riyals. However, I feel compelled to say that the walk back was not the best use of my time, despite being the number one attraction all guidebooks and other tourists told me to see. The end near the Sheraton has some big and modern buildings (much like the other big Middle Eastern cities), and there are a few things to see here and there, mostly a reasonable - if smoggy - view of the skyline, but it's a long walk and Qatar is hot. I mean at 7 am on a July morning, it was probably above 100 degrees already... so it took me a long time to walk, there's not much water available, and I ended up exhausted.

I walked as far as the pearl monument and dhow harbor, which I suppose are nice for a photograph, but I think I would recommend that you start there and forget about the rest of the Corniche. From here it's a short walk to the Souk Waqif, a big winding market that has been restored so it's in really good condition but looks old (I mean it IS old, and they've been careful to retain the old style despite the renovations). It's a good place to see Qataris in traditional dress and lots of shops stuffed full of all kinds of miscellany.

It can be difficult to find a taxi back to the airport - I managed to find one on the street and I was told there is a taxi stand somewhere around the souk. I actually ended up going back to the airport early because I was dangerously close to heatstroke, and the airport is blissfully air conditioned. Getting back in through security and customs was quick, so there was definitely no problem with my plan of visiting the city even with such a relatively short layover.

For what it's worth, I am a woman and was traveling alone, and not only were there no touts or anyone to harass me as a tourist, but I didn't feel any more danger as a woman than I do in any developed country. People generally left me alone.

At the end of the day, I found the part of Doha I saw to be relatively characterless and not particularly attractive, though the souk was kind of nice, and I was interested by all the people dressed in traditional costume (and tried not to be upset by the women with nothing but their eyeballs showing), though in fairness you can see this at the airport too. Who can say if I'd have a different opinion if I had a longer layover or was there at a different time of day, but for now my recommendation is that you might as well go into town if you have a 5 or 6 hour layover (or longer) but I certainly wouldn't pick Qatar as my primary vacation destination.

Tuesday, July 20, 2010

Sri Lanka - A little bit of culture

If you haven’t given up on me by now, I’d like to take this opportunity to tell you a little about the fun side of my trip to Sri Lanka. First of all as a brief overview (I promise, no politics or health care), Sri Lanka is a truly tropical island, with lush greenery, extensive rice paddies, plants with humongous leaves, and giant insects all through the south and coastal areas. The north is more of a desert, with craggy rock formations, and then there is the “hill country,” where the famous Ceylon tea comes from. There are plenty of birds and monkeys, iguanas and geckos, multiple species of sea turtles and whales, plus a few cows wandering the streets. The Sri Lankan people are extremely friendly and welcoming, though it’s an interesting dynamic, as the country is significantly more developed than its large neighbor India, but yet in many ways still developing – this translates to some people still being quite friendly and open, but more people being a bit more cautious. However, when people do open up and decide to care about you, you are shown no end of generosity. Actually one of the things that most impressed me about Sri Lankans is the family structure and how they are so close and look out for each other. Almost never did I see a patient in the hospital without a family member by his side 24 hours a day, sleeping in a chair next to the bed, feeding him and changing his dressings. And of course in my own personal experience I was hosted by the parents of a friend, and although they had absolutely no obligation and had only met me once before, they treated me like their own daughter, and I felt incredibly welcome. In fact, many people I’ve met here – once they have had a chance to get to know me a little – have been overwhelmingly caring and warm.

But back to the sightseeing… the north of the country is still off limits to foreigners, but as far north as you can go you find the Cultural Triangle, a series of ancient cities that were former capitals of Sri Lanka and have more Buddha statues than you can shake a stick at. Probably the crown jewel is Sigiriya, a huge rock (which interestingly is actually the lava core of an ancient volcano, but the volcano part eroded away, leaving this giant rock in the middle of the plain) that you climb and climb to reach ancient cave paintings that are quite well preserved and an ancient meditation center with great views. Nearby Anuradhapura is a whole complex of temples and statues and palaces – this is where the annual Poson festival took place, when thousands of white-clad Buddhist pilgrims flocked from all over the country with lotus flowers in hand. Dambulla completes the part of the Triangle that I saw. This one is a bunch of caves with giant carved Buddha statues, much like some of the caves I saw in China, although these ones mostly have painted statues. All in all, they were pretty impressive sites and worth the steep entrance fees.

