Now in month 8

More about my adventures (& misadventures) in Sri Lanka. Written over past 3 weeks, this is rather rambling, fragmented collection. Perhaps like my experience here.

19 October 2006 Thoughts …

Today I went to the MO-MH clinic in Nikaweratiya. First clinic visit in over 2 months. Dr. Duleeka is a pleasure, very good with the patients. Calm and gentle and perceptive. It was nice that he seemed to be glad I was there/to enjoy my being there. I’m glad can visit the clinics (finally the letter went out to the DMOs making it official).

I’ve been spending too much time working alone on the computer writing the Training Modules. I did well for about 3 weeks, then ran out of steam. Last week was very unproductive; lots of mucking about (though did do training in Chilaw for first time in a month, and prepare for training here this past Monday – after 5 weeks gap). Still no ‘review’ as far as I know; anyway no feedback received. If approved/accepted, I’m doubtful they will ever be used. At least not by the provincial department of health services system. But perhaps some of the doctors will use parts to develop their own work, or training others. And maybe I can use elsewhere.

The rains have come again, often with thunder and lightning. It began Sunday at dusk as I walked up the lane to home (returning from Negombo and visit to Dr. Samantha’s home). For the past 5 days every afternoon it begins to rain, with bursts of heavy downpour, and continues through much of the night. 2 nights ago there was a deluge for hours. The trees and plants look full and strong. Today from the bus I saw flooded paddy fields, and shining expanses of water – almost lakes - where there had been dry marshes.

Now I am spooked. Again tense and more apprehensive. This morning waiting for the bus to leave a young man put a duffle bag on the bus, looked around at the seated passengers, and then left. It is common for people here to put packages and produce on buses to be picked up somewhere, I’ve seen it before. Actually in a few minutes he returned and took the bus, but until he did, I was terrified, and thought of getting off the bus. With the horrendous bombing of the naval transit buses Monday south of Habarana, and yesterday’s attack and fighting in Galle, the violence has gone beyond any semblance of clear boundaries. Also the reports of stones being thrown at Tamil owned shops and a curfew imposed – the prospect of ‘communal violence’ is most disturbing of all. The possible re-emergence blends with the awareness and memories of this in the past. Knowing Dr. L’s situation and family history intensifies my concerns. I offered to try to help him, and now fear will not be able to. And I think he is desperate for some way out/relief. It is all so sad.


23 October 2006

After “6 month partnership review” of my placement in which the doctors I am working with were quite positive, it was agreed to continue the trainings (there had been noises about stopping) but that I needed to write modules so the admin folks could review and approve, or not. I then spent almost a month writing up what have done so far, mostly alone working on computer. I felt like was writing term papers. During that time did no trainings, and also didn’t visit clinics because was waiting for a letter to go out to make those visits official. As of 2 weeks ago I had completed 8 draft modules and submitted them. So far no feedback (and probably has been no review either). It’s like being in a vacuum and I’m decreasingly unproductive. However have begun doing trainings again, and also as of last week visiting some of the clinics. More contact with human beings and feels more satisfying. MAYBE I can make it until next March.

I’ve also been trying to plan more on weekends – visiting other volunteers and going places more. My friend Mary Kay came last week. Now she is on a 2 week tour; next week we’ll travel together. I’m really looking forward to a vacation and a break. The day her tour began there was the bombing of the naval transfer buses with 100 people killed (in an area that the tour would go through). I was very worried, but when finally spoke with her 2 days ago she said tour was great, no changes, they weren’t stopped at checkpoints, everything fine etc. I was relieved, but it’s kind of surreal.
But many things in the country seem unreal, disconnected, illogical.

Now it is the season between the southwest monsoon and the northeast monsoon, but it is a rainy time and can rain anywhere. Apparently a lot here and in the hill country (where we will be traveling and where there have been landslides). For past 8 days has begun raining on and off every afternoon and some nights torrents. I quite like it because it’s mostly cool – but hope we don’t have an 8 hour train ride turn into 20 hours due to a landslide.


27 October

I’m in good mood because tomorrow my holiday (that’s vacation – I’m starting to talk like the British) begins. AM SO READY FOR A BREAK. Now I’m no longer stressed out at/about work, but also am no longer very motivated. And NO, modules have not been reviewed (to my knowledge) and approved; no feedback to this moment.

