MIOT - UK

Healthcare Symposium UK January 2016

Dear Friends
The North and East of Sri Lanka is beginning to emerge from the effects of decades long conflict which
was terminated in 2009.The conflict and the Tsunami have devastated the Health care, Social, Cultural,
Educational and Economic fabric of the region setting it back many decades. The Medical Institute of
Tamils (MIOT), a registered charity in UK, of over 25 years good standing, has provided humanitarian,
healthcare, technological and financial support to affected communities in Sri Lanka regularly. In particular,
senior professionals and more recently our second generation have dedicated their valuable time and expertise
towards the cause in making a substantial contribution to provide an improved level of healthcare, especially
at a time of great need. We are taking yet another leap, in our efforts in organising this symposium to focus
on improving basic health care needs, particularly concentrating on Primary Health care[PHC].
However we need to be extremely sensitive and aware that we work within the boundaries of the Strategic
Management Plan [ SMP, a brief summary in our website] published by the Northern Provincial Council,
and extend a helping hand in achieving their aims and objectives.
At a time when the climate is favourable and peaceful, it is a window of opportunity for the Diaspora to
make a significant contribution and work with the powers that be, to develop PHC Centres along the lines
of NHS-Style General Practice. At present, there is no infrastructure for local communities to access quality
primary health care, and it is available to only those within reach of government hospitals and dispensaries
run by medical personnel who have not had the benefit of necessary training and skills. Severe shortage of
properly trained healthcare professionals at all levels, lack of medicines and poor financial resources means
increased risk of morbidity and mortality.
We propose initially to establish well-known locations in the peripheral areas of Jaffna and Batticaloa,
to make it easy for the local communities to access PHC services. They now have to travel many miles, at
an unaffordable cost, risking a hazardous journey when they are ill. Patients with simple ailments arrive
at a busy A & E Dept, thereby unnecessarily burdening an already congested, understaffed, underfunded
service. Our plan is to provide quality PCCs manned by doctors, nurses and healthcare assistants, well-
equipped and purpose-built centres, to provide high quality urgent and primary care. Hopefully it will lead
to a better planned and easily accessible PHCCs in other parts of the country.
With the recently formed Private Health Service Regulatory Council making it mandatory for ANY
Independant Healthcare provider, including Family Physicians to be registered [andpresumably regulated]
in Sri Lanka, there are clear signs that quality of care and accountability is being given priority by the
government. The SMP highlights the considerable amount of Manpower, Technological and Administrative
resources they will need to realise the goals set out in the document. It is going to demand substantial funds
towards training,employment and retention of medical and nursing [including healthcare assistants] staff,
modern equipment and sustainability of the venture.

Aims
Our sincere attempt in this symposium is to establish a meaningful dialogue between large hearted and
generous entrepreneurial organisations and individuals to come forward and contribute professionally,
intellectually, and most importantly financially, in this endeavor, so as to develop the disciplines of Family
& Community medicine, currently lacking in manpower and financial resources.

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MIOT - UK

A Private Public Partnership enterprise is needed for the long term sustainability of this venture.
Set up a TRUST Fund from willing donors, entrepreneurs and wealthy individuals particularly amongst
the diaspora. It would ideally be administered by representatives from the Medical Schools and chosen
overseas representatives to support worthy causes, and research projects
The symposium also aims to connect healthcare professionals in Sri Lanka with their counterparts in the
UK and create links between Medical Education Institutions in both countries, especially, between their
respective Community & Family Medicine departments.

Expected Outcomes
Provide high quality Primary Health Care with easy local access
Investment in PHC Centres in peripheral areas in North and East
Setting up of academic Primary Care Centres in the North and East of Sri Lanka linking with the
local medical school department of Family & Community Medicine for teaching and training purposes.
Recruiting Post-graduate doctors training for MD [Family medicine] to work in these PCCs.
Medical Students to do clinical attachments
Teaching, Training and Recruitment of Nurses and HCAs to provide good quality staff.
Student Exchange programmes
Linking Family & Community Medicine Educational institutions in the UK with those of Sri
Lankas medical faculties.
Exchange of skills, expertise, and technology from both countries.
Facilitate research and innovation in primary care.

Event Organisers:
Dr S Poologanathan,(MIOT Overseas Secretary)
Dr S Rajasundaram

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MIOT - UK

President
Dr S Uthayakumar

Vice President Healthcare Symposium 2016

Dr N Sivayoganathan

Gen. Secretary
Dr M Logendran
I take pleasure in commending our North Thames Region (MIOT NTR) for
Asst. Secretary
Dr R Chelvan organising this healthcare symposium in supporting development of health
care service in the North, Northeast and East of Sri Lanka.
Treasurer
Dr GKugapala
Amongst the many healthcare projects undertaken by MIOT, this endeavour
Editor by MIOT NTR represents a long term vision of MIOT for a better community
Dr T Gnanachelvan based health service for local communities.
Co-ordinating
Secretaries The symposium recognises the need to make primary care medicine a career
choice for young medics. I congratulate the organisers for taking a holistic
Overseas Affairs
Dr S Poologanathan approach to primary care development by giving importance to creating
Dr D Sivayoganathan much needed primary care centres that will deliver services, as well as being
centres for community based medical education and training of healthcare
Community Care &
Research workers at all levels.
Dr N Niranjan
Dr S Mohan I welcome the professionals from our ancestral homeland as well as those
Social from around the world and from UK who are supporting our mission.
Dr T Balakumar
I wish the members of MIOT NTR and the organisers a successful outcome
Membership
Dr K Rajakulasingam from the event.

Education
Dr J P D Gnanapragasam

Youth Affairs Dr S Uthayakumar

DrR Rajakulasingam President
Dr A Uthayakumar

Trustees
Dr M Chandrakumar
Dr S Natkunarajah
Dr KNiranjan
Dr E Velauthapillai

_____________________
Address
339 South Street
Romford
Essex RM1 2AP
U.K.

Telephone
+44 (0) 1708 722303

Fax
+44 (0) 1708 725388

E-mail
admin@miot.org.uk

Websites
www.miot.org.uk
www.miotyf.org.uk

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MIOT - UK

MEDICAL INSTITUTE OF TAMILS

SOUTH THAMES REGION
A Message from the MIOT STR Vice Chairman
Chairman
Dear Delegates,
Dr S Surenthiran
It is a great privilege and honour, as the Secretary of MIOT South Thames
Vice Chairman
Region, that I send this message on behalf of the MIOT South Thames Region
Committee.
Dr R Chelvan
Todays medical symposium aims to shine a light on the current health and
social issues facing the civilians of the Northeast of Sri Lanka and through
Secretary
international partnership, we aim to shape a more holistic, patient-centred
Dr (Mrs) S Rajaratnam practice of medicine in Sri Lanka. Therefore, it is particularly befitting that
this event is being attended by noteable academic dignitaries from the Jaffna
Treasurer & Eastern universities in Sri Lanka, Manchester & London Universities in UK
and the Royal College of General Practitioners (RCGP). We are also very
Dr N Puvi fortunate to have a first-hand account of the present situation and aspirations
for the future healthcare services in Northeast Sri Lanka from Dr
Committee Members Sathiyalingam, Health Minister of the Northern Provincial Council, Sri Lanka.

Dr F Balaratnam Despite very different healthcare landscapes, our unique partnership will
create novel ways of thinking around complex problems and provide a forum
Dr B Baskaran
for cross fertilisation of ideas to improve skills, learning and expertise. This
Dr (Mrs) K Gnaanachelvan will hopefully inspire and achieve a better future for our brethrens back home.
Dr S Jeyanathan
I firmly believe that the true wealth of a nation lies in the health of its people.

Dr S Krishnapalasuriar I wish to express my gratitude to the MIOT North Thames Region Committee
and organisers for their tireless efforts in co-ordinating and delivering this
Dr (Mrs) I Kumarendran
unique event. On behalf of the MIOT South Thames Region Committee, I
Dr A Loganayagam wish to thank you all for attending and look forward to your continued support
at future MIOT events.
Dr A Mahendrarajah
With Best Wishes,
Dr N Navaratnarajah

Dr (Mrs) E Selvanathan

Dr J Sharavanan

Dr T Sithamparanathan Dr Rishi Chelvan

Dr S Sivathasan
Vice Chairman, MIOT South Thames Region
Assistant Secretary, MIOT Central Committee
Dr (Mrs) V Vijeyakulasingham

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MIOT - UK

CANADIAN TAMIL MEDICAL ASSOCIATION

CHARITABLE ORGANIZATION #823467279RR0001
7-2466 Eglinton Avenue East, Toronto, ON, M1K 5J8
www.ctmainfo.com
ctmacharity@gmail.com

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MIOT - UK

ABN 91 130 857 715

P.O.Box 226, GLEN IRIS, VIC 3146, AUSTRALIA or
P .O .Box 4440, HOMEBUSH SOUTH, NSW 2140, AUSTRALIA
Phone: 1300 990 828
Email: ausmedaid@gmail.com, Web: www.ausmedaid.org.au
A member of the Australian Council For International Aid (ACFID)

23 January 2016

MESSAGE FROM AUSTRALIAN MEDICAL AID FOUNDATION

The Australian Medical Aid Foundation (AMAF) proudly supports this collaborative
initiative, Healthcare Symposium 2016, being hosted by The Medical Institute of Tamils
(MIOT)s North Thames Regional Branch.

The Australian Medical Aid Foundation is a registered voluntary not for profit charitable
organisation and a member of the Australian Council for International Development
(ACFID). Historically, this collective was born in 1996 to help those civilians caught in the
ravages of the civil war. It was formally inaugurated in Australia on the 10th of March 2001.
Since its inception, AMAF has funded numerous vital medical, dental and allied health
projects in the North East region of the Island of Sri Lanka. These projects have helped
change the lives of thousands of disadvantaged individuals and families across the regions.
We are a collective that includes medical and paramedical personnel along with other
volunteers who share a vision of restoring and providing basic health care for those in need.
The major focus has been on Sri Lanka, a country ravaged by three decades of war,
economic deprivation and natural disasters like the 2004 Tsunami.

We are invested in working with fellow organisations such as The Medical Institute of
Tamils to find the most effective ways to provide essential and sustainable health care for
those living in North East Sri Lanka.

Yours Sincerely

Dr. P. Ketheswaran MBBS, FRANCR

Consultant Radiologist
The Chairman, AMAF

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MIOT - UK

International Medical Health Organization

(IMHO)
Mailing Address: PO Box 341466 Columbus, OH 43234
Physical Address: 400 West Wilson Bridge Road Suite 230 Worthington, OH 43085
Tel: (614) 659-9922 Fax: (614) 659-9933
Email: contact@theimho.org

President
Kana Devacaanthan, MD
(Florida)

Vice Presidents January 19, 2016

Rajam Theventhiran, MD
(New York)

Kanaga N. Sena, MD
Dear Members of MIOT,
(Connecticut)

Secretary
Sri Nanthakumar, PhD As an organization that shares our vision in serving people in need
(Texas) around the globe we join hands with you in your endeavors to bring
Treasurer together stakeholders in the healthcare of the needy in the North &
Murali Ramalingam, CPA East of Sri Lanka.
(Ohio)

Directors IMHO is wishing you all the best to achieve your objective of public
Nanda Nanthakumar, PhD
(Massachusetts) private partnership in rebuilding a better healthcare service in the
Sujanthy Rajaram, MD
North & East of Sri Lanka which needs all the support we can give to
(New Jersey) speed up the recovery from the effects of natural disasters and civil
Legal Counsel
conflict.
Ahilan Arulanantham, JD
(California) On behalf of the members of the IMHO family, I want to congratulate
you for organizing the Health Care Symposium on January 31 2016 in
Programs Coordinator London UK.
Gregory Buie, MA
(California)
Our strength is in our unity

Kana Devacaanthan MD
(Florida )

IMHO is a registered tax-exempt, 501(c)3 non-profit, charitable organization in the United States (Federal Tax ID #: 59-3779465).
IMHO is a registered Private Voluntary Organization (PVO) with the United States Agency for International Development (USAID),
and a proud member of InterAction.

