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!

No comments:

Adventure map for 2009...