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Miles away from the NHS

My first week in Sri Lanka has been an eye-opener.

It was Lilly, one of my fellow students at Peninsula School of Medicine who suggested that I should visit Sri Lanka for my elective.  Apart from being one of the most lively individuals that you could ever meet, Lilly was born in Sri Lanka so it didn't take long for her to sell me the idea of Colombo as a medical destination worth visiting.  She also mentioned the spectacular beaches on the island, but I'm pretty certain that didn't influence my decision.

I was accepted to Sri Jayadenapura General in the capital and assigned to the busy Emergency Department.  The Emergency department is the first point of call for many patients with deteriorating conditions who have not previously sought help in the community.

For several patients admitted here the initial medical intervention is a cannula placed in-situ often proceeded by intravenous saline, although I'm not sure yet that all patients require such a painful intervention as a first line treatment before they are even examined. The administration of intravenous fluids is not without risks and in such a humid environment with limited infection control protocols.

In the UK there is a strong link between primary and secondary healthcare.  But in Sri Lanka this link is at best extremely weak. Dr Sudath Dhamsinghe is a G.P. who runs clinics at the hospital and was able to tell me more about the Sri Lankan healthcare system.

In primary care, patients are seen without appointments and attend many different practices, leaving little hope for continuity of care.  As patients do not register at the clinics, GPs do not have access to patients' medical health records, resulting in a major problem for booking follow-ups. Monitoring of healthcare in the community verges on the impossible in many cases.

He also explained that because Sri Lanka doesn't have a GP referral system yet, patients are able to travel to any hospital in the country and request treatment from any doctor. This often leads to overcrowding in secondary and tertiary care.

Because doctors often lack access to records, they can be forced to rely on the patient's own understanding of their medical history - which obviously can be incorrect and misleading at times. For example, I was attending when a 21 year-old man was admitted with suspected anaphylactic shock. The patient developed symptoms soon after he took medication prescribed by a GP, but hwas unable to recall the name of the small orange pills he had brought with him. On further questioning he revealed he had several drug allergies and suffered with mild asthma. Whether this was a true drug allergy or the result of NSAID-induced asthmatic bronchospasm wasn't clear. I did wonder whether it could have been avoided if the GP had had the patient's records. Thankfully the patient was taken to ICU and made a full recovery.

Week two beckons…

Suzanne Reilly is a fourth year medical student from London, studying at the Peninsula Medical School