Sunday, December 13, 2015

the doctor who couldnt speak !



Living among them, working in the heart of the north where people struggled to heal and hoped to survive – This is my story.

“If you can’t speak Tamil , then you’d better pack your bags and leave!” the Consultant said in a blunt tone to the doctors who were newly-posted there.


A few years ago, the sound of guns, bombs and aircraft filled the atmosphere of the North. Everything ended for good in May 2009, and now they are in the process of regaining their normal lives, even though most of it had been destroyed beyond repair by the brutal war.

Yes, I wanted to serve in the North and it was the time that our country needed our help by whatever means possible.

Despite the objections of my family, relatives and friends, I started my journey to the hospital at the other end of the country. Traveling to an area in the aftermath of a brutal war was not easy when there were, road blocks, checkpoints and warning tapes on either side of the roads where demining took place. Roads were all wrecked; there was ongoing construction work here and thereby raising heavy brownish clouds of dust and dirt, which eventually stuck to the skin, giving us a brown-dusty tint.

On the very first day the consultant yelled at us popping our ‘highly excited to do the doctor work’ bubble with a loud pop! For, we had no fluency in Tamil.
So here I was, struggling my way around, with no fluency in the language in which 98 percent of this community spoke. It was the time that I regretted the most for not having learned the other language of this country. Now I had to learn it super-fast and become a pro to serve and survive.

Communication was the key of our profession as we had to talk to patients to get the history to identify illnesses and treat them.

Many offered us help with translations during the ward rounds and clinics but with the heavy work-load and the crowds, we couldn’t ask the staff to be with us all the time as this was one of the main general hospitals in the North. Those days it was busy as a beehive. Shortage of staff made life difficult for all who worked and this made them sort of depressed or frustrated.

Our call for help when taking patient histories, was definitely adding more stress to their workload.

In addition to that, there was a risk involved as any errors in translation could make errors in diagnosis which would be disastrous. Going through the ‘Learning Tamil in Sinhala’ books which my mom sent, was a joke with 24/7 on call duty, we hardly had time to eat.

Most of the internal conflicts in this country, I believe, are the results of poor understanding and lack of communication. During first few days, I felt a huge barrier between us and the Tamil speaking staff. In order to lessen the space between us and build a proper work relationship, I wanted to communicate with my staff. I wanted to know them, to share their stories and be a part of the daily chit chat after the ward rounds.
I had to act fast as I was determined to speak Tamil! At first, I took a small diary with me and scribbled all the words I heard. All those basic questions and possible replies were glued to my mind at the end of the day after examining about hundred patients. Then I learnt the grammar components which were the key when forming sentences. With, often, at, on, in, or else… I learnt them all and I was connecting words and forming sentences in no time.

Well, I wasn’t perfect with my pronunciation at start. Often made a bit of a blunder with similar sounding nouns, like kattil (bed) and kudi (hut). Sometimes, patients asked me which room to go to, when I simply wanted them to get on the examination bed. Ambala (male) pombala (female) was another that slipped my mind, and I sang the song “pombule mage pombule tharadevi pombule” (from the drama Thaaradevi)…in my head to sort out this mishap before I opened my mouth!

Every single day I remember myself laughing at one of my colleges who tried to learn Sinhalese, when she went to a pregnant mother and said “amma kahanna” (mother could you scratch?) instead of “kahinna” (cough) and the response of the confused patient was hilarious. Now the table had turned and I was the joke, bringing laughter to the patients with my mix of Tamilsinglish.

Within a week of practice I was speaking Tamil in ward rounds, clinics and even with the sanitary workers whom I met in the corridors. Instead of sending patients to a nurse or a midwife outside, I could talk to them and give them all the advice on follow up and treatment in their own language.
One day it caught the eye of a new Consultant who was a Tamil. He was surprised to hear that I learned on my own and improved within weeks.

Knowing that the Tamil speaking doctors weren’t fluent in Sinhala he told them that they should start learning and speaking Sinhala language like I did, for one day it will come in handy when they are posted to an area with a Sinhala speaking community.

Once a young lady was admitted to our ward with a high fever and a vaginal discharge. She showed signs of septicemia and was not in her senses. As soon as she underwent surgery, to remove the infected parts of a dead fetus, we had to transfer her to a hospital that had an Intensive care unit. When we tried to arrange an ambulance the transport unit was not fully aware of the patient’s condition and had other tasks assigned to it on the way to the other hospital. Delaying transfer would cause major issues regarding her recovery and now I had to reason with the officer who was in-charge of transport that this patient’s life is more important than their other assigned tasks.

After the arguments when I finally got into the ambulance the driver gave me a thumbs up and said, “suuupper doctor, I just heard you speaking in Tamil? I wondering if you aran’t from this area because your surname sounds alien.”

My transformation into a Tamil language Pro within weeks was a surprise to all, some asked if I was from north, or my village was near the hospital. When I accompanied a patient, on a transfer to a hospital in south, the nurses asked if I was a Tamil as now I had developed sort of an accent!