www.TheIMHO.org

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MIOT - UK

STRATEGIC MANAGEMENT PLAN

FOR DEPARTMENTS OF HEALTH & INDIGENOUS MEDICINE
NORTHERN PROVINCE, SRI LANKA
2016 2018

Strategic management plan serves the purpose of direction and means to reach a set goal. In the effort of improving
or establishing services through an organization, setting up goals and focusing on achieving those goals through
a well-planned strategic management plan is highly likely to give results quicker.
After protracted civil war, the Northern Province of Sri Lanka need a well organised development. People living
in the province always give priority of education and health. Health care was always a priority at the policy level
and the government health care services were free for all.
Before the provincial councils were established the national government provided the healthcare to the whole country
while the private sector involvement was mainly existed in big cities. During the period of civil unrest, though
there is no proper account as to how these needs were met for the few who were remaining in the province, there

expedited programs to re settle the displaced and re habilitate the areas so the resettled people can look forward
for a progressive improvement of their lives.The improvements of the health sector also need to be synchronized
with other physical developments in the areas for the people to enjoy a healthy life.
Some areas are more vulnerable to some diseases than others due to different reasons. Therefore, it is important to
understand the prevalence of certain diseases, in order to develop proper strategies to address the issues. Availability
of human resource is a another major issue in health sector.
The 13th amendment to the constitution in 1987 saw devolution of some powers and functions to the Provincial
Councils. The devolution functions involved administration and management of the provincial hospitals network

to carry them out. This resulted in concomitant changes in the management structures, roles and responsibilities of
the Central Ministry that had operated through a decentralized district health system before 1987.There are several
initiatives in the form of acts, policy frameworks and standards, to make the health service better.
According to the health Master Plan of Sri Lanka, the Government is committed to ensuring a high quality,
accessible, and sustainable health system for the people of Sri Lanka.
The Ministry of Health of the Northern Province is making the best effort to provide comprehensive health care to
the citizens of the province. The motto of the Ministry is Health is Wealth. The vision they have is emphasizing
their devotion to make the whole province a healthier province. The accomplishable mission the Ministry has

Ministry has acknowledged a set of values to base the services on, to offer the best care to the people of Northern
Province, to make each and every one to feel secured and taken care by the health system in the Province.
Vision
The vision of the Ministry of Health is as follows. A healthier province that focus more on prevention than cure,
contributes to its economic, social, mental and spiritual development through western medicine and indigenous
medicine, where each individual have equal access to health care, be educated about the value of a healthy lifestyle.
Mission

health services to the people of the Northern Province by formulating policies and strategies in concurrence with
national development plans which enable to face the issues and challenges emerging in the provision of services
within the Northern Province.

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MIOT - UK
care system of the Northern Province and identified following strengths, weaknesses, opportunities
Values
andMinistry
The threats (SWOT).
of Health in the Northern Province is operating on values such as Equity Compassion, Dignity,
Commitment, Integrity, Excellence, Accountability, and Collaboration in providing health care and facilitating
related services.
Strengths, Weaknesses, Opportunities and Threats (SWOT) in the Health care
In this context, new Provincial council was elected on 21st of September 2013. An initiative started to by me after
systemthe
assuming of Hon.Health
the Northern Province
Minister of newly elected Provincial Council. A consultative group was established in

The health
following care system
strengths, in theopportunities
weaknesses, Northern Province is blessed
and threats (SWOT).with strengths and opportunities to
provide healthcare
Strengths, in the
Weaknesses, modern age and
Opportunities to many needed
Threats ailments.
(SWOT) However
in the Healththere
care are weaknesses
system in
of the Northern
Province
the system that need to be addressed and there are some threats to be concerned about as well. Basic
The health care system in the Northern Province is blessed with strengths and opportunities to provide healthcare
in strengths,
the modernweaknesses,
age to manyopportunities
needed ailments.
andHowever there
threats are areidentified
being weaknessesandin listed
the system
belowthat needtable.
in the to be addressed
and there are some threats to be concerned about as well. Basic strengths, weaknesses, opportunities and threats

Table 8: List of Basic Strengths, Weaknesses, Opportunities and Threats

Lack of facilities to provide the best possible

There is a healthcare system in place
care for the population
There is a functioning institutional mechanism
Lack of expertise for the systems optimal
in place
operation
There are healthcare services available in
Lack of funding and allocation to make the
western and indigenous medicine systems
healthcare services at its optimal
There is awareness in the administration about
Lack of awareness and access to information in
the deficiencies of the healthcare system
some levels of the services
There are hospitals, other healthcare providing
Lack of technical advancements and the
facilities and staff available
opportunities for it
There are policies and Standards defined by the
Lack of specialized equipment in hospitals
government within the country regarding health
leading to unnecessary testing and treatment
care; the provincial governments can adopt
resulting inwastage of resources
those.
Low and middle income families cannot afford
There some expertise within the country, willing
high cost investigation and treatment, which are
to give their support to improve the existing
not available in the state sector
healthcare system
Pharmaceutical supply in the system sometimes
There is an allocation for the development of
will not perform as per the regulations, thus can
the provincial health care system by the GoSL
cause threats to the public.
budget.
The existing disconnect of the systems in place
The post war development trend is looking
that results in less than adequate service
favourable towards improving and further
providing
developing the health care system
Lack of integrating the treatment systems to get
the maximum benefit of the available services

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 Lack of integrating the treatment systems to get
the maximum benefit of the available services
MIOT - UK

Interruption of implementation/programs due

Central Government has included the
development of the province in to its future
planning
The provincial government have the will and
the capacity to plan the improvements for the
health system
The province is in a development phase, where
most of the infrastructure is established, brand
new or renovated
As an assistance to post war
development,donors are willing to help the
province to get back in to their normal systems
The governmental health infrastructure system
is accessible to all citizens
Sri Lankans who are qualified locally qualified or
abroad are permitted to join to health service
Increased number of researches in the sector,
and the system provide provisions for valuable
researches.
Integrating the western and indigenous
medicine systems for better care
Well implemented strategic management system
can improve the health condition of the
population which will result increased standard
of living and economic prosperity
to changes of policies, fund availability, human
and other resource availability
Changes of available resources and funding due
to need of diverting resources and funding in a
crisis, such as an unexpected disease outbreak or
a situation like Tsunami(Climate change related
health issues are becoming prevalent but no
adequate planning to address those)
Inadequate or improper planning and
implementation of programs related to health
services
Inactive participation of the service recipient
towards record keeping and preventive
healthcare measures and building awareness
Ignoring war trauma issues of the population
and not providing additional assistance
(monitoring such needs) to the female headed
households
Imbalance demographic cross section. The
number of elderly is rapidly increasing and the
aging structure is no longer pyramidal. Thus can
cause problems if the healthcare system is not
well organized
Escalating health care cost due to
epidemiological transition and rapid changes in
the health care with the introduction of modern
technologies.

The above SWOT analysis has been used in developing the strategic plan to identify and prioritize the areas of
The above SWOT analysis has been used in developing the strategic plan to identify and prioritize
the areas of improvements needed for the healthcare system in the Northern Province. There are
1.
fifteen Human
priorityresource development
areas were identified and a working group was formed in August 2014. The areas
2.
which Improve
were the provision
identified of quality data and Health informatics
as follows:
3. Reduction of incidence of Communicable Diseases
4. 1. Reduce
Human theresource development
prevalence of Non-Communicable Diseases
5. 2. Elderly
Improvecarethe provision of quality data and Health informatics
6. 3. Maternity
Reduction of incidence
& Child of Communicable
Health Issues Diseases
(Adolescent Health, Family planning, Maternal care)
7. 4. Oral
Reduce the prevalence of Non-Communicable Diseases
Health
8. 5. Inter and Intra
Elderly care sector coordination and sanitation
9. 6. Injury prevention
Maternity & Child Health Issues (Adolescent Health, Family planning, Maternal care)
10. Nutritional problems
11. Mental Health Issues
12. Disability

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MIOT - UK

13. General Health Promotion

14. Development of Ayurveda
15. Emergency health care

to support the initiative. Workshops were carried out with the support of the professionals and the strategies were

proposed by the 15 groups of experts are provided in table format under each sector. The information collected
from the 15 groups is annexed as annex 1 to 15 for further reference in the original report.

cross cutting therefore when implementing it is best to identify such cross cutting strategies to avoid repetition.

Goals of the Healthcare System for the Northern Province

and Indigenous Medicine, Northern Province, namely

1. High Quality Care,
2. Universal Health Care,
3. Equitable, Low Cost and Affordable
4. Patient Centred
5. Evidence based

people in the province using the facilities available in the western and indigenous medical systems at
present and possible improvements through effective planning
2. Improve the quality of human resource factor and record keeping in the health care system in the
Northern Province to deliver effective services
3. Empower the population with awareness and to make them want to be proactive towards a healthy
lifestyle for the betterment of self and the betterment of the society
4. Making improved health a key factor in improving the economy through productivity in the province
which will lead to improving the quality of life in the population and by reducing the cost of healthcare
Objectives

objectives under each goal will be given below each goal. Strategies to accomplish the objectives will be proposed
and activities to implement the strategies and how to monitor the implementation and the outcome will be given
in a table format in the chapter below.

people in the province using the facilities available in the western and indigenous medical systems at present and
possible improvements through effective planning
Objectives:
I. Provide equitable services to all citizens with ready access to resources

delivering a better service

due to repetition, when there are no records to follow on a patient

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MIOT - UK
IV. Include all vulnerable groups in community health programs to monitor their condition whether they
come to seek medical services or not
V. Treat injured (such as trauma, poisoning, domestic violence, snake bite and burns) promptly and
properly to reduce injury related morbidity and Mortality
Goal 2:Improve the quality of human resource factor and record keeping in the healthcare system in the Northern
Province to deliver effective services
Objectives:
I. Employ enough service providers and strengthen the human resource capacity for better service providing
II. Improve the skills and knowledge of the personal (through new technology, training and hiring experts
and consultants) and encourage getting their knowledge relevant to the services when they get updated
III. Develop a well-balanced roster system so that the patients are always being attended to while the
employees get their due rest and vacation time (it is important to be concerned about the health of the
service providing teams)
IV. Emphasize the importance of acceptable and kind mannerism towards patients
Goal 3: Empower the population with awareness and to make them want to be proactive towards a healthy
lifestyle for the betterment of self and the betterment of the society
Objectives:
I. Educate the citizens on the importance of preventive approach including preventing accidents, better
food habits and good hygienic practices
II. Encourage people to seek health advice at the earliest possible time to have a better chance of a healthy
life

IV. Creating awareness about the importance of using medicine that is prescribed by a professional
V. Creating basic awareness of communicable and none communicable diseases, reporting, how to prevent
from being vulnerable and seeking assistance if sick and how to treat people under those conditions
Goal 4: Making improved health a key factor in improving the economy through productivity in the province
which will lead to improving the quality of life in the population and by reducing the cost of healthcare
Objectives:
I. Target to reduce the future healthcare cost by preventing unwanted predictable injuries, promoting and
ensuring healthy lifestyle, proactive preventive care of diseases, and well planned monitoring
II. Introduce cost effective improved machinery, technology, infrastructure and drug development/
purchasing through proper research and development

with activities to be carried out to accomplish the objective.

Detail plan is provided in a document for your comments and review.

Province is using the strategic management plan to provide the services to the citizens of the province to achieve
the listed targets listed below, through healthcare.
Providing equitable services to all citizens
Improve in-patient and home care.

Include all vulnerable groups in community health programs.

Treat injured properly to reduce injury related morbidity.

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MIOT - UK

Employ enough service providers and strengthen the human resource capacity.
Improve the skills and knowledge of the personnel.
Develop a well-balanced roster system so that the patients are always being attended to.
Improve staff capacity to provide services for the satisfaction of the customer or patient.
Educate the citizens on the importance of preventive approach.
Encourage people to seek health advice at the earliest possible time.

Create awareness about the importance of using medicine prescribed by a professional.

Create basic awareness of communicable and non-communicable diseases.
Reduce future healthcare cost by preventing unwanted and predictable health situations.
Introduce cost effective improved machinery, technology, infrastructure and drug development/purchasing
through proper research and development.

Conclusion
A strategic management plan is simply a guide or a work plan for an institution for it to carryon a process to achieve
progress. Decision making and implementation become more focus with a well crafted strategic plan making the

The strategic management plan for the Northern Province, Ministry of Health has been focused in emphasizing
the core belief of the institution Health is Wealth.
The overall goals are developed to improve and introduce effective and productive services to their patients.
The target is to serve equally and equitably to all patients regarless of what corner of the province they are from.
Special emphasis are given to address the needs of vulnarable groups, socially induced health issues and mostly
to be proactive in providing care believing that the prevention is better than cure.

provide services as well as to keep track of disease occurence, individual responses to treatment and many more
health related inputs that will help in managing a good health care service in the province.
Although the initial activities to gather information has been done under 15 different sectors in health services,
most of the issues which lead to develop strategies to address the issues are crosscutting in nature. Therefore, the

this document. However, those individual sectors can develop their detailed plans by isolating the required main
goals and the objectives that the starategies are provided under. This activity will be supported with the documents
annexed in here, which are the information provided by the 15 sectors from their discussions.
The costing of strategies have taken the current market values and few other assumptions towards processing, as
indicated in the paragraph. Similar to indentifying and specifying activites for individul sectors for their detailed
implementing processes, detailed budgets also should be prepared at the time of implementation.
Planned strategies will guide the decision makers to plan the activities with a basic plan which should help in
improving the services and facilities in the Health sector in Northern Province an example to the counterparts in
the country.

