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My elective was spent at a teaching hospital in Galle, in Sri Lanka. My time was spent shadowing final year students in the specialties of general medicine and paediatrics. This period provided me with much food for thought in comparing and contrasting the health service in Sri Lanka with that of the UK and also considering the differences in the style of medical education. In addition, during my stay, I was able to gain some appreciation of the political and organisational problems faced by a country in the midst of a civil war.
In this report, I have attempted to integrate an account of my observations with a discussion of the thoughts and emotions that I experienced while working in a developing country. Studying in Sri Lanka facilitated my appreciation of facets of British health care and medical education that I had not previously considered. However, fewer resources do not necessarily mean poorer patient care: could Britain have something to learn from the Sri Lankan Health Service?
(Postgrad Med J 2001;77:139--143)
Keywords: Sri Lanka; elective; medical education
My elective attachment was spent in Karapitiya Teaching Hospital in Galle, Sri Lanka. I attended the hospital for three weeks in the specialty of general medicine and four weeks in paediatrics. My time was spent shadowing final year medical students for ward rounds, ward classes, clinics, and general ward work.
During my stay at Karapitiya, there was a period of industrial action by the national doctors' union and I was able to gain some insight into the political and organisational problems facing the Sri Lankan Health Service. It was this experience, coupled with the exposure to a different style of medical education, that I found the most thought provoking. In this account, I hope to integrate a account of my observations with a description of some of my experiences, followed by a discussion of some of the issues raised.
A word about Sri Lanka...
I was keen to spend my elective in a developing county. I chose Sri Lanka specifically because of a personal connection: my grandparents met there during the second world war and my grandfather wrote several short stories about his experiences in the jungle. Now, Sri Lanka is in the midst of its own war. For the past 16 years the Liberation Tigers of Tamil Eelam (LTTE) have been fighting in the north and east of the country for "Eelam", a separate state for the Tamils. The Tamils represent 18% of the population, the majority 70% being Sinhalese.
Despite the terrorist activities in the north and east, southern Sri Lanka remains a safe, attractive destination for the discerning traveller. I stayed in Galle, in the southwest (fig 1); the south and west are virtually untouched by the troubles of the war, and life continues largely unhindered.
Sri Lankans are renowned for their hospitality and friendliness, especially to foreign visitors. The family I stayed with were no exception to this rule; they were continually interested in my work and provided every possible assistance with both my studies and the management of my leisure time. There is much to be seen in Sri Lanka; the country itself encompasses a broad range of geographical features and is rich in natural beauty. Stretching sandy beaches, tropical rainforests, the barren hill country, and lush tea plantations can all be seen in one day's travelling on the island.
HEALTH CARE PROVISION
The government in Sri Lanka provides a free health service in the form of Western medicine, practised in hospitals all over the country, and Ayurvedic medicine (an indigenous, ancient healing philosophy) practised in one hospital in Colombo. The health service (Western medicine) can be divided into preventative and curative sectors.
Preventative medicine is concerned with the control of communicable diseases (especially rabies, sexually transmitted diseases, tuberculosis, and leprosy), sanitation, family health, and health education.  Preventative health care is delivered by medical officers of health and …