Along with the launch of the world’s biggest civilian hostage rescue operation, General Hospital Vavuniya is faced with a massive influx of patients demanding medical and surgical attention. This displaced civil population includes a significant proportion of children. These rescued civilians, including children are being settled temporarily in the Vavuniya District. As a result, the General Hospital Vavuniya is compelled to cater to an extra influx of nearly 170,000, 10% or more of whom are children under five years.
The number of child patients in the general paediatric ward has increased alarmingly over the past few weeks.
The total number of the hospital admission has shown a fourfold rise, comprising 50% surgical admissions and nearly 30% paediatric.
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| Dr. Vasana Kiridana |
The paediatric ward with a 40 bed capacity has now more than 250 patients a day. This figure sometimes goes upto 360 to 370. These children are invariably accompanied by one or both parents and other siblings sometimes increasing the total number of people in the 40-bed ward to about 700.
Extensions are now being constructed to enable accommodation of these people. Checking on the patients on daily ward rounds, giving medications on time and even providing meals have become daunting tasks.
Adding to the problem of over crowding, is the reluctance of the patients who are discharged to go back to their temporary shelters but opt to stay on in the hospital. This is creating an additional burden on the medical and administrative staff.
Initially, it was a nightmare because of the skeleton staff comprising seven nursing officers, one paediatric consultant, four medical officers and four intern house officers. However when authorities realized that the unfolding situation at the hospital was a national crisis, assistance started flowing into Vavuniya. Regular nursing teams from General Hospital Kurunegala provided an invaluable service to the Paediatric Unit until recently when a new batch of nursing officers was permanently appointed to the hospital. A new batch of doctors too arrived recently.Both doctors and nurses are tirelessly working round the clock to save these hapless children. I appreciate their dedication and the loving care they extend to them is more valuable than the best medicine in the world. Most of them are far away from their homes and working without a break or proper meals.
Meanwhile the children have undergone weeks of terror, starvation and emotional disturbances. We have identified numerous medical as well as non-medical problems in these children. They have not received any medical care for months due to the displacement. Children with long term medical problems like asthma, fits (epilepsy) and urinary tract infections have been without their regular medications as they were unable to attend regular clinics. We have also identified many complicated medical conditions that have not been investigated at all.
Many of these cases I would not expect to see so commonly in my entire clinical career.
Many children suffer from moderate to severe chest infections, diarrhoeal illnesses and communicable diseases like typhoid and hepatitis. Behavioural and psychological issues too are cropping up due to acute emotional stress. Varying degrees of acute malnutrition is a well identified public health issue contributing to the low resistance to infections and recovery from protracted illnesses. These children have been living through the most miserable period of their lives over the past few months, living under trees and bunkers suffering physical and mental anguish, with minimal supply of food and water. Some children have been suffering from fever, cough and diarrhoea for weeks. They need careful resuscitation and stabilization until their lives are out of danger. The number of patients requiring mechanical ventilation at the General Hospital Vavuniya have also increased significantly.
Unfortunately, sometimes it is impossible to save some of the lives either due to extreme delay in receiving medical attention or inadequate intensive care facilities.
From the beginning, the paediatric unit has been getting meticulous attention from the Health Ministry. Regular assessments by Ministry officials have helped identify deficiencies and shortcomings resulting in diversion of extra manpower and facilities to the unit. The young patients also received a lot of help and support from well wishers and various nongovernmental organizations. The Medical Superintendent of Vavuniya Hospital has been working hard towards improvement of the paediatric services in the hospital.
The latest development is the launch of the therapeutic feeding centre in collaboration with the UNICEF in the paediatric ward for children with acute malnutrition. A dedicated team including doctors, nurses, nursing students and volunteers were trained to feed and monitor this special group of children. The nutritional programme is progressing successfully under the close supervision of Dr. Ajith Mendis, Director General Health Services and Dr. Palitha Mahipala, Deputy Director General Public Health Services and the UNICEF team.
I am thankful to the consultants and the paediatric postgraduate trainees from Lady Ridgeway Children’s Hospital and other general and teaching hospitals of the country for the service they are providing in the general and peripheral hospitals and the temporary settlement areas in Vavuniya district which helps to reduce the workload at the GH Vavuniya in this crisis situation.
Some of our extremely ill patients have been transferred to bigger hospitals like Kandy General Hospital, Sirimavo Bandaranaike Hospital, Teaching Hospital Peradeniya and the Lady Ridgeway Children’s Hospital. Most patients, who recovered, returned to us with smiling faces and their parents were grateful to the doctors and nurses of those hospitals for the loving care given to their little ones. For most patients, it was their first time out of Wanni and therefore were thankful for the opportunity to see what the rest of the country looked like.
It is nice to see the smiles on their faces and strength in their little feet to run around as they recover under our care. It is the best reward and feedback we gain as clinicians to strengthen and motivate us to continue our hard work. Some children have lost either one or both parents and other loved family members and although they breathe a sigh of relief today, these children will have stories full of sorrow and tragedy to relate throughout their lifetime.
Therefore, I believe it is our prime duty as medical personnel as well as human beings to treat these withered flowers with loving care so that the weary petals could refresh and bloom again.
The writer Dr. Vasana Kiridana (MBBS(SL) DCH(SL) MRCPCH(UK))
is the Consultant Paediatrician of the General Hospital,
Vavuniya |
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