With all the rain the land is transformed. All the trees and plants are thriving, and shades of green deeper. What were dried marshes and meadows have turned into wide ‘tanks’ (lakes) with many - more - white egrets. The paddy fields are full of water, reflecting the sky and gleaming. Now the farmers are plowing and planting, and some of the fields are turning new green. Unfortunately in the hill country, where we will go this coming week, the rain means shortened travel days and possibility of mudslides. But will enjoy it, no matter what.

Happy Halloween! (I keep being surprised when am reminded of the holidays – feel completely disconnected as climate is so different, as well as the culture.)


5 November 5, 2006
It’s Sunday, the last day of my vacation week. My friend Mary Kay came and took a 2 week tour, then we traveled for a few days. I met her in Negombo the weekend she arrived, and then again in Colombo at end of her tour. Had dinner with her and tour group (tiny, only guide and 3 others) in the dining room of Grand Oriental Hotel which had an incredible view of the harbor – it’s like you are right in it. The next day we met another VSO volunteer and went to special shopping places, then took train back to Kurunegala (MUCH better than bus). We just stayed overnight and left the next morning for 4 day trip which was great. Was so good to have a break and see different area of Sri Lanka. We rented a car and went to hill country. Lots of beautiful scenery, tea plantations, waterfalls, wonderful views, fun shopping, eating much. Driver Anura was wonderful (had been recommended by another volunteer and is more like a guide than a driver), really helpful, intelligent, took good care of us, good company. I took lots of photos; that really helps keep the experience alive for me. I’ve got to try to figure out how to shrink them so can send or put on Snapfish. Weather really cooperated until Friday afternoon when we had to go to airport - drove there thru deluge of rain, and van back with me ending up going thru flooded road and then backtracking to go around as road was awash with water overflowing the paddy fields (this at 10:30 at night). It was scary and beautiful at same time. But eventually everyone got where going, exhausted but fine.

After weekend washing clothes and putting things back together, returned to work doing a training on Monday. It went ok, but I think the MO-MHs are looking forward to finishing, and I am too. It’s just hard with no administrative support or recognition. It’s harder and harder to get anything done during the (many) times when am working alone preparing/writing (or supposed to be). I’m no longer stressed out about the work situation here; however I’m also no longer very motivated. It’s very hard getting the writing done with no feedback, and I think it’s unlikely these modules will actually be used within this health department, even if “approved.”

It’s my 8th month here, and thinking more on what I’ll do after finish here in March, but no decisions yet. It looks like I can get COBRA extension, which would take pressure off – wouldn’t feel necessity to have a position (volunteer or otherwise). There is the possibility of extending and doing some short term work in other part of Sri Lanka. Hopefully that could be more satisfying – but I need to be very clear about my boundaries and requirements. I could also see if VSO Canada has another position somewhere – but idea of coping with another language is not appealing. A few weeks ago I saw a Doctors Without Borders position working with street children in Honduras and contacted them to express interest, but they selected someone else (yet another position where they really wanted a psychologist). Also there’s the possibility of just traveling. Whenever I do leave here, I’m thinking of traveling some in Southeast Asia and maybe China. Would like to visit people in Cambodia, and also staff of Children Ctr in Baoji. Still just thinking though.

Am planning to go to a meditation center for a few days over the holidays.

Still raining in Kurunegala every night and most afternoons. (The biggest rain was the day we went to the airport!) It’s cooler but a little buggier too.

November 7-8, Election

I voted absentee ballot. When Mary Kay told me Angelides has been way behind in the polls, I was really shocked. Hope the rest of country shows more sense than CA and our movie star governors.

Election results – HONDAI! HARI SHOK! At least it’s a start. Hope Pelosi is right about now making progress.


Contributions to VSO Canada still much appreciated. Here’s the link:

http://www.vsocan.org/display.aspx?pid=290&cid=608

WHAT IS MY WORK?

August 2006 What is my work?