The other place that absolutely everyone hypes up is Kandy, Sri Lanka’s “second city.” Well, I must say that for me it didn’t live up to the hype. To my eye it was a rather congested, smoggy city with a fair number of tourists (relatively speaking) and a fair amount of hassle. There is a nice lake, and the claim to fame is the Temple of the Tooth – which supposedly houses, inside a very large series of golden boxes, the canine of the Buddha himself, salvaged from the funeral pyre. You can’t see it, but you take it on faith that it’s there. Plus Kandy is famous for its dancers, whose costumes are lovely but the dancing itself either isn’t very special or they don’t make much of an effort for tourists.

Around Kandy there is a “Temple Loop” of three temples built in the surrounding hills. The temples themselves aren’t much to write home about, but it’s a pleasant enough walk, and I had the pleasure of meeting a lovely local family who took me back to their nearby home for tea. Their house was a plywood shack with a tin roof, no electricity and the kind of kitchen that we were warned is a major worldwide cause of COPD (due to the smoke it fills the house with). As I sat there in their only chair I noticed a big bunch of red bananas on a tree nearby, and I mentioned that we don’t have those in America – only yellow bananas. To which my host said “you want banana?” which I took to mean she would take one off the bunch and give it to me to eat, so I said ok. Next thing I know, her brother has come with a machete and chopped the whole tree down, and they start piling this bunch of bananas – there must have been 50 of them – into a bag, and she says to me “you take banana to America” with a big smile. I can’t tell you how touched I was by this gesture, and it almost broke my heart to have to tell her that first of all, I can’t bring bananas into America, and second, I can’t carry 50 bananas around for the next week in my backpack. I don’t think she quite understood, but I took about 10 of them, and I’m sure they made good use of the rest.

From Kandy I made my way to Ella via a very long and significantly delayed train ride that had stunning views of the miles and miles of tea plantations in the hills. The train reaches 2000 meters in altitude, which is pretty high, especially when you consider you are essentially starting from sea level. Ella is a super-relaxed, backpacker hangout, but due to my short vacation time and the delay of my train, I wasn’t able to do any of the walks in the surrounding hills that I had wanted to do. Instead I treated myself to a full Ayurvedic treatment in the spa there, of which the most surprisingly wonderful part was a steam bath in which you lie down completely naked in what looks like a medieval torture device/casket, with only your head sticking out the end. When they closed the lid on me, I just about had a panic attack, and I am not a claustrophobic person. They then proceed to steam you like a brussels sprout for half an hour until you beg for mercy. In fairness, the first 15 minutes or so were pure bliss – it felt like my body disappeared and just my head was left, and I thought I could stay there forever. And then I started to really sweat, and I started thinking about how I was becoming hypovolemic and vasodilated and was going to pass out when I got up (ah, the joys of studying medicine), and eventually I got overheated and asked to be let out, at which point I got dizzy and was offered a glass of tap water, which I luckily asked about the source of before drinking. The evening concluded with shiro dhara, the pouring of hot oil on your forehead, which also sounds like a method of torture and is also amazingly blissful and highly recommended. It sounds weird, and you smell like a coconut for about three days afterwards, but is well worth it.

So much for Ella, as the next morning I set off for the southern coast, where I stopped at the beach town of Mirissa for a few days. Mirissa is quite underdeveloped, with a few guesthouses and about two little restaurants on the beach, and it is so quiet and peaceful and gorgeous and wonderful… not a single tout wandering the beach trying to sell you anything or bother you. So you sit on the sand, swim in the ocean, and generally enjoy the atmosphere of relaxation. I would recommend it if you are looking for something a little less commercial than a standard package beach holiday.

From there I went to Unawatuna, just to see what all the fuss is about, and what I found was exactly what Mirissa is not – a totally built up beach with so many guesthouses and restaurants and touts and taxi drivers that there is not a moment of peace. But it’s great if you want to just hang out in a resort with tons of other tourists. Unawatuna is right next to Galle, where the claim to fame is an old Portuguese fort with the walls still intact and winding little alleyways inside the fort. I found it to be much less charming than expected, and ended up spending most of the afternoon chatting with a British medical student I happened to meet there. Not that Galle isn’t worth a visit, but I wouldn’t have spent a lot of time there.

