Wednesday, January 09, 2008
By Jill Daly, Pittsburgh Post-Gazette
A pediatric intensive care specialist from Children’s Hospital recently left her patients and research behind for a brief visit to an area of Sri Lanka struggling to recover from the December 2004 tsunami.
Dr. Ericka Fink, 37, is part of a team of volunteers helping design programs at a proposed 100-bed, two-story pediatric teaching hospital that will provide high-quality care in the city of Matara. It will be a separate wing of a new hospital complex that will include a women’s hospital as well as a general hospital.
Dr. Fink said she found during her Nov. 30-Dec. 8 trip that medical care in Matara is severely lacking.
“Basically the whole southeast coast was affected by the tsunami. … The tsunami came inland, the river flooded the hospital, which is made up of several different smaller buildings. Although they’re functioning, the hospital remains at risk.”
Project Peds: Sri Lanka Tsunami Relief was created for the project by the nonprofit World Children’s Initiative, which recruited help from Children’s Hospital here and Children’s National Medical Center in Washington, D.C. They in turn sought expertise in helping Matara from Physicians for Peace, an international nonprofit devoted to improving health care though medical training and sustainable programs.
The project is expected to be a template for other state-managed health care facilities elsewhere in developing nations.
Since Sri Lanka is affected by Tamil-Sinhalese civil conflict, the project enlists professionals from both groups and aims to promote cooperation for the humanitarian effort. People using the current Matara hospital live in nearby villages, and fishing is the primary source of income.
Dr. Fink is compiling her recommendations for the Physicians for Peace medical mission together with her travel colleague, Dr. Bryan Fine of the D.C. hospital.
In Matara now, the women’s maternity hospital and children’s hospital serve about 1 million children, Dr. Fink said.
“When you walk into the pediatrics ward, you see maybe 100 children, with three residents [doctors]. There are lots of nurses, but all their equipment is old and run-down,” she said.
Even before the tsunami, crowding and unsanitary conditions caused problems. It’s worse now.
“For example,” she said, “a child with whooping cough is next to a child with asthma, next to a child with diarrhea. There’s no infection control.”
Nevertheless, she said, the staff is dedicated: “I didn’t see a dirty child. These people are doing the best they can.”
She’s concluded that there’s a need for more programs in preventive health, as well as improvements in treatment.
The emergency system also needs to be streamlined, Dr. Fink said, pointing out that there is no 911 system. The only ambulances go to the more sophisticated hospitals, five hours away, and they are not equipped with oxygen.
When people find their own way to the Matara hospital, there is no triage, or the separating of patients who need immediate help from those who have less serious medical problems.
“Everybody gets admitted to the hospital,” Dr. Fink said. “It’s overloaded.”
She said many children there have a huge health disadvantage:
“The overlying problem is there is 25 percent malnutrition in toddler and school-age children. Once they are done with breast-feeding, the problem is they don’t get enough protein. Their immune system is very much at risk.”
The pediatric hospital will continue to have a traditional ward layout, but will have a separate space for critical care, Dr. Fink said. Nurses will be specially trained for pediatric care.
She said Sri Lanka now has one of its own pediatric critical care physicians able to train others.
“It’s a start, a good beginning. They need many more like him. Critical-care medicine is just blossoming in Sri Lanka. Next they need to address the more extensive needs of emergencies and very sick people.”
She sees a long-term commitment from the outside agencies to help implement the training and maintain programs at the hospital.
“With Physicians for Peace,” Dr. Fink said, “we asked what they thought they needed, not just what we think they need. They’re very happy to have us there. There’s a large potential to implement change.”
The doctor, who lives in Shadyside, said she hopes to return within a year, armed with a plan for the Matara community.
After going away and seeing other cultures, she said she is inspired and motivated when she’s back in Pittsburgh.
“It fulfills what I’d like to get in life. Now I have a job where we treat all people equally, we give them the best care we can give, regardless of what they can pay.”
Her own research lies in brain injuries in children after cardiac arrest, and she’s finishing up a degree in clinical research.
She said she hopes to maintain ties with Matara.
“We met people doing research in Matara: an epidemiologist and his wife, a hematologist, both physicians who are doing research in malnutrition and problems with clean water in Matara,” Dr. Fink said.
“We’d like to partner with them in research and see if we can intervene in malnutrition and health problems, and make a difference.”
To learn more about the Sri Lanka project, visit the Web site www.physiciansforpeace.org.
Jill Daly can be reached at jdaly@post-gazette.com or 412-263-1596