Several of you have said that it’s not clear what my work is. That may be because I’m not sure myself, & become less so as time goes on. My position description had 3 main components:

1 - Training in ‘psychological interventions’ including ‘psychotherapy’ for the
Medical Officers of Mental Health (MO-MHs) in Northwestern Provincial
Health Service, which presently includes 7 in Kurunegala Province and 4 in
Puttlam Province. This involved developing a training curriculum (? In
consultation with the Consultant Psychiatrist in each province).

2 - Developing training in basic understanding of mental health & of counseling
for the other Medical Officers in the area (over 200 in Kurunegala Province). This was to be begun by me, and then continued by the MO-OHs.

3 - Every other week case conferences at 2 hospitals and a rehabilitation
program. I was especially interested in this part of the work.

This work was to take place in English.

There was also a request for a 2nd volunteer position: Program Manager. This person was supposed to help coordinate, develop the network of services, & policies and procedures. This position was not filled. (MAY be filled at the end of this year.) This is a problem because it’s much needed, because the training (my position) would ideally dovetail with developing the services, and because the current – new – Consultant Psychiatrist for Kurunegala Province wants that position filled, and basically doesn’t want the main part (#1 above) of my position.

Current status of my work is as follows:

3 – As of my arrival, case conferences had apparently dropped off the map.

1 - Training with the MO-MHs began in June. Due to various factors, separate trainings have been scheduled for Kurunegala (3x/month) & Puttlam (2x/mo) Provinces. Initially this seemed going well, but now less so. This training & the frequency is now being reevaluated (gory details below – you can skip them if not interested). Today (Aug 21) we had ANOTHER discussion about the MO-MH Training for Kur & changed schedule somewhat.

2 (in part) - One day trainings for other Medical Officers in basic mental health has begun in Kurunegala Province, & I’m doing a 1hr presentation on Psychosocial Factors in MH, with a bit of assessment thrown in. I was not involved in planning or developing this training.

A possible + positive is some facilitating system & program development. Because the MO-MHs are getting together regularly they are talking about some of the problems and beginning to address these with the higher-ups (so far results not evident but may come).

System is/has
HEIRARCHICAL BUREAUCRACY
Competitive
Insecure
Poor communication
CRITICAL
De-motivating
Invalidating
and yes, Challenging & Frustrating

I muddle & stumble around in the convoluted workings & the departmental & inter-system politics. Right now feels like Alice thru the looking glass – what’s good/bad, right/wrong, which way is the current going? Lots of inconsistent and conflicting directives. I know it’s good to go with the flow, but current keeps shifting, and most of the time I don’t know which direction. And there seem lots of hidden rocks to bump against. So I’m trying to ‘not take things so seriously,’ clarify my thoughts, and do a better job of clarifying what’s wanted & what I can/am willing to do here (to the extent possible) and being assertive (without offending which seems easy to do here).

* * *

DETAILS (you can skip this part, but it’s necessary to maintain my personal mh):

-The main problem is that my position was developed by the previous Consultant Psychiatrist, Dr Arambepola, who is no longer here. The new Consultant Psychiatrist, Dr. Panduwawela, (started in January, so this change was in the works before I was offered the position) is completely not interested in the original plan. Oh, and also he basically doesn’t believe in psychology (or know anything about psychotherapy or process or relationship), and thinks (even if psychology MIGHT be useful in the west), it’s not relevant to Sri Lankan people. Or something like that. As my position was to involve training in psychological interventions, psychotherapy and counseling, this creates some conflict. Also he seems unwilling to talk together to sort it out or re-negotiate my work. He basically doesn’t talk with me. Apparently he wants to change much of what the CP was doing. Everyone finds him difficult to talk with. But he is THE CONSULTANT, so everything adjusts to him. At the beginning I thought he was avoidant. Now I think he is arrogant & narcissistic. Not good.

-Second problem is that the Deputy Provincial Director of Mental Health – DPD – was away for 2 months right after I started. She is very competent, clear thinking, organized, and seems the only one with the authority get people to work in some kind of coordinated way. (Except the word ‘people’ in the previous sentence does not necessarily included Dr.P) Now back, she questions the training as begun by myself & Dr. Samantha, the MO-MH who has had responsibility of ‘coordinating’ MH services in Kurunegala Province (with the verbal agreement of Dr. P). So things didn’t really get worked out at first and now there’s lot of tension, confusion, backtracking and redoing.