Lastly I stopped by Kosgoda to visit the turtle hatcheries. Six different species of sea turtles live in the waters off Sri Lanka’s coast, and they have largely become endangered due to both animal and human predators, who take the eggs off the beach to eat them. Due to joint efforts of foreign and Sri Lankan volunteers, several hatcheries have sprung up where they collect the eggs off the beach, very carefully incubate them in sand piles, and then keep the babies for three days (until their shells close up entirely – turtles have a fontanelle!!) and then release them into the ocean. This vastly increases their chances of survival, and any that are blind or have deformities are kept at the center so they wont die in the wild. They let you hold the little babies, and oh my, are the ever CUTE! And very strong – I was amazed by how strong their little fins were, pushing against my hands.

And thus ended my time in Sri Lanka. I wouldn’t call it my favorite country I’ve ever visited, as one well-traveled backpacker called it when I met her years ago, but it was well worth a visit and has some beautiful and unique places to visit, great food and wonderful people. If you have been to India, you absolutely cannot consider it is just more of the same, and now that the war is over and the country is generally peaceful, it’s a great time to go before the masses arrive once again.

Some practicalities:

Language: Sri Lanka’s primary language is Sinhala, with a decent-sized Tamil minority. They all learn English in school, but I found that in general most people don’t speak it much if at all. Try the well-dressed ones who look like professionals if you are really in need of an English-speaker. Sinhala is hell to pronounce, and I can’t say I made a lot of inroads into the language during my stay there. I was ok with English, but it definitely added an extra layer of challenge since a lot of signs are not written in English, particularly destinations on buses, though I think this is slowly changing.

Costs: Traveling in Sri Lanka is quite expensive by regional standards. I found in general – in the off season – that I couldn’t find a room for less than $5/night, and in Colombo it was as much as $15. Colombo is well worth giving a pass, though. A meal generally costs around $2-3 for a fair amount of food, and train and bus travel is pretty decent value, though again more expensive than, say, India. Where they really get you is the entrance fees for the must-see sights, where they totally take advantage of foreigners who’ve come so far they aren’t going to turn away now. The big ones like Sigiriya and Anuradhapura are a whopping US$25 each (a veritable fortune in Sri Lanka – the entrance is free for locals), and many others are $5 or $10. This can hit the backpacker budget quite hard.

Food: Restaurants haven’t really caught on in Sri Lanka, so most people just eat in their guesthouses. You tell them in the afternoon if you want dinner, and they provide you with the standard dinner – a giant pile of rice with several bowls of curries. Sri Lankans eat with their hands, but they usually have forks on hand for tourists. Breakfast in guesthouses is generally white bread toast with butter and eggs, which I generally skipped because I don’t want to eat any of those things. A real Sri Lankan breakfast is either rice and curry or what they call “hoppers,” which are kind of like French crepes, also served with curry. The food is very spicy, though they will often make it bland as soon as they see your face. I found it quite difficult as a vegetarian. Guesthouses would accommodate me, but restaurants, such as they were, had few vegetarian options. I must say, though, if you can get yourself invited to someone’s house, eat there. Even in the guesthouses where they were just a family making food for me, I never in my entire stay had food as good as what I got at the home of my hosts, who ruined me for the rest of the country. And do take advantage of the amazing tropical fruits, which are mostly in season in the summer time, including super sweet-pineapples, about 18 varieties of bananas, piles of rambutans, and the infamous durian (I recommend you avoid this one).

Visas: US citizens get a free 30 day entry visa on arrival. Most flights leave Colombo somewhere around 3am, so I found many people wondering if leaving the country after midnight on the 31st day would get them in trouble – from my experience, no. I did it, and no one said a word.

Bus and Train travel: So… public transport is not Sri Lanka’s strong point. The train network is not very extensive, and the delays are measured in quarters and halves of days. However, you can sit down, and it is certainly more comfortable than the buses. On the other hand, the buses are often faster and cheaper, and if you can handle hanging on for dear life while pressed into a crowd of Sri Lankans, I’d opt for the bus every time. The major other problem with the buses is that most of them are not labeled in English letters, so you have to either rely on the generosity of a local to help you find the right one or stop every one that goes by and shout your destination at them until one of them doesn’t look at you like you are crazy.