Ministry of Health, Northern Province

document[Summary] indebted to
EML CONSULTANTS PVT. LTD

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MIOT - UK

Reforms in Medical Education in Sri Lanka

Sri Lanka was initiated in Peradeniya Medical School(PMS) by its founder Dean, late Professor SenakaBibile in
the early 1970s. A group dedicated for this purpose named as Working Group on Medical Education (WGME) was
formed with senior academics from the faculty in Peradeniya and clinical consultants from the General Hospital of
Kandy. Their intense study, deliberations and recommendations to the Faculty Board resulted in the establishment
of an academic unit- the Medical Education Unit (MEU) by the Senate of the University.

one of the two leading centers established for promoting medical education in USA, from University of Illinois
at Chicago and University of California at Los Angeles respectively. Subsequently more academic and support
staff were recruited and trained for the sole purpose of promoting the process of education in schools of medicine,
nursing and allied health.

The World Health Organization (WHO) supported the initiatives of the PMS by providing training fellowships in

Centre (RTTC) for health professions teachers from the entire South East Asian Region (SEAR) and made use
of the facility to promote reforms in curriculum, teaching and assessment in the different countries. Those who
received training in MEU Peradeniya with a few trained from global centers, established their own national
centers in their countries in the late 1970s. In India two such centers are still active in the All India Institute of
Medical Sciences (AIIMS) in Delhi and the Jawaharlal Nehru Institute of Post Graduate Medical Education and
Research (JIPMER) in Pondicherry respectively.It should be emphasized that Sri Lankan medical educators trained
in educational science have played a leading role in shaping curricular reforms in Sri Lanka as well as in other
SEAR countries and beyond.

Today all medical schools in Sri Lanka have their own Department or Unit in medical education with the oldest

Unlike in the past when the schools curriculum consisted of bundles of isolated syllabi of separate disciplines
from departments (rarely made available and mostly not documented), today all medical schools in Sri Lanka have
their own documented curriculum with learning outcomes, subject content, teaching and assessment methods.
A few schools have introduced innovations aimed at reforms as part of the curriculum development such as doing
away with dissection of cadavers in the basic science phase in the Kelaniya University in Ragama, and schools
showing radical transformation departing from isolated departmental structures to completely integrated and
problem based curriculum (PBL) as in Faculty of Health Care Sciences, in the Eastern University in Batticaloa.
The Post Graduate Institute of Medicine (PGIM) of the University of Colombo has established formal programs
leading toa MD degree in the discipline of medical education.

Having had a glimpse of the nature of advancement in pedagogical aspects of medical education, it is important
to know the current needs and realities in practice of medical education in shaping health care in Sri Lanka. Such
a discussion can be meaningful only when global trends are considered in todays knowledge based economy in
the digital world. It is also important to look at medical education as a continuum from the time a student enters
the medical school for undergraduate training to specialization and continuous professional development until he
or she gives up practicing medicine.

Global Trends and Concerns

University based training of medical practitioners was a global outcome since the Flexners Report in USA in 1910.
He exposed the discrepancies between description of courses in different medical schools and clinical opportunities
and realities of training in the USA. His ideal was academic and clinical training in an enquiry based environment
in the university hospital. His concerns were felt throughout the world and even medical training which was initially
commenced in the Colombo Medical College since 1870s became science based academic training in the former

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MIOT - UK
University of Ceylon. It may be useful to note that training of doctors by American Missionary practitioners in
Jaffna has been recorded even before the Colombo Medical College commenced its program. Some of the medical
books translated in the local language by Dr Green is still available in the Jaffna College library in Vaddukoddai.

Early part of post-Flexner period witnessed integration of investigation with teaching and care of patients.
However, the situation changed when medical research became increasingly molecular, bypassing patient care
and teaching. The basic science disciplines expanded in to several branches claiming departmental status and
additional curriculum time for each area without any consideration of the knowledge requirements for training
a basic practitioner within the period of training in the medical school. Thus curriculum development became a

practitioners, a harsh commercial atmosphere prevailed in most countries pushing clinical teachers to increasingly
be involved in generating revenue rather than teaching.

Lancet Commission Report

Almosta hundred years after the Flexner Report a Lancet Commission (2010) consisting of 20 professional
and academic leaders from diverse countries came together to develop a shared vision and a common strategy

fragmented, outdated and static, graduating ill equipped graduates with mismatched competencies for patient and
population needs and having narrow technical focus with predominant hospital orientation. Their training was
found to be lacking in promoting team work, leadership skills, policy analysis and communication skills. The
lack of common goals and shared vision between the professions in their training and practice was considered to
betribalistic in nature.

learning and joint solutions in a world where there is migration of both professionals and patients.
The Commission recommended both instructional and institutional reforms. They suggested improvements in
admission process, continuous curriculum update, and faculty development, multiple learning experiences to
match competencies, self-directed learner centric culture, and inter-professional learning. Institutional reforms to
focus on joint planning by both education and health sectors, included engagement of all stake holders, extending
academic sites in to communities and strengthening of quality assurance and the accreditation process.
The report tried to portray the past hundred years of instructional pattern to have had 3 phases Informative

this theory as early as in 1970s in Columbia University. Possibly problem based learning (PBL) with cognitive
psychological orientation evolved with similar intents, moving away from behavioristic mastery learning concept
adopted in a Competency Based curricula.

Selection of Students forMedicine

Professional education should be considered as requiring different attributes when compared with general

for selection of students for medicine. The current system adopted in Sri Lanka based solely on knowledge based
competitive A/L examination may leave out promising candidates with other desirable attributes required for
learning and practice of medicine to improve health and quality of life.

management.Many schools in the developed world have included different techniques to go beyond assessment
of knowledge to include evaluation of some of the listed desirable attributes in selecting medical students. They
have considered aptitude tests, personal statements, autobiographic submissions, reference letters, situational
judgement tests (SJTs), emotional intelligence tests, interviews, and multiple mini interviews (MMIs). Available
evidence suggests that aptitude testing, MMIs and SJTs are better than other methods.

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MIOT - UK

Transformative Education
The highlight of the Lancet commission report has been on the mismatch between education of health professions

part of one aspect of the health system function. However, the health professionals play a major role in shaping
all components of the system.
The Lancet report suggested transformative education as a forward step to bring about reforms that may solve
existing disconnect between education and health. Three common themes of this approach are - the centrality of

experience that is the starting point and the subject matter for transformative learning (Mezirow 1995). The Lancet
report also emphasized the need for reforms to be competency drivenand adaptive to local challenges but within
a global perspective.

In terms of innovation research transformative efforts involve radical innovation involving structural changes
in the existing settings. Suchinventive efforts have been successful in schools adopting problem based learning.

concern for the process of teaching and learning. Stenhouse (1975) critiqued this trend as equating education with
training. There is hardly any evidence of success in those schools which adopted the traditional behaviorist model
of competency based curriculum.

have included cases or problems in their under- graduate curriculum with incremental trend in integration of
basic and clinical disciplines. However, there is still some resistance from traditionalists towards innovation and
transformative changes. Since Sri Lanka followed the British system in medical education, most changes follow
changes in the UK. The PGIM graduates who return from UK after their component of foreign training for a MD,
have been a motivated group in promoting such educational reforms taking place in Sri Lanka.

Inter Professional Education

Interprofessional education (IPE) is a collaborative approach to develop health care professionals as future members
in the health care team. IPE is currently practiced in several universities in Europe, USA and Canada. The Lancet
Commission, World Health Organization (1998) and Institute of Medicine (2003) have encouraged Medical, Health
and Social Science programs to go for collaborative IPE to provide better health care and quality of life for all
people at all ages at affordable cost.
IPE programs consist of two or more programs associated with health and social care engaged in learning with
and from each other. There are several IPE programs with different combinations and varying periods from one

the same learning experience either in the same location or by teachers from different professions, without student
interaction and sharing of experiences is not considered as IPE.
In Sri Lanka efforts to have IPE in the Faculty of Medicine in the University of Peradeniya was thwarted by some
members of the medical profession and few militant medical students resulting in a separate faculty for Allied
Health Sciences. In the Eastern University the medical school is a part of the Faculty of Health Care Sciences
(FHCS) established with a broader vision to initiate IPE, which is yet to be achieved.
In Nepal, B P Koirala Health Sciences University Medical and Nursing students work collaboratively in a Maternity
and Child Health program.University of Florida in the USA has conducted a yearlong Inter disciplinary Family
Health course involving students from medical, dental, pharmacy, nursing, physiotherapy, and public health and
nutrition programs.

Post Graduate Training and Specialization

This is the second part of training of medical practitioners after their full registration following an internship program.
The MEU Peradeniya conducted a research study on internship (Abeykoon et al 1982) and made recommendations
for follow up. The internship is an important year for medical graduates to decide on their choice of future career
in medicine.
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MIOT - UK

In Sri Lanka, the Post Graduate Institute of Medicine (PGIM), University of Colombo is the only institution
currently responsible for conducting Diploma, Masters and MD programs. The subject boards include relevant
experts from all other universities. The MD program includes one year of foreign training in recognized centers
in UK, Australia and India.The PGIM offers specialization in all major disciplines and most sub specialties.

The Ministry of Health is responsible for providing cadre positions in all specialties. However, these positions are

contact in the developed world, the health system in Sri Lanka is yet to formalize this important area which cuts
horizontally across all specialties.

which commenced its medical training almost 100 years later than in Sri Lanka, we are still training only a small
number of specialists. In Nepal more than 5 institutions have initiated post graduate training with expertise hired
from leading institutions from India. Our Universities have the necessary autonomy in the University Act to initiate
programs based on immediate needs of the country or even to support countries in need provided proactive steps

Public Health Education

and human resources to carry out essential public health functions. At the turn of the century public health leaders
from the SEA Region came out together with the well-known Calcutta Declaration on Public Health (1999).This
declaration called for strengthening and reforming public health education, training and research. As a follow up
of this declaration WHO made concerted efforts to strengthen institutions and programs in public health.
In the British - Common Wealth countries in the Region, traditionally public health was taught mainly in the
medical school environment. After the Calcutta efforts new schools/ programs were created in India, Myanmar
and Nepal. Bangladesh also had an Institute National Institute of Preventive and Social Medicine (NIPSOM)
offering postgraduate programs for medical graduates. Thailand and Indonesia have already had well established
public health schools with post graduate programs. In Sri Lanka, the National Institute of Health Sciences (NIHS)
Kalutara, is the only institution providing basic public health courses in addition to nursing, midwifery and pharmacy.
Several reports by international consultants recommended to upgrade this institution to offer degree programs.
Currently PGIM is the main institution providing post graduate degrees for MBBS graduates.
Globalization and health trends in the 21st century have alerted the global health community on the need for trained
human resources in public health. Threats due to epidemics such as HIV, SARS, Bird Flu and Ebola have shown
the increased vulnerability of the global community and the need for interdependence of countries on each other.
It is estimated that over the next 20 years the non-communicable diseases (NCDs) will cost more than 30 trillion
US dollars, which is almost half the global GDP in 2010. Unless the countries invest on institutions and human
resources for public health the situation can hardly be controlled.
Public health is currently considered an independent profession with varied specializations in administration,
management, sociology, economics, and medical informatics. In Sri Lanka PGIM trains only public health
physicians amongst MBBS graduates leaving no option for other health professionals to lead a career in public

promoted specialized training in Field Epidemiology for public health professionals in SEA countries including
CDC Atlanta in USA and recently in the Ministry of Public Health program in Thailand. Sri Lanka should consider
alternative model/program to train human resources for public health. Creating a school of public health following
the model in the USA is an option to be considered.

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MIOT - UK
Conclusion
Medical education in Sri Lanka has gone through incremental changes in pedagogical reforms with a few radical
innovations. Medical educators from Sri Lanka have contributed to curricular reforms at national, regional and
global levels. As pointed out in the Lancet Commission Report the linkages between health and education systems
are far from satisfactory. Problems in health care require engagement of politicians and decision makers in an
informed and coordinated manner. Since the subject of health and medical education come under different ministries

the autonomous universities should do more to engage politicians to bring about change. The existing system of
admission should be discussed at the national level to select appropriate candidates for training in professional
courses.

The medical schools should continue to innovate with more contextual learning for students
indifferent settings of individual and population health care. There is a dire need foran inter professional environment
during training and search for curricular segments where IPE can be implemented between professional groups. The
number of graduates selected for training in both curative and public health specialties is inadequate compared to
regional norms. There should be more well planned programs to undertake specialist training in some autonomous
universities. The scope for public health education need to be widened and upgraded.Family medicine training

in the private sector.

