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Postcard from Jaffna, Sri Lanka
  1. Arani Nitkunan
  1. Correspondence to Dr Arani Nitkunan, Department of Clinical Neurosciences, Atkinson Morley Wing, St George's Hospital, Blackshaw Road, London SW17 0QT, UK; anitkunan{at}nhs.net

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Introduction

At the age of 3 I left my birthplace—Sri Lanka. Since my teenage years, I have wanted to return to work there. The reasons are difficult to explain: to find my roots; to share what I have learnt; to give back something to my country of birth. More recently, I wondered whether having the opportunity to work within another healthcare system might identify ways of improving ours in the UK.1 Here I describe my recent 1-month attachment to the neurology unit in Jaffna, Sri Lanka.

Geography

Sri Lanka is an island nation in the Indian Ocean, just off the southern tip of India (figure 1). Jaffna is the principal district of Sri Lanka's Northern Province. The Northern Province is divided into five districts, containing a million people. Jaffna District (figure 2) accounts for 600 000 of that 1 million, covering an area of 929 square kilometres.

Figure 1

Map of Sri Lanka.

Figure 2

Images of Jaffna. (A) Nallur Kandaswamy temple, (B) Springs at Keerimalai, (C) Jaffna Public Library and (D) Jaffna town.

History

Sri Lanka was under Portuguese rule from 1505 until 1619, followed by the Dutch until 1796 and then the British until independence in 1948. It was known by many names in the past, including Ceylon, until 1972. For 30 years till 2009, Sri Lanka was in the throes of a civil war. Decades of war and lack of government investment in health have had their price.

Healthcare structure

The Teaching Hospital Jaffna (figure 3) is the principal tertiary/secondary health centre for the province. Each district has a general hospital, and Jaffna's general hospital also acts …

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