Women: I heard a lot of mixed reports before I went, such that I was a little worried about traveling alone there. Sri Lankan women don’t generally go anywhere alone, and I was met with the usual “but can you manage?” However, while I didn’t have the same sense of safety being put with other women that I did in India, I found that if I dressed conservatively (covered upper arms and down to below the knees, no tight clothing), looked confident and rudely, if necessary, rejected any advances, I was fine. I did not have any incidents while I was there, but in fairness I must report that a woman I met was not so lucky, as she had a man do something very nasty to her on a bus and received no help on attempting to report the event to the police. But for the most part, using some common sense and being a bit on the defensive, and perhaps avoiding night-time travel, I would say it’s fine to travel around as a lone woman.

Monday, July 12, 2010

Health care disparities, part two: the private sector

And now, in the second and final part of my survey of health care in Sri Lanka, I'd like to give you a look at the private hospitals, and a little side note on an NGO working with displaced Tamil refugees in the north.

In order to show me that not all Sri Lankan hospitals are like Colombo South, my hosts took me to see Colombo's Central Hospital, a swanky private hospital that was built just a few months ago. The first thing I noticed when I walked out of the elevator onto one of the medical floors was a teenager playing games on his iPhone. This should give you an idea of the clientele. The place looked like a hotel, with nice private rooms at, I believe, about $100/night for room and board, and "super luxury" rooms on the top floor with kitchens and dining tables complete with a full setting of hospital branded plates going for about $220/night. They had all the latest equipment, including fancy computerized MRIs, and the place was mostly empty. I was told that last year of all the hospital admissions in Sri Lanka, approximately 8% of them were to private hospitals - this should solidify your idea of who has access to this kind of care.

Interestingly, despite the fact that the place was modeled on a hospital in Singapore and had all the latest technology, they didn't seem to be washing their hands there either. I was told that this wasn't feasible given the number of patients, and that alcohol hand sanitizer doesn't exist in Sri Lanka. Upstairs in the ICU, I saw a bottle of alcohol hand sanitizer at the foot of each bed and was told "of COURSE we clean our hands before we touch the patient"... so even between floors there was a huge disparity. In the lab I was told that people were supposed to wear gloves but often didn't because it is "hot here." Upon pressing further, I amazingly got the same reply as in the government hospital - "they know the risks, so it's up to them if they want to wear gloves."

Nonetheless, if I had to get care somewhere in this country, it would definitely be at this private hospital. To compare, I spent a week at the private clinic of my hosts in a smaller town near Colombo. It was also quite clean and people had their own private rooms for the most part, but the hygiene problems persisted. I didn't see any hand washing, and I watched them repeatedly take the temperature of feverish kids and adults with the same thermometer that was being stored in nothing more than normal saline in between. When I asked if they ever disinfected it, the response was "what? between each patient? that's not practical!" The same argument for everything - we see too many patients here, and we don't have time for hygiene.

So clearly there are some major obstacles to be overcome that are not a matter simply of money. You're always better off if you have money, but it obviously doesn't solve the problem. For my part, I'm feeling a lot more appreciation for the American system, as awful as it is, than I did before.

And now just briefly I'd like to tell you about two NGOs that are doing good work here:

Survivors Associated is an NGO run by the mother of a friend of a friend of mine. I must start by saying that there are two sides to every story, and as I am not allowed into the region in which they work, I cannot go see for myself what is going on. However, the stories that I heard from them are horrendous. During the war, the hardest-hit regions were the north and the east. Tamils were displaced from their homes, which were torched, and more than 300,000 of them crowded into refugee camps built for 75,000 people. After being fired upon by the LTTE, who were supposedly on their side but instead used them as a human shield, the injuries were severe, with many amputations. Foreign NGOs such as MSF were working in the camps until the government made it so unattractive that they left, and the government claims that the one hospital in the area can handle it just fine, but I am told that not only is the hospital not enough, but these amputees have no means of actually getting to the hospital. The Sri Lankan government is proud of how many Tamils they have relocated back to their homes, but apparently there is now no infrastructure there - no access to clean water, no buildings, no means of work or food - and people are actually worse off than they were in the camps.