Where there are problems of funding by the Government, Private Public Partnership needs to be encouraged. This is
a contractual agreement between a public agency (national, provincial or local) and a private sector entity. Through
such agreement skills and assets of both sectors are shared in delivering a service or facility for the welfare of the
general public. It is impossible for the State to provide everything for health and education in a country where

Suggested Reading
Flexner A (1910) Medical Education in the United States and Canada: a report to the Carnegie Foundation for
the Advancement of Teaching.

IOM (2003) Health Professions Education; A bridge to Quality In Greiner A C, Knebel E (Ed) Washington DC
National Alaline Press

Lancet Commission Report on Medical Education (2010) Dec 4: 376(9756); 1923 58 E pub 2010 Nov 26.

Mezirow.J. (1995) Transformation of Adult Learning; In M R Welton (ED) In defense of the life world (pp 39
90) New York, State University of New York

WHO (1998) Report of the sub group on multi professional education, Technical Report Series 769; 1 72
Geneva

P T Jayawickramarajah
MBBS(Colombo) MEd (Illinois) PhD(Groningen) PhD (Southampton)FCollP
Professor and Consultant in Medical Education

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MIOT - UK

Green Memorial Hospital Manipay

Green Hospital in Manipay, Jaffna was started as Sri Lankas first Medical School in 1847 by the
American Medical Missionary Dr Samuel Green. It was the second most premier Hospital in Jaffna until the
onset of the conflict. During the conflict it served as the only hospital with operating theatre facilities in 2007.
Thereafter it was damaged further in the war and ceased functioning for a few years.

A UK charity ( Friends of Manipay Hospital; FOMH ) approved by the UK charity commissioner was formed
to support the regeneration of the hospital in 2004 and the efforts have enabled the hospital to become active
again.

The hospital was commended by several governing officials during colonial times by visiting luminaries and
remains a valuable institution worth preserving.

Although the responsibility for running the hospital rests with the Jaffna Diocese of the Church of South India
( CSI ), the Board for Medical Works of the CSI has handed over the day to day medical governance of the
hospital to the Medical Advisory Board constituted by 4 leading physicians in Jaffna ( Dr Surenthirakumar,
Dr Sivarajah, Dr Natchinarkinian and Dr Yogarajah )

The objective of the hospital is to provide urgent care for people in Jaffna peninsula, with a minimal cost
contribution from those who use the services.

A medical laboratory was gifted by FOMH to the hospital at a cost of 3 million rupees.

FOMH have also refurbished at a cost of 5 million rupees a dilapidated and war damaged building ( Jameson
Block ) to be put back into use as a Neurological rehabilitation ward and as a teaching campus.

The Neuro ward and Teaching Campus is thus independent of the Hospital and is run by the Institute of
Medical Sciences which has taken a lease on the renovated building from the hospital at a minimal rent in
recognition of the charitable contribution by FOMH.

The Institute of Medical Sciences is a new charity in Sri Lanka which aims to provide health education in
niche areas where the Government Sector does not provide such training. The idea of creating such an Institute
based at Green Hospital was born from the desire to revive Green Hospital to preserve its great heritage.

Around 25 students train as Health Care Assistants at the hospital currently and some of these students are
from orphanages around the country and others from single parent or low income families.

Manithaneyam Trust a UK based humanitarian charitable trust funds the full cost of their tuition and training
as well as their food and living costs. Manitheneyam Trust has contributed Rs 10 million so far.

Medical Institute of Tamils UK has provided pump priming monies of around Rs 3 million to run the Neuro
rehab centre. IMS provides a monthly free clinic ( Attended on average by around 30 people) for deserving
people who cannot make the cost contribution.

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MIOT - UK

IMS also run a free health screen programme for early detection of diseases funded by MIOT.

Around 30 patients a day use the services of the Green hospital mainly for urgent care and several more see
consultants from Jaffna Hospital on this site for consultations. Patients make a small contribution for their
medical care which helps to pay for running costs.

The revival of the hospital has been an important step in the regeneration of post conflict communities in areas
surrounding the hospital.

By employing around 35 staff the hospital has proved to be a useful employer of female members of the community.

Green Hospital has been able to draw on the goodwill of diverse organisations and people in its quest for
regeneration.

Green Hospital has great potential to form the nucleus of a sub faculty of Jaffna medical school to train
international medical students.

International Medical Advisory Board for IMS

UK
1. Dr S Poologanathan
2. Prof N Sreeharan
3. Dr Jayantha Arnold
4. Dr C Ravirajan

IMS Trustees in Sri Lanka

1. Dr R. Surenthirakumar
2. Dr N. Sivarajah
3. Mr A Rohan
4. Mr.S Suthaharan
5. Mr Sajarooba
6. Dr Nachinarkinian

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MIOT - UK

Moolai Co-operative Hospital

This small, locally well-known Charitable institution the Co-Operative Hospital Society Ltd,Moolai was
established in 1936 as a non profit Co-operative venture, in a village situated about 8 to 9miles from Jaffna. In
the northern peninsula of Sri Lanka the latter is the heart of the Northern province of Sri Lanka, and has the
only reasonably well equipped DGH,providing better quality Secondary Care and Tertiary care to the entire NP
covering a large population of over a million people. Jaffna DGH is also the Teaching hospital for the Medical
School attached to it, and is in need of manpower and technological resources.
You are well aware of the calamitous ethnic conflict since the early 1980s ending in hundreds of thousands
of lives being lost,and families destroyed,affecting the N,NE and E Sri Lanka which resulted in the destruction
of Social and Economic infrastructure in these areas. One doesnt need to spell out how the health care would
have suffered in an already underfunded, under -developed part of this beautiful tourist paradise island in
SEAsia.

Current State
When i visited this hospital in October 2015 I met with the Hospital Board and was taken around by
the members to see and assess their needs- almost a fact-finding mission! Photos of the hospital printed in the
back inside cover show its 5-acre site in its current condition ,showing it requires massive renovation to the
numerous atleast 9 individual buildings- including the surgical theatre,labourroom,X-ray unit ,pharmacy,wards
and out -patient departments .
It was during this visit that I gathered how difficult it is for the locals to access basic healthcare
and the difficulties to mothers [especially ante and post- natal,]babies and children, victims of common
infections e.g.malaria,dengue,TB,as well as preventable complications in catastrophic long term conditions -
Diabetes,Cardiovascular Disease etc. Gynaecological and Sexual Health facilities need addressing immediately.
Psychiatry services are one of the hardest hit,and patients need help badly.Screening is a concept virtually
non-existent because of inadquate prioritisation and resources. Heatlh care services in many parts of the country
suffer lack of resources and poor execution,made severely worse by decades of conflict.

Administration
Moolai Co-operative hospital was always administered by a committee elected by its members since
1936,but was registered as a charity in 1953. Its current board is charged with day-to-dayadministration,and
finances.They are audited by the Commissioner of Co-op Development independently, and advised by them.

Staffing
Because of sheer lack of resources in terms of manpower and finances, medical and nursing staff are
woefully inadequate.They have a qualified doctor, male , whom I had the privilege of meeting.My understanding
is that he works only between 8am to 1330hrs. except Sundays,when a lady Registered Medical practitioner[
an Apothecary] manages the OPD between1400 to1900hrs.

Aims and Objectives

It is our vision to lift this particular 5-acre site with several proper buildings currently in a neglected
state, which at one time before the 1980s,stood as a beacon,offering excellent care and ready access for essential
healthcare needs,to the local population of about200,000 in a relatively remote part of SriLanka, before the
ethnic conflict destroyed the set up in the mid1980s.

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MIOT - UK

Action plan
We would model our business plan on the basis of a Private Public Partnership enterprise- with many
stake-holders, both entrepreneurs and willing individual donors-keen to develop the hospital along the following
lines:

01. Establish a modern,convenient access for patients,serving the local needs for a population of about
160,000 to 180,000.This would serve a radius of several miles and prevent patients,particularly those needing
primary care advise for minor ailments ,and urgent assessments to decide on the need for Secondary Care, having
to travel 10miles or more to be seen in the A&E department,Jaffna.

02. Better local primary care means less unnecessary, costly attendance to an overcrowded A&E in Jaffna
Hospital nearly 10miles away.

03. As a result Jaffna Hospital A&E can improve their performance and get on with their duty of attending
to emergencies.

04. The journey is costly as much as Rs2000[=10] on average,when a mans daily wage is as little
asRs1000[=5]daily, via poorly maintained roads,taking as long 60 to 90mins which can sometimes make the
difference between life and death for many kids, and pregnant mothers eg. in labour with hardly any ante-natal
care,Diabetec Ketoacidosis, which is still common due to poorly controlled Diabetes Mellitus,CHD,CVA,Head
injuryvictims,Snake bite victims etc.Hence the need for modern ambulances ,which is not available.This will
no doubt be life saving,safer, quicker journey by ambulances with resuscitation commenced on the way.

05. We are in the process of improving the facilities in the Institute of Family Medicine at this site in
consultation and in collaboration with the premier Government institution i.e. Jaffna University Medical
School teaching staff,particularly the Community Medicine department,and the MS [medical superintendent]
Jaffna hospital, who have shown a great deal of interest to work with us. A philanthropic minded Dr Ratnam
Niththyananthan ,through Ratnam Foundation ,has been funding a community based Diabetc Clinic in MCH
for several years , especially when it was most needed and we applaud him. Similarly we too see this as a
great opportunity to re-establish some order post-conflict, and prioritise basic healthcare, so as to use the scarce
resources to its full potential.

06. Employment, including training and teaching of Nurses and HCAs is one of the chief objectives , because
a trained nurse is a rare commodity ever since the ethnic war started,as people fled these areas for safety.

07. Re-open the dispensary and pharmacy services which were well organised and provided safe, good
quality medicines easily obtained locally, prior to 1980s.

08. Following mass exodus of people during nearly four decades of conflict, part of the institution has
become a Nursing and Residential Care facility for vulnerable elderly medically infirm patients, and elderly
residents whose families have moved away for the safety and education of their children, many seekng asylum
in ,or migration to countries all over the world .A substantial number of us working in the NHS belong to the
diaspora who migrated or did not return after completing our post graduate training in the UK. These residents
do not have proper healthcare and we want to try and provide support for the development of this.

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MIOT - UK

09. We also plan to develop the model of NHS style Screening and Health promotion to delay and
where possible prevent chronic long term conditions and complications. Good examples would be Type2DM,
Obesity,Childhood immunisations etc. A number of doctors working in different parts of the world have expressed
willingness to volunteer to work free and give some of their Primary and Secondary Care experience.

Business plan
a. Capital expenditure
b. Staffing
c. Equipments
d. Ambulances
e. Training

Specifically aimed at the following categories:

A. Urgent Care Centre-and Out Patient Department for the local population of 160,000 to avoid an
unnecessary, costly journey to Jaffna Hospital A&E,already congested and unable to cope.It also
causes delay in dealing with emergencies.
B. PregnantMothers who need quality Ante-Natal and Post Natal care,easily accessible to them.
C. Gynaecological Services.

D. Paediatric Services -particularly Primary immunisation,Screening

and treatment of malnutrition,worm infestation etc.

E. Psychiatry OP Services

Dr Sittambalam Rajasundaram
GP.Kent.UK.

