June 03, 2009

Ramachandra* was wounded in January during fighting in the Vanni, the former conflict zone in northeastern Sri Lanka. The 18-year-old underwent amputations at a hospital there, and eight days later, was evacuated by an International Committee of the Red Cross (ICRC) ambulance to the main hospital in Vavuniya, about 50 miles south. The young woman is missing her left hand and left leg, and half of her right foot. Without post-operative care and physiotherapy she would remain bedridden for the rest of her life.

Currently, Ramachandra is hospitalized in the Pompaimadhu Ayurvedic Hospital close to the northern Sri Lankan town of Vavuniya. Unlike other hospitals in the area, which are flooded with patients, the Pompaimadhu Hospital appears like a small haven: no wounded patients lying on mats on the floor, no ambulance traffic jams at the hospital entrance. Lots of wheelchairs and crutches donated by non-profit organization Handicap International are placed alongside the beds. At least 30 patients in the hospital have one or more amputations, while another 25 people are paralyzed. Up to 200 patients receive post-operative care here, which can include small surgeries and physiotherapy.

“As the Vavuniya hospital was overcrowded, the Ministry of Health established a post-operative care unit in the Ayurvedic Hospital, which MSF has been supporting since the beginning of May,” said a Sri Lankan doctor* who is part of the MSF emergency team. “It’s a separate space where war-wounded patients receive the complete medical care they need, from small surgery or daily dressings, up to rehabilitation.”

The MSF physiotherapist* attaches Ramachandra’s wrist to a crutch with bandages and she slowly stands up and begins to walk. MSF, Ministry of Health doctors and nurses, and Red Cross Society volunteers quietly move from patient to patient housed under six temporary structures. Most of the patients have several dressings that need to be changed regularly. In a small room in the hospital, MSF surgeons and anesthetists carry out surgical procedures such as skin grafts and wound closures.

An old woman tries to stand up with crutches by herself and falls down, breaking into tears. Emotionally exhausted, the patients have to mobilize enormous energy just to try to walk again. On the next bed, chatter has begun between teenage girls. Among them is a 17-year-old who has had both legs amputated above the knee

Another patient, a 14-year-old girl, smiles as the physiotherapist urges her to walk. “In one month she will walk,” announces the physiotherapist, pushing on frail girl’s knees to help her get on her feet from a wheelchair. She keeps her smile throughout the exercise, but after the physiotherapist has gone she cries and complains about the pain, her distraught mother looking on. “It’s the first time she’s standing up in five months," explains the physiotherapist. "There are thousands of patients like her, in the hospitals and in the camps, who need post-operative care and physiotherapy.”

* Patient's name has been changed and MSF staff names are withheld for security reasons