APOA-MOA SPONSORED TSUNAMI RELIEF TO SRI LANKA
 
posted 21st Feb 2005
Dato' K S Sivananthan

The team comprised the following:-

1) Dato Dr K S Sivananthan (Orthopaedic Surgeon)
2) Dr T Kumar (Orthopaedic Surgeon)
3) Dr Vasan Sinnadurai (Orthopaedic Surgeon)
4) Dr Raymond Ramesh Sinnadurai (Anaesthetist)

These doctors paid for their own travel expenses.

The coordinating orthopaedic surgeons in Sri Lanka were:-

1) Dr S Sritharan, Past President of the Sri Lanka Orthopaedic Association
2) Dr K Umapathy, Consultant Orthopaedic Surgeon, General Hospital (Teaching) Jaffna, Sri Lanka

We had an official invitation from Dr K Umapathy of General Hospital (Teaching) Jaffna to help in the relief work in North Sri Lanka.

We were also told that there is an acute shortage of orthopaedic surgeons in Sri Lanka. Sri Lanka has 25 orthopaedic surgeons for a population of 21 million. Only 2 orthopaedic surgeons are working in the North and East of Sri Lanka which had a population of almost 6 million. One is posted in Jaffna General Hospital and the other is posted in Batticulo General Hospital - a distance of over 350 km.

As requested by Dr Umapathy, we had taken a number of equipment and implants namely external fixators, intramedullary nails and other equipment for our relief work. The donors of these equipments and implants were:-

1) Malaysian Orthopaedic Association - donated RM5,000 worth of external fixators
2) Osteomed Medical
3) Schmidt Biomed Tech
4) Hospital Fatimah, Ipoh
5) Aesculup

The weight of the equipment and implants was about 150 kgs.

The Malaysian Orthopaedic Association (MOA) had obtained letters of approval for our trip from the High Commission of the Democratic Socialist Republic of Sri Lanka in Malaysia and the Prime Ministers Department, Malaysia.

We left Kuala Lumpur, KLIA Sepang on 4th February 2005 at 1.30 pm and arrived in Colombo, Bandaranaike International Airport at 5.15 pm. Dr S. Sritharan had made all the necessary arrangements to facilitate speedy departure from the airport.

On 4th February 2005 night we stayed at the Renuka City Hotel, Colombo. Dr Sritharan treated us to a very delicious Sri Lankan dinner.

The next morning (5th February 2005) at 5.00 am we were taken to the Ratnamalar airport in Colombo and we took a flight to Palali airport.

We arrived at Palali airport at about 10.00 am. Due to the high security in that area, it took us 3 hours to arrive in Jaffna town. Dr Umapathy and his team received us at the Jaffna town and we were taken to Jaffna Hospital. After lunch we had ward round and had discussion as regard treatment of orthopaedic cases that were in the hospital.

Dr Umapathy is a competent and dedicated surgeon. Single handed with limited facilities, he was doing a splendid job treating the orthopaedic cases in North Sri Lanka.

At 3.30 pm, we together with Dr Umapathy proceeded to the Tsunami affected area of Mulaithivu. Dr Umapathy had got the necessary approval from both the government of Sri Lanka and the Tamil Tigers who controlled that area.

It took us about 3 hours to reach Dr Poonambalam Memorial Hospital in Puthukudiyirrupu, Vanni which was near Mulaithivu. We had to pass numerous check points which were manned by the Sri Lanka government forces and Tamil Tigers. We were received warmly by Dr Sivapalan and staff of this hospital. Dr Sivapalan with his staff managed all the orthopaedic and general surgical cases in this hospital. Due to the civil war, he had vast experience in treating trauma cases.

The Dr Poonambalam Memorial Hospital is the only hospital in North Sri Lanka other than Jaffna General Hospital that is partially equipped to perform orthopaedic operations. This hospital has one operation theatre and another room where dressings and minor procedures can be done. This operating theatre has yet to be equipped with an Image Intensifier and an orthopaedic operating table. They have basic orthopaedic equipment. The equipments that we had taken were very useful.

The accommodation in this hospital for guests was luxurious. It was an air-conditioned room with all modern facilities.

Following a sumptuous dinner, we did a ward round in that hospital. We selected 13 cases to be operated the following day (6th February 2005).

After breakfast (6th February 2005), we proceeded with the operations. Two orthopaedic surgeons did the operation while the other ran the outpatient orthopaedic clinic. A number of patients having heard of our arrival came to see us. We saw tsunami affected patients, patients injured during the civil war, congenital cases and other general orthopaedic problem cases.

On 6th February 2005, we operated from 8.00 am to 12 midnight on 13 cases.

The following day (7th February 2005) we selected 12 operations and operated from 7.30 am to 12.00 midnight.

On 8th February 2005, we started operating at 7.30 am and finished at 12.00 midnight and operated on 12 cases.

On 9th February 2005, we started at 8.00 am and finished at 2.00 pm and operated on 3 cases.

The cases that we operated ranged from mal-united fractures, un-united fractures, fusion of ankle joint, shoulder joint and wrist joint due to old fracture dislocations, leg lengthening procedures using the external fixators, neglected bilateral and unilateral club feet, quadricepsplasty for stiff knees, sequestrectomy for osteomyelitis, tendon transfers for nerve injuries, subtalar arthrodesis for old fracture calcaneum with subtalar arthritis and triple arthrodesis for deformed feet. We were unable to do any spine or joint replacement procedures due to lack of facilities.

After doing the ward rounds on 9th February 2005, we were taken to Mulaithivu which was about 10km from this hospital. The whole area was devastated but the local population with the Tiger cadets had done a remarkable work clearing the area and housing the people in temporary camps. While we were there, we saw a number of aid workers too helping the population.

We were then taken to two orphanages; one for girls and the other for boys. Most of the orphans had lost their parents during the civil war and some during the tsunami. These orphanages were well run and we gave a donation to the orphanages.

The next day (10th February 2005), we did an early ward round and recommended the necessary treatment for the patients whom we had operated on. The patients will be followed up by Dr Sivapalan and by the orthopaedic surgeon in Jaffna Hospital, Dr Umapathy.

We left the Dr Poonambalam Memorial Hospital and visited Kilinochi town. This is the capital of the Vanni area. In Kilinochi, we were received by the local council leaders. They thanked us for the help that we had rendered and asked us to come again as they desperately needed our help. We proceeded to Jaffna where we visited some interesting places.

The next day (11th February 2005), we flew from Jaffna to Colombo and left Colombo at 12.35 am on Saturday (12th February 2005) and arrived in Kuala Lumpur at 8.30 am.


Conclusion
Since there is lack of orthopaedic expertise in Sri Lanka, there are many cases that need to be attended to. The population had many orthopaedic problems and neglected trauma cases due to civil war and the tsunami disaster. The local doctors had requested that further teams be sent to help them manage the orthopaedic problem and they also said they would appreciate it if we could source some orthopaedic equipment or implants for them.

Report by
Dato' K S Sivananthan
Immediate Past President, APOA &
Member, MOA Tsunami Medical Relief Committee