Trip to Sri Lanka spotlights need for more tsunami relief

By Tonya Clayton

This Hindu temple was one of hundreds of examples of the tsunami's devestation that Yasodha Natkunam witnessed in her trip in March to Sri Lanka, where about 40,000 people were killed in the disaster.

In the wake of December's tsunami, many doctors and nurses immediately traveled to Sri Lanka to treat the sick and wounded, but the task of rebuilding the nation's ailing health-care facilities—ravaged by civil war and poverty as well as the ocean's wrath—has only just begun.

So last month a medical school pathologist traveled to her former island home to help to set up much-needed laboratories, train health-care workers to run them and publicize how relief is still needed.

"I found an area where I can make a difference," said Yasodha Natkunam, MD, PhD, assistant professor of pathology. "Plus there's a lot I can do now from here at Stanford without physically being in Sri Lanka."

Over the course of a two-week trip in March, Natkunam and colleagues delivered medical and surgical supplies, setting up donated microscopes that they had brought with them from Stanford and sizing up the pathology needs. She found capabilities about 50 years behind what exists in the United States.

And nowhere in her visits to clinics and hospitals in the northern and eastern parts of the tropical island-nation did Natkunam encounter a single pathologist. "There is absolutely nobody to render diagnoses or to oversee a clinical laboratory," she said. At every hospital, she recalled, she heard from the physicians: "We really need this."

The scars from the tsunami remain readily apparent in Sri Lanka. The disaster killed 40,000 people there and left more than a million homeless, many of whom are living in temporary refuge camps.

Yasodha Natkunam (right) interviews a patient at a Sri Lankan medical clinic.

Natkunam was part of a team—including Rochelle Dicker, assistant professor of surgery, and three other physicians—that was laying the groundwork for restoring the nation's medical capabilities as well as providing direct medical care for hundreds of patients. The team's visit was coordinated by the Center for Health Care, a nongovernmental organization in Sri Lanka, which provides medical services to the nation's most-underserved populations.

Six doctors for 200,000 people

The visiting doctors began their trip in the capital city, Colombo, where they were briefed on current conditions. They then traveled 200 miles north to Killinochi, the main referral city for the island's northeastern region, where six doctors serve a population of about 200,000.

Each day, the visiting surgeons saw 50 to 75 patients. Some came with wounds from landmines or bombs or from being tossed about in the tsunami's waves. Others came with chronic problems. In one of the two hospitals, 400 patients were crammed into wards with a capacity of 120. Only one operating room was air-conditioned, and temperatures soared into the humid 90s.

Natkunam recalled one woman with a mass on her check. The woman's doctor thought it was squamous cell carcinoma. Normally he wouldn't attempt a biopsy; samples often get lost, or doctors don't hear results for months—too late for some cancer patients. But with a pathologist in town, the doctor decided to sample the mass. And Natkunam was able to make a preliminary diagnosis of lymphoma—saving the sick woman from a difficult 12-hour journey to Colombo for diagnosis. The doctor sent her instead for chemotherapy only two hours away. "It was a wonderful opportunity to demonstrate what you could do," Natkunam said.

After four days, Natkunam traveled to Jaffna to visit the medical school and teaching hospital where her mother used to work as a pathologist. Now, after decades of civil unrest, clinical decisions are made and patients treated with no pathology support. The donation of a three-headed teaching microscope from Stanford was greatly appreciated by the medical faculty and laboratory staff.

The team concluded their visit with two days on the east coast, where the tsunami hit hardest. Natkunam said the temporary shelters were crowded, but well organized and clean, with healthy drinking water.

"None of the initial fears of a mass outbreak of infection had occurred," she said. "That was so good to see."

In three mobile clinics, the visiting doctors saw a tremendous amount of psychological trauma, and whenever possible, they made referrals for long-term psychotherapy care. Many patients also presented with chronic medical problems, and some were in need of eyeglasses or medications that had been lost during the tsunami.

Despite the terrible need, Natkunam said that she was impressed by the dedication and enthusiasm of the local doctors and relief workers the team encountered. "That was very inspiring," she said.

Wanted: Pathologists and lab technologists

So was the Stanford community's generosity. Natkunam said colleagues donated hours to cover her clinical commitments, as well as money for medical relief efforts. The Department of Pathology gave five microscopes, and its servicing vendor—the Sunnyvale-based Edward Jasinski of the Scientific Instrument Company— donated labor, parts and two additional scopes.

Now back in California, Natkunam is developing a network of visiting pathologists. She said that the island also desperately needs medical instruction, not only for physicians, but also for nurses and rehabilitation and prosthetic specialists. Laboratory technologists, she said, are especially needed, so much so that she is ready to accompany any who wish to visit Sri Lanka. She said that she hopes that soon doctors will be shipping samples—not sick patients—for diagnosis.

In addition to Stanford's Dicker and Natkunam, the visiting team included Doruk Ozgediz, a general surgery resident at UC-San Francisco; Julie Adams, a vascular surgeon with the Cleveland Clinic Foundation, and Rajaratnam Natkunam, Natkunam's father, a retired general surgeon who in 2002 was awarded the Order of Australia Medal for his years of medical service in Australia.

While Natkunam has returned to her daily routine at the medical school, her thoughts still slip back to Sri Lanka. She remembered standing on a white sand beach looking seaward at the calm blue water, while behind her rose piles of strewn debris. At her feet lay a small bottle of Johnson & Johnson baby lotion—the same lotion Natkunam uses on her own children.

"That really got me," Natkunam said, wondering what happened to the woman who used it on her own children. "It's just random stuff, but it really makes an impact. The tsunami could have been yesterday—you cannot appreciate it until you see it."

Posted 4/21/05