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MIOT - UK

Symposium on Community Healthcare Needs N&E Sri Lanka

Public Private Partnership in Healthcare
09:15 10:00 Registration & Coffee

Event Moderator
Dr Aarani Nirkunan,Cons. Neurologist
St Georges Hospital,London

10:00 11:00 Developing Centres of Excellence in Primary Care

Chair: Dr. N. Niranjan GP, Barking & Dagenham, Essex

Moolai Co-op Hospital

Dr. S. Rajasundaram - GP, Pettswood,Kent
Green Memorial Hospital - Manipay
Dr. S. Poologanathan - GP, Romford, Essex
Primary Care Centres in Eastern Province
Dr. T. Periyasamy - GP, Earls Court, London

11:00 - 11:30 Mental Health Services

Chair: Dr S Srikumar, Consultant Psychiatrist
NE London & Essex
Mental Health Challenges
Dr S Sivayokan , Consultant Psychiatrist, Jaffna Hospital,
Senior Lecturer ,Faculty of Medicine, Jaffna

11:30 12:30 Dental / Oral Health Service Development

Chair: Dr Raj Rajarayan, OBE, Former Dean, Faculty of
General Dental Practice, Royal College of Surgeons [ Eng]
Current State
Dr. V. Rajayogeswaran - Senior Lecturer (Ret), Oral Surgery
Guys & St Thomas Hospital
Oral Health- a modern approach
Miss M. Sivaganeshan - Dental Undergraduate, Norway

12:30 13:30 Lunch

24
MIOT - UK

13:30 15:00 Medical Education and Research in Primary Care

Chair : Dr N Sivananthan,GP,Haringey,North London

Dr. Anne OBrien - GP, Redbridge, Essex,

Senior Lecturer & Clinical Lead,Community Based Medical
Education, Barts & London School of Medicine & Dentistry
Ms. Marian Surgenor - Director of partnerships, Manchester Global
Foundation, University of Manchester
Prof. Kay Mohanna - RCGP International Affairs, GP
Director Postgraduate Studies,
Keele University
15:00 15:30 Tea / Coffee

15:30 16:30 Vision for Medical Education and Primary Health care
N & E, Sri Lanka
Chair Dr P Kandasamy, GP,West Essex,UK

Dr .R.Surenthirakumaran , Senior Lecturer,

Community & Family Medicine, Faculty of Medicine, Jaffna
Dr. K. Arulanandem , Lecturer , Family Medicine,
Eastern University Hospital,Batticaloa
Dr. T. Sathiyamoorthy - Medical Superintendant,
Jaffna Hospital

16:30 18:00 Mission for Health care in N&E Sri Lanka

Public Private Partnership
Chair Dr. M. Chandrakumar - GP,Kent
Consultant, Public Health
Dr. P. Kandiah - Consultant Radiologist, Norway
Dr. S. Raviraj - Dean, Jaffna Medical Faculty
Dr. P. Sathiyalingam - Health Minister,
Northern Provincial Council, Sri Lanka
Prof. N. Sreeharan - Foundation Professor of Medicine ,
Jaffna Medical Faculty
18.00- 19.00 Discussion /Networking , promoting the way forward
This programme will qualify for CME

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MIOT - UK

Dr S Poologanathan
MBBS, LRCP, MRCS(Eng), DIMC(Ed), FRCS(Ed), FRCGP, FRACGP
A family physician with special interest in surgery in Havering, UK since 1991.

Started his career in Batticaloa Hospital and Continued as Neurosurgical registrar in Colombo
General Hospital for two years. Continued his post graduate career in UK, in emergency
medicine and trauma surgery until 1991. Fellow of the College of Surgeons (Ed), College of
Emergency Medicine UK, College of General Practitioners in UK & Australia.
PGIM trainer in Sri Lanka for MD and a visiting lecturer in Family Medicine.
Passionate about medical education and developing teaching primary care centres in Sri Lanka.
He is a past president of MIOT and a co-founder of The Institute of Family Medicine.

Dr Mathi Chandrakumar
MBBS LRCPEd LRCPSGlas FRCSEd FFPHM (UK)
Consultant in Public Health Medicine/Communicable Disease Control.
Clinical Director/ Principle Port Medical Inspector Heathrow Airport, UK.
General Practitioner, Hythe, Kent.
Visiting Lecturer, University of Jaffna.
Director of Health Protection for Kent (2000 - 2012)
Honorary Senior Lecturer, University of Kent (1994 2012)

Prof Kay Mohanna

MBChB, MA, Med, PGDipMedEd, FRCGP
Professor Mohanna is the RCGP International Development Advisor for South Asia and
in this role quality assures the MRCGP International Examination for South Asia, based in
Sri Lanka and Karachi. She runs International Teaching the Teachers courses for the RCGP
in South Asia and the Middle East. She is Professor of Values Based Healthcare Education at
Worcester, and a collaborating partner at the Centre for Collaboration in Values-Based Practice
in Health and Social Care at St Catherines College, Oxford.

is a committee member at the National Collaboration Centre for Womens and Childrens Health for NICE. Until July
2015 she was Director of Postgraduate Studies at Keele University School of Medicine and was previously a member
of the National Quality Management of Training Standards Committee for the UK Royal College of General Practice

Training: Making it happen; the RCGP curriculum support resource Care of children and young people; and Teaching
Made Easy, a handbook for teachers and trainers, published by Radcliffe and now in its third edition.

Dr Ann OBrien

undertook General Practice Vocational Training,completing this in 1980. She has been a
principal in General Practicesince then and has had experience of working in the FHSA,
FPC, PCT and LMC in Redbridge NHS over the last 30yrs, and until more recently to
Medical Director level . Ann has been a GP with Special Interest in Diabetes and was
awarded the FRCGP in 2002.
She moved into a more academic role at Barts and the London in April 2004 to follow her interest in undergraduate
medical education. Since being a member of the academic staff she has been involved inteaching communication
skills across all years of the curriculum. This has been in addition to facilitating PBL groups in years 1 and 2, as
well as acting as a mentor to year 3, 4 and 5 students. She has acted as an OSCE examiner for exams across all
years and has been involved in the development of exam questions, recently with responsibility as Senior Internal
Examiner for Year 4 OSCEs.
Within the Centre for Community-based Medical Education, Ann is the lead for Quality Assurance of teaching
in the primary care setting.
Anns interests are in inter-professional education, professionalismin medicine and diabetes.
Publications:Kwong T, Kwong Q, OBrien A, Haswell J, Hill K. Elsevier Medical Communication Skills and
Law made easy: The patient centred approach
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MIOT - UK

Marian Surgenor
Marian Surgenor is the director of partnerships at the Manchester Global Foundation.
She is also the Associate Dean of the Faculty of Medicine of Gulu University and
the Clinical Director Global Health of the University of Manchester.
A nurse and midwife with over 40 years of NHS service, MrsSurgenor has been
Lead Clinical Skills Tutor for the Undergraduate Medical Education Department,
UHSM, and is currently Head of Global Health/Inter-professional Lead at the UHSM
Academy.
She is the founder of THETthe UK support organisation for Health Links between
health institutions in Africa, Asia and elsewhere in the world, and their counterparts
in the UK.
She was instrumental in the health partnership The Gulu-Man Link, founded in 2006 as a collaborative education
partnership by The University Hospital of South Manchester (UHSM), Gulu University Faculty of Medicine and
Gulu Regional Referral Hospital, Norther Uganda, in order to improve healthcare in Uganda through education
and local clinical education programmes. She was appointed the Associate Dean, Faculty of Medicine, Gulu
University, Northern Uganda in recognition of her contribution.
She is an expert in all aspects of supporting NHS and non-NHS volunteers participating in international work.

Dr Nadarajah Niranjan
Dr Niranjan is the senior partner at Victoria Medical Centre in NHS Barking and Dagenham.
He is a product of Medical Faculty of the University of Colombo with over 35 years in
the medical profession.
He is the co-ordinating secretary for community care and research activities in the central
committee of MIOT and a past president of MIOT North Thames Region.
He was a director of the Institute of Family Medicine, a registered medical institution in
the private health services regulatory council in Sri Lanka.
His passion is to develop a centre of excellence in Family medicine in Batticaloa in the East of Sri Lanka. He has

Dr Raj Rajarayan
DrRajarayan was a former Dean of the Faculty of General Dental Practitioners (UK), The
Royal College of Surgeons of England. He is currently the Associate Dean of Postgraduate
Dentistry with the London Deanery.
He founded the National Centre for Transcultural Oral Health at the Eastman Dental
Institute and was co-author of the publication Dentists Patients Minorities sponsored by
the Department of Health. He was a member of Sir Nigel Crisps Black and Minority Ethnic
leadership forum and is a member of NCCA Equality and Diversity Forum.

at the Royal College of Surgeons of England.

He is an elected member of his professional regulatory body, the General Dental Council. He lectures internationally
and has published many articles.
He was awarded the OBE in 1999 for services to dental education and in 2005, given the Humanitarian Award
in Canada by the Academy of Dentistry International.

Dr S Rajasundaram
Senior partner in 4 doctor family practice in a busy suburb,Pettswood in Kent
Has been a Family Physician for over 25 years and a GP with special interest (GPwSI)
in Diabetes and Epilepsy for the past 15 years.
Qualified from Colombo Medical faculty in 1978 and continued his career
in the UK from 1981 and worked in different disciplines of medicine;
chest,gastroenterology,cardiology,nephrology and as a neurology,Medical Registrar
for 4 years before switching to family medicine in 1989.
He had his primary education in Royal College Colombo Sri Lanka.
His interests are in developing an academic primary care centre Moolai Co-operative
hospital in his ancestral home town.
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MIOT - UK
Hon.Dr. P. Sathiyalingam
Honourable Dr. Pathmanathan Sathiyalingam is currently the Minister of Health and
Indigenous Medicine, Social Services and Rehabilitation, Probation and Childcare Services
and Womens Affairs in the Northern Provincial Council (NPC) in Sri Lanka. He was
elected to the NPC as a Tamil National Alliances candidate in 2013.
Dr Sathiyalingam is a community physician. He had worked in Mullaitheevu & Vavuniya
districts in the Northern Province since 1996.

(MOIC) for the regional blood bank and was the regional epidemiologist in Vavuniya.
He was instrumental in publishing the Strategic Management Plan for healthcare development in the Northern
Province in Sri Lanka. He is very keen on its implementation.
He is one of the founders and a past chairman of SHADE; an organisation working on psychosocial issues in
the North & East provinces.
He is passionate about public private partnership in developing the health service in the province.

Dr. S. Sivayokan MBBS, MD

Dr. Sivayokan, is a consultant psychiatrist at Teaching Hospital Jaffna. He has been
organizing and delivering mental health services to the people of Jaffna district for the
past twelve years.
He is also a visiting senior lecturer at the Jaffna medical faculty. He was the president of
Jaffna Medical Association from 2006 to 2009.

Dr. Nalliah Sivananthan MBBS ; MRCOG

Dr Sivananthan is the principal General Practitioner with special intrest in minor surgery
(GPSI) at Alexandra Surgery; a 4 doctor practice in Haringey CCG.
He is a GP appraiser, mentor and a tutor for undergraduates of University College
London (UCL).
He was the Locality GP Tutor with Thames Postgraduate Medical & Dental Education (University
of London ) until 1998.
He qualified from University of Colombo Sri Lanka in 1971 and trained as a

He is one of the four founders of the Medical Institute of Tamils and was one time president of the MIOT North
Thames region and held several portfolios in the central committee.
He is a co-founder of the Institute of Family Medicine.
A member of a regional network of 40 GP Educationalists in North Thames and acts as a mentor to 20 GPs working
along with them to innovate new models of learning to suit their needs.
Involved in the development of self-directed learning programmes for multidisciplinary Health Professionals in
their locality of work.

Dr S Srikumar MBBS MRCPsych

Dr Srikumar is a Consultant Community Psychiatrist working in North East London
Foundation Trust. He obtained his medical degree in SriLanka in 1980 and completed his

and has held medical management and Honorary Senior Lecturer positions.
He currently holds a role as a medical member of Mental Health Review Tribunal Services
for Ministry of Justice and teaches medical students from Queen Mary.
His interests are Neuropsychiatry,
Bipolar Affective Disorders and Service delivery in Psychiatry.
He is also an Ex-President of MIOT.

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MIOT - UK
Dr.R.Surenthirakumaran MBBS, M.Sc. (Community Medicine),
PGD (Applied Statistics) MD (Community Medicine)
Head of the Department of Community and Family Medicine at the Faculty of Medicine, University of
Jaffna, Sri Lanka.
consultant community physician &a senior lecturer in Jaffna teaching hospital.
Medical director of Moolai Co-operative Hospital and Manipay Green Memorial Hospital
He is a member of the Sri Lanka Medical Association, Shanthiaham ( Center for Training and
Counseling), Cancer Registry in North East of Sri Lanka and College of Community Physicians.
He previously was the Associate of South Asian Regional Initiative/Equity Support Program, Assistant
Secretary Jaffna Social Action center and Secretary of Jaffna Nutritional Society.
Has a particular interest in Non-communicable disease and Women & Health and has published more
than 20 research papers in his speciality. He is also a life member of the Jaffna Medical Association and
Jaffna Science Association.
Did his post graduate training in community based medical education at Bart and the London School of
Medicine & Dentistry and Rush Green Medical Centre.
He has won numerous awards such as S. Sivagurunathan Memorial Award for Field Component in
December 2000 and VaithiyanathrNadarajah Memorial Award for Distinction (Honors) in Community
Medicine in December 2000.
He has been an ardent supporter and a linchpin in coordinating MIOT and similar international medical
organisations activities in Sri Lanka.

