Searching for Pirambadithivu

To find the village of Pirambadithivu, you have to hunt for it. Searching the backwaters of eastern Sri Lanka with a fine tooth comb, you'll find it hidden among the paddies, inaccessible during the monsoon season, and down 20 kilometers of such pocked and crumbling dirt roads that it takes two hours to drive there. The village of 1,400 has no store, no primary school, and no health center of its own. When the mobile medical team arrives, the doctor, nurse, two health workers and a psychosocial worker quickly head for a small concrete building with a tin roof and walls covered in children’s drawings: the nursery school becomes a clinic in under fifteen minutes. Stethoscopes, scales and antibiotics; Registration to the right, doctor behind the screen, nurse in the far corner. And a line out the door.

Once a week, the Comité d’Aide Médicale (CAM), a MAC grantee, sends one of its three mobile medical teams to this isolated community – providing the only primary health care for the community within miles. Most of the villagers arrived from northern Sri Lanka four years ago after being displaced by the LTTE-government war – dropped in a relative no man’s land without even the most basic services. Now they scrape by as farmers, often sharing a single meal a day with their families in homes made of cobbled together tin siding, palm branches, fraying UNHCR tarps and concrete.

This is not simply rural poverty in the developing world; this is that level of poverty and isolation compounded by the disruption and uncertainty of displacement, the emotional and physical legacies of decades of war, and the traumas of the 2004 Tsunami, which ravaged Sri Lanka’s eastern coast.

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When you first meet Mala, 27, you would never know that she only has one leg. Wearing a worn print dress and a shy smile, she leads Tharshini, a CAM psychosocial worker, down the dirt road to her home – a small tin roofed hut shared with four members of her family. In the dirt yard, her sister sifts through drying rice, picking out the stones, while her grandmother sits in the shade of a single tree. Though Mala has been visited by Tharshini for weeks now, she was first identified as needing psychosocial attention at the mobile medical clinic, where she went for pain in her remaining leg. Understanding the intimate connection between physical and emotional well being – especially for those with traumatic histories, like the internally displaced – the medical and psychosocial teams refer cases to each other. While the mobile clinic treats the ill, Tharshini sets out on her five home visits in the village. Her support, however small and against the odds of poverty and displacement, is essential here; in addition to the weight of poverty and the living memory of war, domestic violence, alcoholism and school drop-out rates are rampant.

Having lost her leg in the war to a mine, and separated from her parents, Mala lives with her grandmother and sister, whose husband lost a leg and his sight to a mine. Sharing her story, her needs and her daily concerns – many of which center upon lack of income – with Tharshini, has helped Mala gain access to Sri Lanka’s government services for the handicapped, including a new prosthetic leg, which is on the way. Working with Mala each week allowed Tharshini to identify Mala’s sister, whose husband is blind and handicapped, and whose son, Pradeep, is deaf, as depressed; as with her other patients struggling through post-traumatic stress, depression and anxiety, Tharshini began working with her to unknot the frustration by listening and slowly teaching her coping and relaxation exercises, like meditation.

Sitting on a straw mat in the shade of her yard, Mala picks at the straw threads of the mat below her feet. When asked about her wishes for the future, Mala answers that she has, “no idea about the future." Just this: The uncertain poverty of farming, maintaining her modest household, and hoping to see her parents – lost in the frenzy of war – again.

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53 patients patiently wait their turn to see the doctor behind a modest screen. A gaunt elderly man in glasses held together with string leans heavily on an improvised cane; a young woman in a brightly patterned but dusty, worn smock dress shifts her crying baby from one arm to the other; mischievous children tug on their grandmothers’ frayed but still immaculate saris; most are barefoot, a few children boast tattered but impossibly white school uniforms. Here, upper respiratory infections, gastrointestinal diseases, generalized pain – often a sign of psychological distress - are the most common diagnoses.

This is the last time that the mobile medical team make its weekly visit to Pirambadithivu. Frenetic international donor cycles have shifted attention from Sri Lanka – old news to most – to the next humanitarian crisis and with it the money needed to continue bringing health care to 19 villages of resettled Internally Displaced Persons (IDPs), like Pirambadithivu. It’s a classic and saddening case of donor interest expiring before the urgent needs of people like Mala do.

Though CAM’s intention is always to hand projects over to local authorities or community groups, sometimes the realities of too few doctors and resources make that impossible. CAM has conducted numerous trainings – on dengue fever, on first aid, on hygiene and preventive health – for the local Sri Lankan Ministry of Health to bolster their capacity; Regular meetings keep the officials informed of the massive health needs, and yet, they say they simply cannot provide care for these people.

Having stretched their resources as far as possible and with the local Sri Lankan Ministry of Health nowhere near the capacity to take over the clinics, CAM has little choice but to reduce the program to a single mobile medical team reaching just five villages, down from 19. This will leave thousands of people without prenatal checkups, treatment for skin, eye and respiratory infections, malnutrition screenings and the many other basic health and psychosocial services they need so badly.

Last year, MAC kept these very clinics going for another month with a bridge grant of $40,000. To help keep mobile medical clinics in villages like Pirambadithivu, donate now.