I took this opportunity to push myself out of my comfort zone and experience healthcare in a different country. The natural disasters, such as the tsunami in 2004, and the 3 decades of civil war, have dramatically affected the mental health of Sri Lankans, resulting in increased substance misuse and suicide. This attracted me to choose Kandy, Sri Lanka, as a placement to challenge me. I could only go for 2 weeks, and as much as I would have liked to have stayed longer, I still learnt a lot in my short time there.
The hospital I was placed in is the second largest hospital in the country, serving 7 out of 9 provinces, which equates to two thirds of the country. Arriving at the hospital it hit me how busy it was. There are 2406 inpatient beds, with around 5500 staff (including mental health), and a total expenditure on health as a percentage of gross domestic product is 3.96%; compared to my local hospital in the UK which has 1785 inpatient beds with 15000 staff (not including mental health), and a total expenditure on health as a percentage of gross domestic product is 9.8%. These differences were very visible to me, for example the waiting rooms were packed full of people standing around.
We proceeded onto the mental health ward which was set back from the rest of the hospital, away from everybody else. My first day was a huge culture shock. I noticed the lack of funding and resources: the building was older than the rest of the hospital; the windows were metal mesh (which was okay due to the heat but probably not practical when there are heavy downpours of rain); and there was a vast diversity of patients.
The wards were split into female and male, and included mental health, learning disabilities, forensic patients, and the homeless. My first day I saw that someone was tied to a bed, which I felt very uncomfortable with. I asked the master why he was tied to a bed and he explained it was because he had been violent and needed to protect the ward. This really shed a light on the difference in funding between our countries. In the UK we have the funding and staffing to put that person on 1-1 or 2-1 observations for example, whereas in Sri Lanka they do not have this facility.
I got to witness electroconvulsive therapy (ECT) on the ward. The treatment was very similar to the UK, the main difference was that they had the ECT room on the ward, and the speed they got through everyone who needed the treatment; 8 patients in 1 hour and 45 minutes! As soon as someone received the treatment and was starting to recover, the next patient was on the bed getting ready for their treatment. Patients were queuing up with their blankets in their hands, having a laugh and a joke with each other.
I spent time in the psychiatric clinic, where a psychologist offers talking therapies. Common problems the clinic receives are exam related, feelings of guilt due to religious beliefs, and consanguinity. One case I remember was a young autistic boy whose parents were concerned that he had no perception of risk and gave the example of when he bit a deadly snake!
The master on the ward took me and 2 other mental health nursing students to the rehabilitation and training centre. I really enjoyed this day, so much so my face hurt from smiling! This centre is situated on the outskirts of Kandy. The master explained to us the reason for this is due to the stigma of mental health.
When we arrived, we were welcomed by everyone and shown around the grounds. One patient was proudly showing us the gardening he had done and the artwork he had produced. It struck me how forward thinking the staff were. Their vision was to create independence and improve life skills with recreational activities, with the involvement of families and the community. They made things to sell in central Kandy, to create awareness of mental health.
Overall, this placement really opened my eyes and taught me to question why other cultures do things the way they, when in fact they are just doing the best they can with minimal facilities available. Each day all the patients were happy to talk to us and to try and learn English as well as teach us Sinhala, whilst also having a laugh.
I built a strong relationship with the other students whilst in Kandy, where we supported each other and socialised and travelled together in our spare time. The best way to end a day on placement is to go to an elephant sanctuary or go swimming in a roof top swimming pool.
I particularly enjoyed my weekends hiking to Worlds End in Nuwara Eliya, Ella, and Galle. Sri Lanka is a beautiful country, and as a solo female traveller I felt very safe. My only regret is that I wasn’t there longer to explore more.