Dr.T. Sathiyamoorthy
Dr. Sathiyamoorthy is currently the medical director of Jaffna Teaching
Hospital. He is a medical professional and administrator who had gone above and
beyond in his service to the internally displaced and war-affected people of Northern
and Eastern Sri Lanka during times of war and great distress. He has served in

at Akkarayankulam Hospital (2000-2002), Regional Director of Health Services-

Kilinochchi and Mullaithivu Districts (2003-2009)Medical Superintendant for
Kilinochchi Hospital (2007-2009), Additional Provincial Director of Northern
Province (October 2009-June 2010), Chairman of the Dengue Task Force in Vavuniya
District (December 2009-March 2010), Director for IDP Healthcare at Manic Farm,
Cheddikulam (January 2010-July 2010), Medical Superintendant for Vavuniya General Hospital and currently the
medical director of Jaffna Teaching Hospital. In all the areas where he has served, he has been directly engaged
with high numbers of impoverished and war-affected IDPs and resettled persons.

and coordinated emergency medical efforts. According to the ICRC, he, along with two colleagues, co-ordinated
the evacuation of nearly 14,000 patients and their caregivers from the warzone between February and May 2009.
In the post-war period, Dr. Sathiyamoorthy returned to serving the displaced by running IDP camps. Housing
more than 300,000 IDPs, he coordinated efforts related to running hospitals and administering day & night patient
care in all six zones. He organized monthly meetings with all stakeholders and helped to coordinate many of the
health-related efforts of the UN agencies and INGOs. He was able to maintain a strong healthcare delivery system
and implement outbreak control mechanisms.
Dr. Sathiyamoorthy has won the prestigious 2010 InterAction Humanitarian Award for his humanitarian action
in Sri Lanka.

Dr.PanchakulasingamKandiah
Dr Kandiah is a Senior Consultant Radiologist in Haukeland University
Hospital in Norway.
He is also the president of the Norwegian Council of Eelam Tamils.

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MIOT - UK

Dr V Rajayogeswaran BDS, MSc, FDSRCS, DDPH

Retired (2008) Senior Lecturer in Oral and Maxillo facial Surgeonat Kings College
Dental Institute.

Served in Ceylon Health Service as Dental Surgeon, after graduating from dental
faculty of Peredeniya in Sri Lanka before moving to UK in 1970. Had his post

He was appointed to Jaffna General Hospital as a Consultant Dental Surgeon. Subsequently he returned to UK
and worked as a community dental practitioner.
Was a part time teacher at The Royal Dental School in June 1977. Became a full time Lecturer in Oral Surgery/
Maxillo facial surgery in June 1983.
Became a Senior Specialist lecturer in Oral and Maxillo facial SurgeryIn 1988.
Was a member in the admissions panel of dental school at Guys, St Thomas and Kings College.
He is currently a civil activist and member of various charities and civil society organisations. (MIOT,Standing
Committee of Tamils, Centre for Community Development, Elders Group, Amnesty International UK, UNA UK,
Global Peace Support Group UK, Medecins Sans Frontieres) and a human rights activist, peace advocate and
dental health advocate.
He is a past president of MIOT and a founder of dental focus group.

Prof. Nadarajah Sreeharan

MD, PhD, FRCP, FFPM, FACP
Prof.N Sreeharan is a physician with extensive experience in Senior Academic and Industry
Executive roles. He currently consults for the Biotechnology Industry, advises the National
Board of Medical Examiners in the USA and holds Visiting Professorships at Kings
College, London and in Malaysia.

Sree held the position as Foundation Chair in Medicine at the University of Jaffna in the 80s, where he also
functioned as the Clinical Sub Dean and as a member of the University Senate and Council.

After a period as Visiting Professor of Cardiology in Canada, he joined the Global R&D organisation at
GlaxoSmithKline where as Senior Vice President and European Medical Director, he chaired an integrated medical
department based across the European countries and led the research & development of several new medicines
globally.

Sree is a Fellow of the Royal Colleges of Physicians and the American College of Physicians, has authored several
publications and book chapters and was a visiting speaker at the Harvard Medical School. As a member of the

he facilitated its development as an accredited medical specialty in the UK and Europe.

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MIOT - UK

Diabetes- A Discourse
Introduction
If God decides to give one disease to every individual that he would prefer diabetes because it is one of the
diseases easier to control-
- so said the learned philosopher ThirumurugaKirupananthaVariyar, as far back as sixty years ago.
This statement is true to a certain extent. Diabetes if neglected and not adequately managed can maim and
kill. So what is diabetes and how can it be managed?
Diabetes is a disease in which the body is unable to produce or respond to the hormone insulin is
impaired resulting in abnormal metabolism of carbohydrates (any starchy food) and elevates the levels of
glucose (sugar) in blood and urine. There are several types of diabetes, of which most prevalent type in the
community are Type 2 (maturity onset diabetes) and Type 1 (Juvenile diabetes). Type 1 can appear at any
time after the destruction of pancreatic insulin producing cells either due to trauma or triggered by either
bacterial or viral infection. About 98% of the affected diabetics in this group are children and other 2% are
adults. Type 1 is also known as insulin dependent because of their daily requirement of insulin as part of the
treatment protocol.Type 2 diabetes usually occurs in adults. It is also being frequently diagnosed in young
overweight people. The risk of family gene (genetics) is much higher than for Type 1. There is a possibility

Diabetes is rampant, the percentage incidence per population in our communities is much higher when
compared to other countries in South East Asia. The issue was made worse by the recently ended civil war.
Lack of medicine and medical facilities have affected the outcome of diabetes.

Ratnam Foundation is a charity based in London. The Trustees of the Foundation after giving serious
thought to this health time-bomb and decided, with the help and co-operation of Moolai Hospital management
to set up a Diabetic Centre wholly funded and managed by the Foundation. It is worth noting that the Trust
have supplied medicine to Moolai Hospital during the war when there was scarcity of drugs.
The Centre needs to be adequately manned with trained personnel who will provide medical, diagnostic and
other services like podiatry, optometry etc. Diet and weight issues will be addressed and managed.

Global statistics
Type 2 diabetes in particular is now one of the most common long term health conditions in the world. There
are 382 million in the world about 8.5%of the world population estimated to reach 592 million in 20
year time. It is also estimated 175 million people have undiagnosed diabetes. Top 5 countries in the order of
ranking are China, India, USA, Russia and Brazil. There are about 3.5 million of diabetics in UK of these 0.5
million are over 60 years. There are many with undiagnosed diabetes, number not known. The incidence of
diabetes in ethnic minority groups in England is very high and the reason is not known. In general people of
South East Asian origin varies from 3% to 6% when compared to the indigenous of population of England.
People of Sri-Lankan origin have 6% and Afro-Caribbean have 3% when compared to local population.
Historical data suggest life expectancy on average is reduced by more than 20 years for Type 1 and 10 years

Diagnosis and treatment

Diagnosis is generally by clinical symptoms and blood and urine tests. Patients with Type 1 diabetes are
generally young, pass large quantity of urine, lose weight and complain of excessive thirst, tired and weak.
People who have these symptoms should seek the advice of a doctor. The doctor will arrange required diagnostic
tests to make the correct diagnosis and initiate appropriate treatment.
Patients with Type 2 diabetes may or may not have symptoms as above but they are generally early middle age,
overweight and complain of extreme tiredness, blurred vision, slow healing of wounds, unexplained weight
loss. Diagnostic tests are same as for Type 1 but mostly treatment is different from Type 1. Type 2 diabetes
depending on the severity of illness may be controlled by diet and exercise. Depending on the results of the

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blood tests if the doctor is of the opinion that it is a case of borderline diabetes he may refer you to dietitian

be treated with appropriate medication and would be advised on appropriate diet and exercise regime.

Diet
Healthy balanced diet that is low in fat, sugar, salt and containing high level of fruits and vegetables

with diabetes tend to focus either on the quantity of the carbohydrate intake or the speed at which carbohydrates
are absorbed by the body.
The level of glucose produced by carbohydrate digestion and absorption is measured by a term called Glycaemic
Index(GI). It is basically a ranking of carbohydrate(CHO) containing food based on the overall effect on blood

GI. High GI foods like banana, mango, grapes, white rice, white bread etc may be avoided. Generally it is
better to avoid high GI food has detrimental effect on glucose metabolism. Adopting a whole meal natural

are low GI. Choose foods with unsaturated fat. Examples of unsaturated fats are reduced fat spread (half fat

routine of eating lean meat, skinless chicken, eggs, beans , dhal, etc. It is always better to eat steamed, grilled
and boiled and baked food to avoid consumption of unnecessary fat because diabetic patients do develop lipid
metabolism.

Exercise
Maintaining activities should be an important part of ones lifestyles, particularly for those who either

the feeling of well being and helps to control the body weight, reduce the risk of cardiovascular disease (CVD)

average about 5% of muscle mass every 10 years. The amount, the type and duration of physical activity

for 5 days or 150 minutes per week. British Heart foundation recommends 10,000 steps per day to promote
healthy weight, is equivalent to 5 miles. Activities that counts as anything that will up the heart rate a little

tai chi etc

Summary.
Diabetes cannot be cured but it can be very well controlled. Patients can lead a normal active life provided
they follow medical advice, accept and follow the lifestyle changes expected of them. However, ignoring
the advice of health personnel can lead to unnecessary complications. Complications due to uncontrolled
diabetes can be many, but to name a few, cardiovascular disease, lipid abnormality, amputation and even
premature death.

In this report , as far as possible within the limits of available space the author has tried to explain to
the layman the simple meaning of diabetes and how it is diagnosed, common type of treatment and how to
control with diet, exercise and to maintain ideal weight for health and complication free long and enjoyable
life.

Dr Ratnam Niththyananthan
Ratnam Foundation

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Standards of practice for Healthcare Professionals, UK-model.

The government health service in the UK called the NHS,was created in 1948 under the principle that it
was free at the point of use (all 116.4 billion of funding is from tax revenue) to those entitled. It covers a broad
range of services from routine to emergency. It employs about 1.6 million people making it one of the worlds
largest workforces.
The main principles governing the NHS can be universally applicable to any healthcare system.
1) that it be based on clinical need, not ability to pay
2) that it meets the needs of every patient.
3) that it be free at the point of delivery, to those legally entitled.
The NHS is available to all (irrespective of gender, race, disability, age, sexual orientation, religion, gender
reassignment, marital or civil partnership status), and even tothosenot legally entitled, in case of emergency.
It emphasises patient safety and quality of care, and is focused on patient experience. Patients are treated with
dignity, compassion and care. Their families and carers, where appropriate are involved in and consulted on all
decisions about their care and treatment.
It aspires to high standards of clinical excellence and professionalism.
Encourages its employees to learn continuously to keep up with new advances.
Use innovation and current research and be up to date.
Feedback from the patients and staff are encouraged to help improve services.

Primary care
Primary care is the main interface through which most patients access health care, in the NHS and elsewhere.
General Practitioners (GPs),otherwise known as family doctors, look after peoples health in their local community
and deal with a whole range of health problems and a variety of services e.g. health education,smoking and diet
advice, immunisations and vaccinations,contraception, and minor surgery.They work in practices [also known as
surgeries] alongside other clinical (nurses) and non clinical staff (receptionists/ administrators).
It would be necessary for every GP practice to be fully computerised and be signed up to local IT governance
regulations.
The practice itself may provide other linked services e.g. midwives, health visitors, social services. Information

practices e.g. urgently on the day to in advance.

GPs may seek second opinion from secondary care e.g. consultant specialists based in hospitals- both NHS and
private- or other clinics.

Consultations models
The form by which a consultation is held is based on various models which help GPs develop their own styles.
Examples of consultation models are as follows taken from reference 4:
Helmanns Folk model, 1981 the consultation is set entirely from the patients perspective on the reasons for
their illness using questions such as: what has happened? and why me?, using the concept of empathy towards
the patient.
Pendleton et al, 1984 based on the seven task patient-centred model. It addresses the patients true agenda,
considering other problems, choosing an appropriate action for each problem, achieving a shared understanding,
using time and resources appropriately and establishing and maintaining a relationship with the patient. It looks
for problems early on in the consultation and looks at the ideas, concerns and expectations. Such questions may
include anything else you were hoping to discuss today?, What is your main fear/worry/concern about this
problem? and What were you hoping to get out of today?

netting and housekeeping alongside an awareness of minimal cues (verbal and non-verbal) to help discover the
unspoken agenda. Summarising is an important tool to clarify your understanding and demonstrates empathy.
There is achieved management.

Calgary-Cambridge Guide (Kurtz and Silverman), 1996This model looks at the process of the consultation
from initiating the session, gathering information, providing structure to the consultation, building a relationship,
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MIOT - UK
giving information by explanation and planning, and closing the discussion.
These models may be used to good combination during consultation to help achieve a patient centred approach.

The GMC [Professional regulatory body]

The main licensing body to which all [GPs and other ]doctors have to be registered, in order to practice medicine
in the UK is the General Medical Council (GMC). They set guidelines as to the code of conduct of all doctors.
They provide this in their good medical practice booklet available on their website: www.gmc.org.uk
Patients receive the best care when they work in partnership with doctors.Doctors must provide good care good

with you, listen to your reason for attendance, take into account your previous and current health and illnesses,

to take in all the information their doctor is sharing with them, and it is important to clarify this to the best of your
ability..Doctors must listen to and respond to their questions and concerns.Doctors must be polite and considerate
to patientsand treat them with dignity and respect.

