May 13, 2009

Twenty-six staff of Doctors Without Borders/Médecins Sans Frontières (MSF) are working around the clock as caretakers in two wards of the Ministry of Health General hospital in Vavuniya, northern Sri Lanka. The role of caretaker is to support hospital patients' basic health needs from the moment they arrive at the hospital and throughout their treatment.

Sivananthan, the full name of a 25-year old electrician from Vavuniya, is one of the MSF caretakers working alongside Ministry of Health doctors, nurses, and two ward attendants. Along those in his care are 200 patients, including a few paralyzed from the waist down and many with fractures unable to move from their beds.

Wounded in the conflict raging in the north east of the country between the Liberation Tigers of Tamil Eelam (LTTE) and the Sri Lankan military, many of the patients are alone because their relatives are either dead, have been left behind in the conflict zone or are living in one of the camps for displaced people.

"I spent a long time with one of the patients this morning," says Sivananthan. "An older man in his 50s, he has a wound in his backside and he is paralyzed from his waist down. He arrived at the hospital a month ago with nothing other than the sarong he was wearing. He has lost all his family, and all he keeps saying to me is ‘I’ve lost all my family and now I am alone.’ So I spent some time with him this morning, changing his urine bag, feeding him, helping him with the toilet, washing him..."

Sivananthan has been working as caretaker for two months. "At first I found it difficult because I didn’t have any experience, especially with wound dressing," he explains. "But I got some training from MSF and I was taught how to talk to the patient, how to identify the most urgent cases, how to lift the patients, clean their wounds...Now I find dressing wounds quite easy!"

The caretakers’ program started three months ago and the man behind the idea is Voitek Asztabski, MSF project coordinator in Vavuniya. It all began on January 29, when 232 dehydrated, exhausted, and severely injured war-wounded arrived at the hospital from the conflict zone.

"I remember getting our team together to help at the hospital with triage and first aid," explains Voitek. "I stood there in shock watching all these people arriving from the conflict zone being offloaded from buses and ambulances. They were arriving in terrible condition, with nothing or just a few possessions in a plastic bag or bundled up in a piece of clothing. There were some volunteers from the Sri Lankan Red Cross Society helping in the hospital at the time and that is when I first had the idea that MSF could help with distribution of basic items."

So that same day the MSF team started distributing travel bags for patients to carry their belongings, along with a donation of 1,000 rupees (about $8) for patients to buy things like food or a calling card to phone their relatives. Three months on, the program has grown to include 84 caretakers working in 24-hour shifts, seven days a week. When the hospital had 1,850 patients at the end of April, the work of caretakers was even more crucial.

In addition to looking after basic health needs, caretakers go round the wards every day checking the patients’ more general needs and distributing clothing for children and adults, bags, thermoses, slippers, sheets, plates, nappies, and one cash donation as required.

MSF medical teams currently provide surgical and laboratory support in Vavuniya hospital and supplementary feeding in displaced people’s camps in Vavuniya and in Manik Farm. MSF is in the process of setting up an emergency field hospital on the outskirts of the displaced people’s camps in Manik Farm and  starting post-operative care activities in Pampaimadhu Ayurvedic clinic, 5km away from the town of Vavuniya.