So Survivors Associated is working to do rehabilitation programs for women and especially children who have been displaced by the war, as well as trying to get aid workers in to help with other kinds of health and social issues. The government has now clamped down on them as well, as they are apparently making too much noise and the government is afraid that outsiders will find out what is really going on here. In any case, I realize that this is one person's account and that I can't verify it through my own experience, but I would encourage you to read through their website and talk to people about the situation here. They are fairly well funded by foreign governments, and when I asked what would be the most helpful for them, I was told that the best way to help is to spread the word about the situation so that foreign governments exert pressure.

Women in Need, just briefly, is an organization of social workers, counselors and lawyers devoted to helping battered women in Sri Lanka, who by some estimates make up more than 60% of Sri Lankan households. I found out about this organization when a local woman reached out to me for help escaping from her own private nightmare - a husband who beats her, two children who depend on her, and no resources to get out. Spousal abuse is a very real problem not just here but in our own backyard. So I'm sharing this resource because I think they are a worthy cause if you are looking for one, and also because it's a good opportunity to think about this problem that truly affects us all.

Anyway, I'm done with my serious stuff now - next time I'll send you the fun stuff from Sri Lanka, I promise!

Sunday, July 11, 2010

Healthcare disparities around the world

Now that I've given you a little picture of the overall situation in Sri Lanka, let me tell you a little about the places that I've been working. These include a free government hospital, a private clinic, and a volunteer first-aid camp at the Poson festival, each of which has shown me a different side of medicine here. (Please gloss over any medical jargon as necessary.)

The general gist of health care here, as far as I can tell, is that there are free government hospitals in most of the big cities (there are at least two in Colombo), but that the government provides the absolute minimum of care. Then there are private hospitals that people can visit if they have insurance or if they pay out of pocket, which is obviously only available to people who are fairly well-off -- not even the doctors I worked with at the government hospital can afford to go to the private hospitals.

Almost everyone has extremely poor dentition (most have only a few remaining teeth, all of which are rotted) and most have various fungal infections on much of their bodies, especially their feet and nails. The conditions are so common that nobody even bothers to mention them, let alone treat them. The most common infectious conditions seen here are dengue fever, which is currently epidemic here, with over 15k cases and almost 200 deaths since January, leptospirosis, typhoid and other diarrheal illnesses, and other nonspecific viral fevers, including rheumatic fever. Surprisingly, diabetes, hypertension, kidney and heart failure, are also extremely common, despite the almost complete absence of obesity. So in the end, a large part of what is seen here is also seen at home, although usually we see it at much earlier stages, rather than at the end stages that almost everyone reaches here. Blood sugars, blood pressures, and everything else - the numbers I'm seeing here are so high I had previously thought they were incompatible with life.

My first two weeks were spent at Colombo South hospital, the second biggest teaching hospital in Colombo. Everyone tells me that the main Colombo hospital is so nice and has tons of facilities, but I haven't seen it for myself. Colombo South, on the other hand, is... shall we say... often better than nothing. When I pictured a government hospital, I suppose I imagined some kind of run down version of our own hospitals. I was assigned to work on a general medicine ward for men, and it was pretty representative of the rest of the hospital. Patients are admitted on a rotating schedule, with "casualty day" rotating between three wards. On casualty day, everyone who comes in who isn't a trauma or surgical case goes to your ward, no matter how full it gets. On post-casualty day you are desperately trying to deal with the giant crowd that showed up on casualty day, and on pre-casualty day you are desperately trying to empty as many beds as you can before the next casualty day - and so it goes in a never-ending three-day cycle.

Our ward consisted of 40 beds that were about the size of the dorm beds we get in college, all lined up with about 2-3 feet in between them in a big open room with no close-able doors or windows. As such, the place was full of flies, and there were stray dogs and cats running through occasionally. With an average of over 90 patients in the ward, most times the patients were two (or even three) to a bed, and only the sickest got their own beds. Usually the men would lie head-to-feet in order to have more room for themselves, and at night many would bed down on mats on the floor because they had to sit in chairs during the day. I was told initially that suspected TB patients were isolated outside, but I later saw two TB patients inside with everyone else, including one sharing a bed with a heart failure patient (who was about to also be a TB patient).