-Third thing is that I haven’t had anyone to work with me on developing the training (I thought it was supposed to be the Consultant, but not happening). So no doubt I have made more mistakes than might have otherwise.

-Fourth is that Dr. Samantha is fed up and resigned from coordinator role – with DPD’s consent. He told DPD & CP that he just has too much to do – and also at one point got angry and told them he was leaving mental health work and might leave the province as well. A number of things have happened in the system that he has been upset about. I think generally he’s tired of trying to keep things going and get them to work without support, being in the middle & lacking authority. (Middle management, but worse.) For a couple of weekis he wasn’t talking with me but around me, which I was upset & disappointed about. We did talk about it, and now that’s better.

One good aspect is that the doctor who now is supposed to be coordinating MH programs, the new MO Training, has more seniority than Dr. S and doesn’t report to the CP, so may be more able to deal/negotiate with him. He is in charge (temporarily) of non-communicable disease programs, doesn’t know anything about mh, but is capable and very nice. On the other hand he apparently doesn’t have authority to make decisions either.

- Fifth problem – at least for me – is that many of the trainings & meetings that I was told would be in English, have been conducted in Sinhala. This means that I do not understand most of what is going on, and so cannot take it into account in planning/developing/doing training. I have requested translation help, and gotten (selected?) bits. I plan to more formally request a translator for these sessions in Sinhala, as continuing this way is not workable.

- Also tied in with all the above is that the health department is really 2 systems. There is Provincial Department of Health Services – PDHS – which I work for, and the MO-MHs work for, and MOs and MO-OPDs. Also there is the Kurunegala Teaching Hospital that is under the federal government Health Dept. The CP is based at KTH & is not technically part of the PDHS, although he is in charge of all the MH services (clinically, not administratively) & is the boss of the MO-MHs who work at the District Hospital MH Clinics and are under the PDHS. Except that the MO-MHs are appointed by the Director of MH who is in the Federal System. (KTH has the inpatient psychiatry wards, and there are 3 MO-Psychiatrys working there under the CP. There are also several outpatient psychiatry clinics at KTH). If you are CONFUSED by now, you’ve got the
picture.

Actually the training in Chilaw, Puttlam Province seems going smoother. One of the 4 doctors seems to have dropped out; the other 3 are interested and enjoyable to work with. (Of course, it helps that I can learn from the experience in Krngla, and modify by the time I get to Chilaw. Also, there is a different Consultant Psychiatrist.)

(End of DETAILS section)

* * *

Now I definitely understand why all the warnings & caveats about difficulties of working in SL government system, ‘easy going volunteers do best,’ ‘no one ever questions or disagrees with the boss or senior people,’ ‘there are many abrupt changes & you may get very short notice’, ‘it’s best if one can adapt to the changes even if don’t agree with them,’ ‘if you expect people to do what they say will, you’ll have trouble,’ etc.

It’s hard to know when to send off this saga about work, as things keep changing
I’m working on not taking things personally, and coping with uncertainty.
I’ve also written a letter to the DPD requesting clarification of some of the issues and assistance.

Life in general

I’ve made a list of the places I want to visit in Sri Lanka (that are not off-limits now), to make sure I go in case I do need/decide to leave early (because of the growing conflict, or work situation, or both). The next couple of weekends will do some sight-seeing around here with other volunteers and my Sinhala teacher Jayanti – Dambulla cave temples and Yapahuwa ruins are first.

The conflict in Sri Lanka is very distressing, sad and horrible for the many people caught up in it, but as of now is not affecting life in Kurunegala. Here everything is calm, and daily life goes on as normal. If that changes, I will definitely leave. Some patients, especially in the northern part of the 2 provinces, have family members affected by the conflict – living in the north or east, or in the armed services. And staff also – one young administrative assistant in the Training Center said his cousin in the army was killed 2 weeks ago, just 3 months after getting married. I’m sure many more people are affected, but I don’t know. For now, I am just more restricted in where travel in the country, including some apprehension about going to Colombo due to recent targeted explosions. I just heard on the BBC that the ICRC has begun evacuations of foreigners from Jaffna (now the ship has reached Trincomalee in the northeast) – hopefully 2 VSO volunteers who have been stuck there are among the INGO staff leaving.