Doctors must be honest and trustworthy

must not cross their professional boundary e.g. impose their own beliefs , or pursue an inappropriate relationship.

Doctors must take prompt action if they think that a patients safety, dignity or comfort is being compromised.
Doctors have to report any mistakes that may compromise their patients care ,so lessons can be learned.
Doctors must review their own practice.
Doctors in the UK have an annual appraisal to review their performance and identify areas where they can

e.g. questionnaires. This may be part of their revalidation to practice.

Eventhough these principles apply to doctors, it applies equally to all healthcare workers.

References:
All information above has been extracted from the following references:

1) http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx
2) http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx
3) www.gmc.org.uk
4) http://www.gponline.com/consultation-models-practice/article/988629 - Consultation models in practice
- 11 March 2010Dr Lynda Carter
5) http://www.bradfordvts.co.uk/wp-content/onlineresources/0200consultation/consultationmodels/
consultation%20models.pdf
6) http://www.rcgp.org.uk/~/media/Files/GP-training-and-exams/Curriculum-2012/RCGP-
Curriculum-2-01- GP-Consultation-In-Practice.ashx
7) http://www.gmc-uk.org/guidance/good_medical_practice.asp
8) http://www.nhs.uk/choiceintheNHS/Rightsandpledges/complaints/Pages/NHScomplaints.aspx

Dr. Rinaldo Selvanathan MRCGP

GP Tutor and Trainer
South East London

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MIOT - UK

Cost effective Imaging for Primary Care in Sri Lanka

Technology has advanced so rapidly in the medical world in the last 30 years or more. This is very evident in the
world of medical imaging. Tele-medicine and Tele-radiology have evolved with vast improvements in information
technology.There has been so many imaging modalities at their disposal in most hospitals in the developed countries.
This has invariably led to over investigation and in many cases over treatment. In the private sector there is also
a tendency for commercial exploitation of imaging particularly in developing countries.

Ultrasound Scanning(USS)has been in clinical use for over forty years now and it has evolved and hasbeen
more extensively used , covering a wide range of clinical specialities.In the last twenty years. CT [Computerised
Tomography]and MRI [Medical Resonance imaging]are readily available in most hospitals in the developed
countries. In developing countries like Sri Lanka though, only tertiary centres ie teaching hospitals, and private
clinics in major cities like Colombo, Kandy and Jaffna have the capacity to install and maintain expensive equipment
like CT and MRI scanners. It would not be cost-effective unless there is a minimum use of the equipment to justify
the cost of the capital, installation and servicing.

Extensive usage of CT and MRI scanners particularly in the developed world has perhaps undervalued the
capabilities of ultrasound. Modern US machines with higher resolution images they produce, still remaina highly
effective and in most instances, a very cost -effective cross sectional imaging modality. It is a more economical

USS could be extremely useful and productive in developing countries particularly in the peripheral units. The
clinical applications in ultrasound are very wide. It can be used to scan from head to toes in babies and from neck

pathology in the abdomen and pelvis.

and paediatrics. Doppler US imaging has been in use for a very long time, particularly useful to image carotid and
limb arteries and to diagnose/or exclude deep venous thrombosis. Doppler US is also a valuable test to investigate
pre-echlampsia in pregnancy.

In the modern era many interventional procedures are performed with US guidance, for example performing
arthrograms ,biopsies, draining of abscesses/ascites/ pleural fluid and percutaneous biliary procedures,
nephrostomies to mention but a few.

Setting up an US imaging service is not particularly costly but maintaining the machine could prove rather

service. Replacing some of the parts like US probes (easily breakable) may be very costly. Distant learning to an
extent could be addressed by tele-medicine/tele-radiology.

In addition to US, it would be very useful and cost effective to provide a basic radiography service. Chest and
abdominal radiography would be extremely valuable in a peripheral hospital in Sri Lanka, given the high prevalence
of tuberculosis and other chest diseases. Radiography is indispensable in trauma medicine particularly in imaging
bones and joints.

Installing a mammography unit in addition will incur additional cost. But combination of US scan and mammography
will help to diagnose most of breast cancer. It may be possible to offer a breast screening mammography service
for a suitable patient population locally.

SabaratnamSurenthiran MBBS FRCP FRCR

Consultant Radiologist
Lewisham & Greenwich Trust

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MIOT - UK

Higher training attachment in Anaesthesia at

Teaching Hospital, Jaffna, Sri Lanka July - August 2014
Location
Jaffna Teaching Hospital is a government hospital and the only teaching hospital in the northern province of Sri
Lanka. It is linked to the University of Jaffna. It currently conducts a wide variety of healthcare services. Recently
consultant specialists have been appointed in neurosurgery, cancer surgery and paediatric surgery. Recently, it has

In 2013 Dr Peter Odor and Dr Sam Ma conducted an 11 day intensive academic teaching program for anaesthetic
trainees and medical staff based at Jaffna teaching hospital. The focus of the trip was academic teaching but they
visited the main theatre block to get an overview of clinical anaesthesia. The plan for my clinical attachment was
based on information gleaned from them.

Department of Anaesthesia
There are four consultant anaesthetists working in Jaffna. They oversee work in the main theatres, intensive care
unit, emergency theatres (in a separate building), eye theatres and provide anaesthetic support to the rest of the
hospital. The on call service runs as a 1 in 4 for the consultants. The trainee anaesthetists during my attachment
were very inexperienced with most of 6 months to 1 year of anaesthetic experience.

Equipment
The equipment currently available in Jaffna hospital was of a mostly of a good standard. They have modern
anaesthetic machines with plenum vaporisers. The anaesthetic agents were propofol, thiopentone, ketamine,

and only offered volume controlled ventilation. The only pressure controlled ventilators were available on the
intensive care unit. I used one of these ventilators in a case where we had patient with bullous emphysema needing
a general anaesthetic. This required running propofol without a target controlled infusion pump or any depth of
anaesthesia monitoring. There was no vapour analysis available and so depth of anaesthesia required close attention
to haemodynamic variables.

Airway equipment was limited. All laryngeal masks, endotracheal tubes and airway adjuncts were washed, sterilised

locked in a cupboard for consultant use only.

Paediatric equipment was very limited while I was there. There was a small supply of paediatric laryngeal masks

hours of hand ventilation. There was not even a paediatric blood pressure cuff in the anaesthetic department during
my stay.

There was some provision of a service for epidural anaesthesia which required admission to the intensive care unit
for post-operative management. There were no dedicated epidural pumps and so intravenous infusion pumps were

Many operations were done under spinal anaesthesia. This included some paraumbilical hernias and abdominal
wall surgery that would usually be done under general anaesthetic in the UK. Opiates were rarely added to spinal

analgesia.

Organisation of attachment
My attachment at Jaffna was overseen by Dr Premakrishna who is the senior anaesthetic consultant in Jaffna. My
primary aim was to be attached to the main theatre to get exposure to clinical anaesthesia. I was also given the

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MIOT - UK

responsibility of leading the lunchtime teaching sessions for the department of anaesthesia on Tuesdays and the
equivalent of the primary FRCA teaching sessions on Fridays.

I was also given access to the ultrasound machine to conduct and teach ultrasound guided regional blocks. I took
with me some airway equipment including 20 airtraqs and 40 block needles kindly provided by Fannin and Braun.

Clinical Attachment
My clinical attachment in Anaesthesia at Jaffna hospital was for 6 weeks in total. During this time I helped to
conduct 55 cases. The specialities of surgery included general surgery, orthopaedics, neurosurgery, paediatrics,
ENT, obstetrics and gynaecology. Working hours were generally 8am - 2pm Monday - Friday. I also spent some
time visiting the wards and attending clinical meetings including theatre meetings and a regional meeting on
maternal mortality and morbidity.

In theatre I supervised junior anaesthetists and helped to teach the use of airtraqs and ultrasound blocks.

I also assisted in the integration of the WHO checklist into main theatres. This was done by the initial audit of the
situation and discussions with current staff. I then started using the checklist personally in orthopaedic theatres
where the surgeon was particularly keen to adopt this patient safety initiative. I then started to use the format in
other theatres. I also conducted two teaching sessions about the origins of the checklist and the evidence behind it.

developed in my own hospital.

Anaesthetic Teaching
I was given two one hour teaching sessions to lead each week. The following topics were covered:

Tuesday CME teaching

1) Human Factors and airway disaster - The case of Elaine Bromiley
2) The World Health Organisation (WHO) checklist
3) Surviving sepsis and its applications
4) Morbidity and Mortality meeting

Friday Primary FRCA teaching

1)Cardiac muscle physiology and blood pressure measurement

2) Intravenous induction agents
3) The new and old drugs of the neuromuscular junction
4) The physiology of pregnancy and anaesthesia for cesarean section
6) Nerve stimulators for testing neuromuscular blockade and quiz

I also presented about the WHO checklist at the Jaffna Medical Association meeting.

Basic Life Support Teaching

I spent one day a week teaching basic life support (BLS) to nurses, healthcare assistants and allied staff, with the
help of my husband, a GP. The teaching was based on the Resusitation Council UK guidelines. This was done
with the help of the charity Medical Institute of Tamils (UK) who provided mannikins and airway equipment to
facilitate this. These sessions were practical and based at the Green Memorial Hospital, Manipai, Jaffna and also
at the Centre for Family Medicine in Jaffna. Each session had 12 candidates and lasted approximately 90mins. At
the end of each session there was an assessment of the conduct of the BLS algorithm. A total of 107 people were
taught over the period of 2 months.

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MIOT - UK
Outside of Work
I travelled to Sri Lanka with my husband, mother and 2 children aged 4 and 2. We rented a 3 bedroom house
which was a 10 minute cycle ride from the hospital. We spent one week traveling across to the east coast and
the weekends were often spent by the sea. Travel was mainly by van over long distances. In the town we took
3-wheeled tuk-tuks and I cycled to work.

My children had an amazing time. They learnt so much about living in a different culture, tropical fruits, animals
and trees. They particularly loved the sea and traveling in tuk-tuks. There were many dangers too with car seats

and my mother for helping with childcare. Overall I would thoroughly recommend taking children to Jaffna.

The northern peninsula of Sri Lanka is very dry and vegetation is sparse compared to the greenery of the south.
The palmyrah tree dominates the landscape, and is the emblem of this area, thriving in the environment. The A9
road to Jaffna is a visual reminder of the recent war. The roadside is still undergoing mine clearance and broken
buildings and scorched earth highlight previous bombings.

The city of Jaffna is recovering after the war. The people are predominantly from a Tamil background and are
mainly hindu. The culture is conservative and religious. Most people are tea-total and vegetarian. At the time of
our visit there was a religious festival and meat was not allowed in the district where the temple was situated.
Ladies swam fully clothed in the sea and I certainly got used to wearing a dress on top of my swimming costume.

English is spoken freely in the hospital amongst the doctors and nurses. The standard of English in the general
public is low. I generally spoke Tamil in public. Western culture is much less apparent when compared to the rest
of Sri Lanka. They have recently developed a shopping centre with a Kentucky Fried Chicken retailer and a pizza

Future visits
Dr Premakrishna and the other consultants are keen to develop a link between Jaffna and anaesthesia abroad.
There is scope for future anaesthetists to visit with a focus on many different areas including clinical anaesthesia
and teaching. There was an interest in airway skills and regional teaching. Anyone who is interested in organising
an attachment here can contact the department via myself.

Dr Arani Pillai
ST7 Anaesthesia
Queens Medical Centre, Nottingham

aranipillai@doctors.org.uk

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The role of PAC in making Anaesthesia safer

medical speciality. Particularly, during the last six decades anaesthesia has transformed into a very safe discipline
in medical practice. About half a century ago, the peri operative death rate that was solely attributed to anaesthesia
was 357 per million, the current mortality rate is 34 per million [Bainbridge D, et al. Lancet. 2012].