I never saw the sheets on the beds changed, nor hands washed, except sometimes when doctors were leaving for the day. I rarely saw gloves used, and on multiple occasions I watched doctors and medical students get blood all over their hands when they performed a procedure without gloves on. When I asked about it, I was told that HIV isn't very common here. When pressed further, they told me that people knew the risks, and if they didn't use gloves it was their own fault. Doctors coughed freely without turning away or covering their mouths. Almost everyone on the ward was on antibiotics, not surprisingly given that infection was likely carried from one patient to the next.

Patients with end stage kidney failure were dialysed only when on the verge of death, after which they were sent home until their symptoms overwhelmed them once again and they returned for another emergent dialysis, and this only if the doctor in charge was feeling sympathetic. Diabetics consistently came in completely uncontrolled despite having been given medication, and even after a day or two in the hospital, their glucose was still sky high. Doctors would give orders and these would only occasionally be carried out. Patients would be wheeled three at a time sitting on a metal stretcher if they needed to go for tests, as there weren't enough wheelchairs for them to each have their own. One time I was in the ward when a patient died, and the body was wrapped up in the bedsheet and then left in the ward for about 3 hours before being wheeled out. Incidentally, this is the only time I ever saw a bedsheet removed from a bed.

In the maternity ward I was shocked to learn that new mothers are allocated 4 hours alone in a bed after they give birth, after which they must share with another woman. Because two women and two babies can't comfortably fit in a bed, almost all the beds had two babies lying on them, with their poor mothers sitting in plastic chairs next to the bed. I had the good fortune to walk into the delivery room just as a woman was giving birth, and I was then appalled to watch a young doctor take the baby over to a table to listen to its chest, answer her cell phone and take a call in the middle of the exam, and then leave the baby wriggling on the table and walk away.

In Peds I was told that they separate the viral fevers from the diarrhea in different parts of the ward, and when I asked how they prevented infection, I was told "in pediatrics, even the medical students wash their hands," as though this was something to be proud of.

What was interesting was the air of defeatism that pervaded the place. Every time I would ask about something, I'd get the same answer that there is no money, and we are a poor country, and people get their care for free so they are happy with what they get. But I was amazed by the things that I saw that could easily be prevented by simple things like hand washing and cough covering. Little things that wouldn't cost much at all could save tons of money in the long run by shortening hospital stays and reducing the need for antibiotics, which are horribly over-prescribed as it is. Yet no one would listen, always telling me that this is just the way it is in a poor country.

So I think it's important to remember that it may seem like there is no way to fix the problems we are facing even in our own "first-world" situations, but sometimes if we look from another angle, the main thing that is really limiting us is our attitude. My big question now is how someone like me (and you) can change the attitude of such a monstrous machine as a health care system. In fact they do need money and they do need manpower, but most of all they need a paradigm shift. So I'm open to suggestions and would love to hear your thoughts.

Sunday, July 04, 2010

Sri Lanka: Please allow me a moment on my soapbox

It's a truly interesting time to visit Sri Lanka. I'm here by a happy coincidence and the generosity of my friend and his family, who have arranged for me to spend a month working in a few different hospitals here to get some experience in a different kind of medical setting. If you are desperately trying to think of where Sri Lanka is, it's a small island nation near the south-eastern coast of India. Despite popular belief, it is a sovereign nation, and is in fact very different from its larger neighbor, although its inhabitants are largely descended from Indian immigrants who came here hundreds to thousands of years ago. The clothing is similar but not the same (their saris have ruffles), the food is actually quite different (less spicy, more coconut, and more meat), and their roads are more often paved and less often clogged with cows. The major language is Sinhala, mixed with a smaller group of Tamil speakers. It's a tropical island with the associated vegetation, including 70% of the world's cinnamon supplies.