Priyani, a nurse in the health department who lives close by my residence, has befriended me. She and her husband invite me to go with their family here and there. She is very warm and open, not formal (as many Sri Lankans are). She has 2 sons 14 and 11. Her husband’s mother also lives with them. Husband is from Galgamuwa, a poor farming area in the north of Krngla Province, and is the only one of his siblings to get more education and a professional job (working in a bank). Priyani’s extended family is in Galle, in the south of the island.

The first weekend in July, after a meeting in Colombo, I went to Unawatuna & Galle with several other VSO volunteers, 3 of whom were finishing work and getting ready to leave. We went down in a van from Colombo and I came back on the train – about 6 hours. In the van (on way down) and train (on way back) passed clusters of new graves of tsunami victims, the bare concrete foundations of small houses – just left in areas that could not be rebuilt, and lots & lots of repair and new construction in process.

Unawatuna is a beautiful long curved bay ringed with coconut palms. There are rocky outcrops at each end, and a couple of rock islands out in the bay. The sound of the waves was lovely, walking on the sand, swimming in the surf (rolling waves rougher than they appeared). Before tsunami there were fisherman’s huts all along the beach. Now it is a clear curve of sand, with rebuilt & in process of rebuilding guest houses & restaurants newly painted. The beach has gone more upscale “added a star” as Angie said. Near the center of the strand, in a break between the buildings & the road there was a collection of small brightly painted boats.

The 2 days were lovely and sunny, not too hot, but in the middle of our 2nd night there a horrendous gale came up. I woke about 3am being rained on in bed – slanting rain through the open window. Went outside to get things off the line; my new towel had blown off and I grabbed everything else and brought it inside soaked.

Sunday afternoon we visited Galle. The old part of the town is on a promontory enclosed by the walls of the old Dutch fort, built in the 1600s. There are many interesting old buildings with worn, textured surfaces. We looked at some elegant shops and galleries and the special jewelry shop that one of the volunteers knew (I bought some lovely silver earrings with tiny blue opals). Along the embankment of the western seawall there were families and groups of young people strolling, flying kites, playing soccer. I liked the town very much and hope to go back.

Had a good weekend in Colombo Aug 4-6. Met 2 new volunteers and one who is returning. Miranca, a management volunteer from Holland, and I spent Saturday wandering about, shopping and looking. Went to Lanka Hands, a wonderful crafts store with a variety of lovely things. I stayed in a pleasant guest house between Galle Rd. and the sea, and checked out some other places to stay and eat. Enjoyed being in Colombo (somewhat to my surprise), but now the idea of going isn’t very appealing, with the uncertainty of possible violence there – though the actual likelihood of being in the proximity of a bomb is very unlikely. Foreigners, including Americans are not targets, so any danger would be due to being in the wrong place at the wrong time.


Odds & ends:

2 Sundays ago I joined one of the MO-MHs, Dr. Ariyarathna going to his temple’s English language Buddhist school. We met with about 25 teen students, and talked about mental health and problems young people may have. I basically led a discussion, with good help from Dr. A. It was fun, and we were pleased, along with the Buddhist monk who is the school principal.

Elephants & mental health – yes, there is a connection. The CP, Dr. P is very concerned about mental health problems in the Maho (north of Krngla Province) area caused by wild elephants destroying rice paddy fields and sometimes the homes of poor farmers. This causes financial problems and can precipitate serious depression and sometimes suicides. Of course, this is not funny, but what is funny is that Dr. P decided to invite the Director of the Agriculture Dept in the province, and the Director of Wildlife to the Mental Health Review Meeting (along with representatives of Social Services, Child Probation & Welfare, and the Police Dept). Unfortunately they did not attend, so we missed opportunity to plan behavior modification for the elephants. Dr. S said we could invite the head of the herd .

The Perihera was held in Kandy for 10 days at the beginning of August. It is a series of big processions and ceremonies involving the (‘Buddha’s) tooth relic which is kept at the Sri Dalada Maligawa (Temple of the Tooth). There are lots of elephants, and traditional Kandyan dancers. On the last day the priests go to the Mahaweli Gangha river outside the city for the water cutting ceremony. This is all supposed to bring rain. And amazingly it did – after a month of very dry hot weather here, it began raining torrents the same evening, and continued regularly for almost 2 weeks! So maybe I need to reassess my attitude towards relics. (Unfortunately the efficacy of the Perihera and rituals hasn’t extended to the northern dry areas.)

