March 1, 2nd day in Sri Lanka

The hosptial entrance sign... plus a tuk tuk, for effect!

My second day began by departing the house at 6:15 am.  All three of us, Hanna, Emil, and I squeezed into a tuk tuk which took us to the train station.  From there we took the train from Columbo city to Ragama.  Lucky for us we are going in the opposite direction of the people-traffic.   We were able to get seats on the train with lots of room to spare, unlike the train travelling into Columbo, which was packed with people hanging out the doors.  Personal space is luxury on that train.  People are packed in like sardines.  

The train to Columbo, note the people hanging out the doors.  Doesn't look packed from this distance, but it is.

Once we reached Ragma we stopped to get some breakfast at the local fruit stand and bakery, which is just outside of the train station.  We got banana’s (apparently there are 9 different varieties in Sri Lanka.  I tired 2, but really didn’t taste the difference.  They are small and fat, about half the size of what we would see in North America), sticky buns, and yogurt.  We marched off to the Ragama Rheumatology and Rehabilitation Hospital (aka the P & O school) with our breakfast in-hand.  The hospital is about 2 km from the train station.  When I arrived at the school, I was already hot.  I can understand why people on this side of the world move so slowly.  It’s an attempt to keep cool.  The temperature is about 35 degrees Celsius, but with the humidity it feels more like 40 degrees Celsius.    

Hanna buying fruit before school

On the road to school

After settling into the day, I pretty much spent the morning following students and other teachers around.  I think people are scared to ask me questions or approach me.  I try to talk a little with the students, some are friendly, others just look at you with their big brown eyes, not sure what to think of me.  I was told not to confuse the students with too many questions, because the upper years are getting ready for their final exams in two months. Some of my questions might be confusing or they haven’t been taught the terms I know.  This school is classified as a category II prosthetics and orthotics school, where as in Canada we are a category I .  What does this mean?  Basically the Canadian and European education has a greater emphasis on pathologies, biomechanics, mechanics, different componentry, etc.  Don’t get me wrong, what they are learning here is still very good and they can provide excellent P & O services to the patients.   It’s just different.  The prosthetics componentry is plastic (using the IRC methods) due to climate conditions.  The humidity would corrode and breakdown the metals too quickly.  Also plastic is more affordable. They use a SACH type of foot for prosthetic devices, due to climate conditions; the rubbers break down too quickly with other styles of feet, and they can fabricate this style of foot in-house, if needed.  These are called Jaipur feet.  The orthotics componentry is very basic; only single axis knee joints; either free range of motion, drop locks or bail locks.  Articulated ankle-foot-orthotics include, tamarack or Oklahoma joints. Lower extremity devices are fabricated out of polyprolyene (reinforced with extra plastic or corrugated to increase strength) with metal joints or strictly metal braces (klenzak style).  Most often the lower extremity orthoses are used with sandals or they put soling material on the device and they walk with a flip-flop on the contralateral side.  Spinal bracing is strictly polypropylene plastic TLSOs/Boston bracing.  

(*** I included this section for my P & O readers)

Trying out his new transfemoral socket

Modification/Rectification Room

Transfemoral fitting

Transtibial casting

Student workshop

Patients at the clinic awaiting treatment

After observing for several hours, I decided to take a little more initiative and creat a task for me to do; I couldn’t handle standing around and observing any longer.  I took a look at school’s teaching manuals and thought I would do some work on improving their curriculum (of course asking permission first).  So I dove into the spinal section, as I came armed with info on that subject. 

The school is a busy site!  There are a lot of amputee’s hoping or walking about. The students are running about doing fitting, gait assessments, and adjustments.  I have been told there are usually more orthotic patients, but not this week.  Figures!  It’s interesting all the same, plus I get to recall all my old prosthetics terminology, assessments, casting, and fitting techniques.   I can really see the need for prosthetics on this side of the world.   

Assessment before a transtibial casting

The day ended around 4:30 and we headed home on the train.  When I got back to the station Hannah and Emil had to do some errands, so I said I would walk home on my own.  They offered to get me a tuk tuk, but I thought the walk would do me some good.  I was given directions to get home: “take a left out of the train station and the first street on the right” (no other descriptions).   Scary!  It was so noisy.  Tuk tuks honking; lots of people bustling about in all directions; lots of starring at me because of my blonde hair; people shouting “hello madame, where are you from?”; stray dogs running about; interesting mix of smells including curry and sewage (those silly Dutchmen left their canals here and they are stinky because of the old stagnant water); and cars zipping past so close you can feel a breeze on your arms as they go past.  

They drive on the wrong side of the road here in Sri Lanka, and no one follows the rules of the road.  The lines are only a guideline.  The middle of the road seems to be the way to pass other cars, for both sides of the road.  This is scary when two tuk tuks are passing cars in the opposite direction of each other!!  You think there will be a head on collision, but at the last second the cars move out of each other’s way.

My walk home was an adventure.  At first I thought I was going the wrong way.  I tried to call Hannah, but I couldn’t hear a word she had to say over all the noise.  I gave up on that idea after 2 calls.  I decided to just follow Emil’s directions and hope that I get home.   The trek home was an eye opening experience.  There is a lot of poverty and the buildings are not what you would see in North America.  It reminded me of places I had seen in South America.  It really makes you appreciate all the luxuries you are used to back home.  People live such simple lives here…. They are definitely not weighed down by possessions.   

This weekend I am off to the central part of the country with my Swedish friends.  I will likely have lots to report when I get back.