Having just in the past year emerged from thirty years of civil war colored by terrorist attacks from the LTTE (Tamil Tigers), the country is experiencing a surprisingly robust recovery. People tell me stories of taking separate buses from their spouses in case one of them didn't make it, and of relatively deserted festivals and once-bustling markets that people avoided because they never knew when to expect the next bombing. The strife started, as far as I can tell, with the British colonists (doesn't it always?). Apparently they initiated the tension between the two major ethnic groups here - the Sinhala and the Tamils - and then after they left, the new government made it infinitely worse by instituting Sinhala as the national language, thus effectively shutting down Tamil culture. Of course the Tamils responded by agitating for their own language and their own separate country, and thus began years of warfare, suicide bombings and civilian casualties. It's amazing how you can take the names of the groups away and this story just repeats and repeats around the world.

However, with the death of the LTTE leader last May, the war finally came to an end. The military has continued to expand and the streets of downtown Colombo remain somewhat deserted, with sandbagged military installations and groups of soldiers with machine guns on every corner. There are random document checks along the roads to make sure you are who you say you are, and apparently if you don't stop for them, they can shoot you without fear of repercussions.

At the same time, the bustling streets of the market area of Pettah have returned to their former liveliness. The hospital no longer receives large numbers of blast victims, and people's fear seems to have dissipated much more quickly than I would have expected. At this year's Poson festival in Anuradhapura, celebrating the bringing of Buddhism to Sri Lanka and one of the two biggest annual festivals here, there was a huge turnout of what I heard was almost 200,000 people. For the last 30 years people had largely been too scared to attend this festival, so now that it's finally safe, they turned out in droves. It was quite a sight to see, as thousands of pilgrims dressed in white flocked to ancient temples and a bodhi tree said to be over 2000 years old and grown from a cutting of the original one where the Buddha attained enlightenment.

So it would seem like a time of great opportunity for Sri Lanka, but there are some major challenges. There is a very wide gap between the rich and the poor, with the former seemingly unaware of the latter. I've been told by multiple people that no one goes hungry in Sri Lanka, but the UNDP points out that 23% of the population lives below the official national poverty level, and one out of three children is underweight and malnourished. These same people also tell me that most people have health insurance and can go to the fancy private hospitals, but they haven't seen the crowds at the government hospital, where patients are three to a bed and sleeping on the floor, and they would seem to be contradicted by the fact that Sri Lanka's infant mortality rate, a widely-used indicator of human development, is 18.6/1000 (compare this to 2.3 for the best, and 6.3 for the US). 18% of people don't have access to clean water.

Unfortunately the new leadership is proving to be corrupt, with the president favoring the rich with tax cuts on luxury vehicles and worsening the situation for the poor by increasing taxes on basic goods such as flour, rice and tea. He looks to be gearing up to try to revamp the law so that he can serve an additional term, and you know what that means. Additionally, the situation in the north, where the worst of the fighting happened, is dire, but the government is working hard to keep out any groups that might get word of the situation out to the rest of the world. I'll leave that subject for my next post, since I think it merits extra attention.

So why am I telling you this? If you are like I was two weeks ago, you have little or no idea what is going in Sri Lanka, except a vague idea of Tamil Tigers and terrorism. After spending a couple of weeks here, I think Sri Lanka is a lovely country, and the people I've met - rich and poor - are warm and friendly and extremely generous. The richer segment of the population is doing very well, but a lot of work remains to be done, particularly in the areas of health and human rights and fighting corruption. Sri Lanka, as a small, out-of-the-way country, often gets overlooked, so I'd like to encourage you to give it a moment's attention. Donate to an NGO that is providing essential services like food, clean water, health care, or medical supplies. Put pressure on your own government not to support the corrupt policies of a government trying to cover up human rights abuses. Volunteer a bit of your time to help improve the situation here by building houses, digging wells, or treating patients. Most of all, be aware of what's going on, and tell others.

By the way, I happen to be in Sri Lanka right now, but the situation here is far from unique. It's all too easy for us in the US to just sit back and remain blissfully unaware of what is happening all over the world, but it is irresponsible of us not to do something about it, even if the only thing within our means is to talk to other people so that we raise awareness. Once enough people take an interest, our government is more likely to do something about it.

Ok, I'm done with my soapbox speech for now. Next time I'll tell you a little bit about the hospital where I've been working and an organization that works with Tamil refugees in the north. I'll have a week to travel towards the end of my time here, so I'll save the sightseeing and more fun cultural details for then.

Adventure map for 2009...