That’s all for now.

To contribute to VSO, go to my link at:
http://www.vsocan.org/display.aspx?pid=290&cid=608

Kandy to Kurunegala

Kandy (or Nuwara meaning ‘city,’ in Sinhala)

During the initial training, we stayed just over 2 weeks in Kandy, in the hills about 2 ½ hours NE of Columbo. On the way there, we climbed through green hills, towns and villages. The name Kandy is from the word ‘kandu’ meaning hill or mountain. The higher elevation and temperatures a few degrees lower were welcome.

Lake Bungalow was an improvement over Lake Lodge in Colombo (though it could use more cleaning as well). On a lane just up from Kandy lake, it had 2 stories with 3 rooms each around a large sitting area built above a preschool on the ground floor (run by the owners’ daughter). Just behind is the owners home, filled with interesting furniture, antiques and photos, with a lovely covered patio where we were served breakfast. There is a large cage of birds, including a talking minah sort, and lovely plants and blue flowering vine. My room, in the back, had large casement windows with view of hills and houses toward the back, and on the side overlooking the residence of the head abbot of the Malwatte Vihara, the second most important Buddhist pansila (temple) in Kandy. On the door a small sign: “NOTICE - PLEASE CLOSE THE WINDOWS AND DOORS BEFORE YOU LEAVE THE ROOM TO AVOID MONKEYS”. Apparently they can come in and explore and play with whatever interests them, taking shiny and interesting items and generally wrecking havoc. (None did, but we did see them at times in the trees outside.)

Beatrice’ room in the front had a balcony and great view of trees and the lake to the hills on the north side. Down the slope, the branches of 2 large trees were hung with large fruit bats that flew about after dawn and before dusk. After a few days afternoon rainstorms began, starting earlier and continuing longer each day. From the balcony we watched them pass over from east to west; twice there were spectacular lightning storms over lake. Walking between Kandy commercial center and Lake Lodge we went along the south shore of the lake, with birds – singing, calling, flying, now and then a long-legged egret or cormorant wading along the bank. For a few days a large turtle sunned on a rock, and once I saw a crocodile. At dusk, white birds flew in small V formation skimming over gleaming surface of lake, heading to a large nesting tree on a small island near the Sri Dalada Maligawa – the Temple of the Tooth (Buddha’s). This is the most important pansila in the country, due to the importance of the relic. (It’s kind of scary to think that the rule of the country is supposed to be determined by who possesses this relic – in the past which king, now it is part of the idea of Sinhala nationalism.) But the Sri Dalada Maligawa is an impressive place, with an elegant setting and rich shining interior. Twice a day crowds of Buddhist Sri Lankans, interspersed with tourists, come for the dawn and dusk pujas, conducted around the 2 story interior shrine built to keep the relic.

Our classes were held in the ‘Training Center’, a large house high in the hills with extensive grounds containing a variety of trees and flowers, and a grand view. Each morning after breakfast, the van driver Piyadasa collected the 4 of us, and drove through the congested market/bus stand/train station area of town to the other side, and up the narrow winding road to class, and more tea. 2 cooks, Wimela and her daughter Khumari, prepared lunch, with close supervision from our organizing teacher, Ianthe. The meals were huge, with multiple dishes. We were treated to all sorts of Sri Lankan foods, and some SL versions of ‘western’ meals. The final 3 days we chose our favorite Lankawe recipes to learn to cook. And at the end of the training, we received a SL cookbook put together by the teachers, along with our specially created grammar and vocabulary handbook. The language lessons were excellent. Although the ‘cultural orientation’ talks seemed to fall down a bit, being in Kandy over New Years provided much cultural experience.