Many factors contribute to the safety of modern anaesthesia. Perioperative assessment is one of the important
components that contribute to this improvement in safety. In fact, it has been shown that the Pre-operative
assessment process facilitates the patients pathway through the peri operative period and improves the safety
of anaesthesia. Pre assessment Clinics (PAC) have become an important entity in institutions where elective
surgical procedures are undertaken.

establishes that the patient is fully informed and wishes to undergo the procedure. It ensures that the patient is

As illustrated above, the PAC intercepts the patients pathway between the surgical out patient department and
the operating theatre to ensure the patients are appropriately assessed and adequately optimised prior to surgery.
The PACs are generally led by consultant anaesthetists who oversee the development and smooth running of
these clinics. Trained nurses assist consultants in the PAC.
How does a PAC function? In the past, the patients are
admitted as inpatient prior to surgery for assessment
and optimization. This is no longer practised as its
expensive, increases the risk of thrombosis and infection,
and interferes with the activities and employment of
patients. Hence, pre assessment is performed as an out
patient exercise.
PAC is ideally a guideline driven service and its
appropriate for patients who undergo elective surgical
procedures. Patients would need to attend a PAC as
soon as a decision is made for them undergo a surgical
procedure.

tool is designed to look into the various aspects of the health of patients. A completed PAQ is screened by a
nurse, in consultation with an anaesthetist, and selected patients are required to attend the PAC for further
assessment. PACs coordinates with primary healthcare and specialised clinics such as cardiology for further
assessment and optimisation of patients. The PAC is expected explain the peri operative path way to the patients.

How can the quality of service provided by the PAC be monitored?

Patients satisfaction survey is a useful tool for this purpose. Secondly, monitoring the number of patients
whose surgery is cancelled on the day of surgery due to medical or anaesthetic reasons is also a very important
data. In the UK about 2 % patients are cancelled on the day of the operation due to nonsurgical reason.

Most patients are very apprehensive during the peri- operative period. A well established

pathway, to make it as smooth and comfortable as possible.

Dr Kanagasabapathy Chandradeva FRCA

Consultant Anaesthetist & Clinical Lead Pre assessment Clinic
Queen Marys Hospital Site
Kings College Hospital NHS Foundation Trust

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Immediate Post-operative care facilities suitable for

North and East, Sri Lanka
Immediate Post-operative period is one of the most critical and vulnerable period for a patient during his/

the majorcontributory factors. Also Patients are transferred from high intensity monitored environment of theatre
managed by highly skilled team consist of Anaesthetists to general ward with limited facilities. Up to 60%
perioperative morbidity/mortality occurs in the immediate post-operative period. High risk associated with this
transition period is well recognized and there are clear professional standards developed all over the world to
improve the patient safety. The dedicated area where the patients are cared for is calledPost Anaethesia Recovery
Unit(PARU or Post Anaesthesia Care Unit (PACU)
Every theatre complex should have a dedicated, well-planned, well-equipped, well-staffed and well-managed
post-anaesthesia recovery area. The facilities may vary depend on the complexity and the volume of operations
performed but all the recovery areas should comply with minimum standards. Immediate postoperative facilities
vary widely across thehospitals in the North and East. Currently most hospitals, both in the government and private
sector, lag behind the expected international standards due to the effects of prolong civil war on the resources and
the training of the staff. It is important for the local professional body to develop a national or reginal standards for
the recovery area based on the international standards which can be implemented across the region. This should
be consolidated through continuous professional development of the staff and provision of resources.
General facility
Recovery area should be a dedicated area in a central position within the theatre complex enabling ease of
access from the operating theatre and outside. The layout of bed spaces should allow staff to have an uninterrupted
view of several patients at once. There should be at least 2 bed spaces per number of theatres.General facilities
should include adequate ventilation,lighting,communication facilities, Wall clock, and storage areas for equipment,
hand washing, and a secure supply of drugs.
Monitoring and Equipment
An appropriate standard of monitoring should be maintained until the patient is fully recovered from
anaesthesia. Clinical observation should therefore be supplemented with multifunctional monitor which should
have a minimum of pulse oximetry, non-invasive blood pressure monitoring, ECG and capnography should be
available.(Table 1).Each bed space must be provided with an oxygen outlet medical suction complying with relevant

andInvasive monitoring facilitiesshould be immediately available. There should be access to diagnostic imaging
services, Blood gas and electrolyte measurement, refrigerator for drugs and blood.When the patient is moved from
the theatres to the Recovery area the Anaesthetists should satisfy with the level of monitoring and provision of
oxygen during transfer.
Drugs

surgical complications should be immediately available.

S
Anaesthetists takes the overall responsibility for the patient until the patient is ultimately transferred to

control, respiratory and cardiovascular stability, and are able to communicate. There should be at least 2 staff
present in the recovery area and one should be registered recovery practitioner.
Documentation and protocols.
There should be clear criteria for minimum standards of monitoring (clinical parameters and the frequency)
in the recovery area and discharge from the recovery area.( Table 2)There should be a comprehensive formal hand
over/check list when the patients are transferred from the theatre to the recovery area and from the recovery area
to the ward. There should be agreed protocol for escalation of care .It is very useful to have written algorhythm
for the management of common life threatening emergencies as posters.

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Children
Children have special needs which are best met by having a designated, paediatric recovery area that is
child-friendly and staffed by nurses trained in the recovery of children and have necessary paediatric equipments.
Critically ill patients.
Provision of Critical care facility for all the hospitals is a major challenge not only in the North and East
but across the developing world. However there should be clear agreed arrangement for the transfer of critically ill
patient. This include appropriately trained staff and transfer equipments.It may be more cost effective to develop
retrieval teams from centralized intensive care units.
Governance and training
The provision of quality care during recovery relies heavily on investment in the education and training
of staff.The recording of key quality and outcome data from all patients passing through the recovery area should
be documented.
Concept of audit, incident reporting and morbidity and mortality meetings should be introduced for the development
of accountability and transparent multi-disciplinary team working.
Reference /Further reading
1. AAGBI Safety Guidelines :Immediate Post-anaesthesia Recovery 2013
2. AAGBI Supplement :UK National Core Competencies for Post-anaesthesia Care 2013
3. Guidance on provision of Anaesthetic services for post-operative care :2014:RCOA
4. Raising the Standard: a compendium of audit recipes:RCOA:3rd edition: Section 3
5. ANZAC Recommendation for Post Anaethesia recovery room .(2006)
6. STANDARDS FOR POSTANESTHESIA CARE American Society of Anesthesiologists

Table 1 Minimum information to be recorded for patients in the Recovery area

surgical drainage volume

Table 2 Minimum criteria for discharge of patients from the postanaesthesia care unit.

an acceptable level, ideally within parameters set by the anaesthetist, and peripheral perfusion should be
adequate

emetic regimens prescribed

Dr Mohan Sivarajaratnam MBBS (Jaffna), MD( Colombo),FICM ,FRCA

Consultant in Anaethesia & Intensive Care Medicine
North Middlesex University Hospital .UK
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Stroke Rehabilitation Unit

Base Hospital Chavakachcheri, Jaffna

A Project of the
Neuro-Rehabilitation Trust,
Northern Province, (NRTNP)
SriLanka
Stroke Rehabilitation Unit

Stroke! We can Strike back.

Encouraged by the policy of the government of Sri Lanka in stroke rehabilitation, a group of young doctors have
emerged to support this initiative in the health sector by embarking on establishing Stroke Rehabilitation Units

people of the Northern Province.

Rehabilitation services are fundamental in enhancing patients functional independence and play a vital role in their
health care. Effective rehabilitation services require a diverse range of health professionals, services and external
agencies to work together and overcome challenges such as separate funding, administration and reporting structures.
The need for such units is very vital, relevant and urgent as there is no such facilities in existence at this moment
of time. In addition to the initiatives and commitments of the government to take up such projects, it is also the
responsibility of the public to come together and harness their resources in realising the visions and plans of this group
of young doctors who have joined hands and formed the Neuro-Rehabilitation Trust Northern Province (NRTNP).
The aim of this project is to develop stroke rehabilitation units to provide optimal rehabilitation, information,
advice and support about living and recovering from a stroke for patients affected by a stroke.

Hospital Chavakachcheri. The Provincial Ministry of Health, Northern Province has already allocated the land
for the project and necessary approvals are secured.
Chavakachcheri is a key town in Jaffna Peninsula, 14 km from Jaffna town and is easily accessible from most
parts of Jaffna and this makes it comfortable for the public.
The base hospital is located in the Kandy- Jaffna main road (A 9 - highway). The geographical coordinates of the
location are latitude - 9.7500 deg N and longitude- 80.1500 deg E.
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The plans, layout and drawings of the building are under progress with the Department of Buildings Northern
Province. The building plan for this unit is of 3 stories, which will encompass wards with a total of 50 beds (25
for males and 25 for females), rooms for therapists, doctors, allied healthcare workers, administrators and storage.
It is the intention of the trust to build 2 stories initially (approximately 10,000 sq. feet ) and a 3rd story at a later
stage in view of the constraints in the funds. We propose to commence the project in early 2016 and complete it
within 1 year of commencement.
The cost of the project is estimated to be approximately SLR 650 lakhs (USD 450,000) for building, equipments
and furnishing. This is a preliminary estimate and detailed studies are underway to prepare a feasible estimate and
will be made available to the prospective donors by end of January 2016.
The National Stroke Association of Sri Lanka (NSASL) and the International Medical Organisation of Health
(IMHO) have come forwards to assist in planning the unit with their know-how and technology and also help
raise funds.

Neuro-Rehabilitation Trust Northern Province

Understanding the principles of accountability and transparency expected by the public in view of their participation,
this group has a formed a Trust that will undertake the project and comply to the laws, rules and regulation of
the country. The name of the trust is:
NEURO-REHABILITATION TRUST NORTHERN PROVINCE
The Board of Directors of the Trust are
Patron: Dr. T. Sathyamoorthy. MBBS. MD (Admin)
Director, Teaching Hospital Jaffna.
Chair Person: Dr. S. Uthayakumaran. MBBS, MD
Consultant Physician, TH Jaffna.
Vice Chairperson: Dr. V. Sujanitha. MBBS, MD
Consultant Physician, TH Jaffna.
Secretary: Dr. G. Selvaratnam. MBBS, MD
Senior Lecturer in Medicine, University of Jaffna
& Hon. Consultant Chest Physician, Teaching Hospital Jaffna
Asst. Secretary: Dr. A. Arasalingam. MBBS, MD, FRCP (Edin)
Consultant Neurologist, TH Jaffna.
Treasurer: Dr. S. Premakrishna. MBBS, MD
Consultant Anaesthetist, TH Jaffna.
Editor: Dr. J A Pradeepan. MBBS, MD
Lecturer in Medicine, University of Jaffna.& Hon. Consultant Physician
Member: Dr. P. Lakshman. MBBS, MD
Consultant Cardiologist, TH Jaffna
The trust will reach out to the international organisations, international community, health care industry, local
community and local cooperate companies to participate in this humanitarian project and join hands to uplift the
health care facilities in the Northern Province.

The National Stroke Association of Sri Lanka (NSASL)

The NSASL is the pioneer organisation in Sri Lanka working for the development of stroke services and stroke
rehabilitation in the country. Many eminent members in the council of the NSASL currently headed by Dr. U.
Ranawaka (Consultant Neurologist and Senior Lecturer in Medicine, University of Kelaniya) are providing us
with expert advice in all aspects of developing this project and they have taken up this project as one of their main
projects for development of rehabilitation facilities.
The International Medical Health Organisation (IMHO)

infrastructure in under-served regions worldwide. The organisation was founded on principles of humanitarianism
and neutrality in 2004 by a volunteer group of committed doctors and other professionals that
shared a vision for improved global health and medical care. IMHO aims to improve health care across the globe
for those in need, by identifying health needs and providing resources & training to address those needs.

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Conclusion
The members of the Neuro-Rehabilitation Trust, Northern Province (NRTP) appeal to all well wishers for voluntary
contributions to accomplish this project which will help to rehabilitate stroke patients and reintegrate them into
society enabling them to lead a productive life.
Contact Details:
All well wishers who wish to contribute please contact
Dr. A. Arasalingam. MBBS, MD, FRCP(Edin)
Consultant Neurologist, Teaching Hospital Jaffna
Asst. Secretary, Neuro-Rehabilitation Trust, Northern Province
Telephone: +94772210803
email: NRTNP1@gmail.com
or.
Dr. G. Selvaratnam. MBBS, MD
Senior Lecturer in Medicine & Hon. Consultant Chest Physician
Secretary, Neuro-Rehabilitation Trust Northern Province
Department of Medicine, Teaching Hospital Jaffna, Sri Lanka
email: NRTP1@gmail.com
Account details will be provided to volunteer donors if requested.
NOTE:
All contributions will be collected only by
1. Neuro-Rehabilitation Trust Northern Province
2. National Stroke Association Sri Lanka
3. International Medical Health Organisation
No other organisations or members are currently involved in the above project.

1. Provincial Director of Health Services, Northern Province

Dr. R. Jude
2. Deputy Director of Health Services, Northern Province
Dr. A. Keetheeswaran
3. Regional Director of Health Services, Dr. K. Nanthakumaran

NEURO-REHABILITATION TRUST-NORTHERN PROVINCE

Address:
DEPARTMENT OF MEDICINE,
TEACHING HOSPITAL JAFFNA.
Email:
NRTNP1@gmail.com

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