SURGIA Newsletter: General Surgery Edition Volume II Issue 1 | Page 40

KANDY
GENERAL HOSPITAL
Sri Lanka
by Rachel Sanders

M

y placement began in Kandy General
Hospital in the hillside area of Sri Lanka. In a town
of roughly 100 000 population, the 2000+ bed
hospital was a landmark in the town. The hospital
contained every speciality imaginable plus more,
with a university for both nurses and medical
students attached to the hospital. It sprawled up a
hill, covering a vast area of the town, yet could not
cater to all the population of the area. There would
regularly be patients on mats on the floor instead
of beds.
My elective was in General Surgery. My team
consisted of a consultant, 4 registrars, 2 residents
and 16 medical students. General surgery covered
everything from tendon repairs to appendectomies
to amputations. The general surgeons practised
extremely general surgery. The registrars were
taught all from caesarean sections to mastectomies,
were extremely skilled and knowledgeable. It is
necessary in Sri Lanka to do some of your training
abroad to become a consultant. The registrars
mainly to travel to Australia, Canada and the UK
and are extremely interested in the practices we
have the differences between our practices and
theirs.
With the skill and knowledge of Sri Lankan doctors
similar to that in Australia, it is a severe contrast to
the resources and equipment that is available.
With no staple guns, all suturing is done by
hand. Many times procedures were performed
under local anaesthetic when general anaesthetic
would have been more appropriate such as toe
amputations and tendon repairs. All procedures
were performed open as laproscopic equipment
is costly. Most materials used at reusable such as
gowns and sterile drapes.

37 | SURGIA Newsletter The General Surgery Edition

During my time in the department I attended
ward rounds, theatre lists and outpatient clinics.
Theatre consisted of both planned surgeries such
as appendectomies and thyroidectomies but also
an emergency list once or twice a week.
The emergency list consisted of any trauma patient
that needed treatment for a wound as well as other
procedures such as incision or drainage. There
were always so many patients that there were
always at least 3 patients per theatre with multiple
surgeries being performed at once. The week
before I arrived in the operating theatre there
were multiple people injured after an elephant
stampede after a local festival. I was allowed to
help assist in surgeries and suture minor wounds.
Outpatient clinic was a real life textbook, every
patient we saw had similar signs that we do not
usually see back home. It is unfortunate in Sri Lanka
that farmers and workers do not routinely visit any
health practitioners or visit the doctor or hospital
only when the pain is unbearable. Bleeding,
diarrhoea, constipation is something that most Sri
Lankans do not see as warning signs of something
more severe and just manage these symptoms
themselves. This in turn means that the patients
do arrive at the hospital with severe progression of
their disease state.

“With no staple guns, all
suturing is done by hand...
Through this elective I
learnt that healthcare in
Australia is absolutely world
class.”