Friday, November 27, 2015

From North with love ... here's to a start !

My chest throbbed with immense pain while watching the movie” Ira handa yata,” Under the sun and moon. This movie reflected the 30 years of war that ruined the lives of millions in this country, and I felt it deeply as I was a victim of it since I was born and until I finished my medical degree. The tears of the living dead and the cries of the innocent had been reflected sharply throughout the film as I witnessed most of it myself during the time I served in an immediate post war area. The theme it carried not only bears a clear history of the war but also the humanity and its relativity towards the nation.

It takes a lot of courage and kindness to look at one another with love and compassion even when one has lost almost everything he owned. “It’s so good that it all ended doctor” every single person I met, told me, that their lives are so much better, the children are safe and they’ve returned “home”.
It was not all sunny and bright! Every day I come across hundreds of people who come to us with all their illnesses. Billions of fears, tears and pains seem to flock beneath their smiles. Even though they greet us with a smile sometimes, I have come to an understanding that it’s not easy holding all that down. Most people I meet seem to have tiredness in their faces; we can’t expect cheerful grins from them as they have lost their happiness on the road to salvation.

Rangamma (pseudonym) was a 42 year old admitted with very low hemoglobin. Apart from her medical conditions it was her eighth pregnancy, in which she carried a high risk for postpartum problems. Risk of heavy blood loss, still birth and gestational diabetes are high in elderly, multiparous women (women who have given birth to more than one child)
“Your hemoglobin is very low and considering your age, risks are high you know.” I tried to explain her situation.
“Even though I had seven children, I lost six of them doctor Amma,” she said. Amma is a word of respect in this language.
Her older boys were taken by the terrorists to be trained as child soldiers and she lost two children during the tsunami that hit the coastal areas. Tears dropped down her cheeks and I was struggling to contain mine.
“I have only one child, who’s 16 and wanting to go abroad to his relatives. Is it wrong for me to have more children doctor?” she asked.
Ramya (pseudonym) was about 26 weeks pregnant when she was diagnosed with gestational diabetes (high blood sugars during pregnancy).  We started her on soluble insulin as her blood sugar levels were rising up on each visit for blood sugar series. As her condition was manageable with the insulin I had to explain her on injecting it herself and the care of insulin .
“You should store this in a refrigerator…”
“Doctor, we don’t have a refrigerator. Do I have to stay here? ” she interrupted me.
This is a common question we always come across as most of the villages don’t even have electricity.

There were four other kids and she was pregnant with the fifth. She had most of the factors that indicated that it is a high risk pregnancy. Her condition will be severe if she’s unable to use medications at home. They’ve returned to their villages recently to their roofless homes with shelled walls. The rural hospital seems to be far away from her home and keeping her here was also a challenge as she had 3 months to go.

Asking them to come to a closer residential area for this matter was a joke as they never understood that life risks are greater than a piece of land they owned.  They barely have homes and survive on Kuli weda (menial labor) which pays about 200 to 300 Rupees a day. It’s not enough at all for a family of six.  After so much of debate and a talk with her husband, he agreed to paddle every morning and evening to the hospital nearest to them for the insulin and we taught the method of storing it in a clay pot buried underneath a cool spot in their garden or home.
Every day we come across these kinds of problems and we seem to be the listeners and bearers of their pain. Hospital is the sacred place for them to resolve all their issues and sometimes family matters too.

They expect us to resolve all their problems but all what we can do is merely help them with unrealistic solutions such as inform about them to the welfare society of the hospital, social workers or a helpful NGO.
Coming for clinics seems the only chance for them to dress up and travel. They come there with the best clothing they have, not to mention that they love silver and gold. Most of them are dressed in sarees bathed in gold or silver dust. At the end of the physical examination rounds we transform into shiny golden statues by all the dust from their sarees and salvars.
On their long run for survival many lost their homes and were taken as a human shield by the terrorists till the final battle from town to town. So, almost all of them with chronic diseases had lost their clinic books or diagnosed cards from past along with their homes, valuables and family members. Yes family members too!
Whenever we ask them what happened and why couldn’t they secure those cards or books, a river of tears fall out with the war wounded history. Lives of these people have torn, twisted and blasted sometimes but regained as I write this note now, that’s the change we see at present in this end of the country.
War had hit them really hard. Almost all seemed to bear a scar or a wound from the past.  A shell, a bullet or a bomb blast written all over it. It was so painful at start but we overcame the pain as this was a common sight.
Communication was the key of our profession as we had to ask everything to understand the illnesses. When I was posted there I had no fluency of Tamil language in which 98 percent of this community spoke.  It was the time that I regretted the most for not having any interest to learn the other language. I had to, somehow learn it and become a pro to survive and serve here. My Transformation into a Tamil language pro within weeks was a surprise to all and how I overcame that challenge is another story…