During our stay in Kandy we went to see a performance of traditional Kandyan Dance (kind of a sampler), visited Buddhist temples (pansila), Hindu kovils, and saw mosques and churches. The week before Sri Lankan New Year (Sinhala Buddhist and Tamil Hindu) on a Poya Day, full moon, included a Hindu chariot festival, Mohammed’s birthday, Passover, Good Friday and Easter. Pretty comprehensive! We went to see the beginning of the chariot festival in the evening mid-week. 5 large chariots decorated with statues, lights, flowers, each dedicated to a different god were moved into the street by crowds of devotees pulling on long ropes. They were beginning a circuit of the town that would last through the night. The celebration of New Years involves astrology to determine the exact auspicious times to light the first fire of the new year and cook and eat the first meal. The first food eaten is kiri bat, a firm pudding of coconut milk and rice. Family members visit each other, and there are many special sweet foods all day.



To Polannaruwa and Sigiriya (April 15-17)

Saturday after Sinhala New Years we left for 3 day excursion to ancient cities north of Kandy. Our group of 4 volunteers with 3 teachers and a driver. We visited Polannaruwa and Sigiriya, and went on a dusk ‘safari’ to see wild elephants and other animals. Was a good trip. The ruins of Polannaruwa extend over a large area and our 3 hours wasn’t enough time, so I plan to go back. Sigiriya is a fortress/palace built around and on top of a striking sheer rock formation. Around the base are ruins of water gardens and rock gardens. We set out to climb Sigiriya at 6:30 am, and it was beautiful, the favorite place so far for all of us. I especially liked the water gardens, have never seen anything like them. Will add photos of this, as if I try to write about it, will never get this finished.

In Kurunegala (April 27 – June 18)

This part is about getting back to REAL LIFE. No more sumptuous meals prepared, no more teachers always there to translate, give advice and solve problems. I’m trying to pull my thoughts together - parts of this might be a little repetitive for some of you.
First, I am fine. There is no conflict evident here where I am, and the situation hasn’t affected me directly at this point. The news from the north and east is increasingly bad, and the peace agreement seems very shaky. But at this point, violence is confined to the north and east – mostly around Jaffna and Trincomallee. VSO Sri Lanka office has had volunteers in those areas leave several times, and currently several are away from their positions. Since late May we are not allowed to travel into the north and east at all. Hope it calms down and the peace process resumes. (But the past 2 weeks, that seems unlikely, and the escalating conflict brings feelings of anxious uncertainty.)

Had a difficult time getting computer connected to internet after arriving in Kurunegala month ago, because the phone here isn’t a landline and required a special cable only available in Colombo. Meantime had to take bus into town to internet café which was extremely slow, besides being inconvenient. I felt kind of trapped. Once I got cable couldn’t install the driver (?) and had to take computer & phone to computer place for them to set it up. FINALLY got it all working, but a week later not and brought it in to work where Mr. Ranjit, a very nice young clerk who is the computer expert in the DPD office, helped me re-connect. Have catching up with corresponding. On top of that I managed to lose my glasses (in their case, not wearing them) on a crowded bus 10 days ago and had to go to Kandy to order new ones, at least didn’t have to go to Colombo which is farther. It took 2 weeks for the new glasses to be ready (was told 1 week), but now have them and they’re fine (and someone commented they look prettier than the lost ones!).

I’m living in a small annex in Malkaaduwawa, a neighborhood outside of Kurunegala center, just off Negombo Rd. It is about 3 kms west of the DHS offices, 10 minutes by bus. Parakum Mawatha is kind of a suburban lane, very quiet & green. The landlord & wife (speaks Sinhala only) are next door; there grown daughter is there & the younger daughter in a university in Colombo. They are pleasant but pretty much ignore me, except for the younger daughter who is friendly when she is around. The annex is relatively cool, and has lots of windows. All in a row are an entry sitting room, middle room (that has everything that doesn’t go anywhere else: dining table, wardrobe, extra bed, ironing board), and small kitchen. To the side off middle room is one very tiny bedroom, so if anyone comes to visit they would sleep n the middle-dining-dressing room. Kitchen is also tiny, & a little grundgy. I’m in constant struggle with the various ants & tiny flying, sometimes biting insects. Plus mosquitoes which aren’t as bad as anticipated, but require closing all the windows from about 5pm to midnight. (This country is ready for some entrepreneur to make a fortune on screens.) The best view is from the bathroom (the only room with cross ventilation) which is at the back & looks toward the expanse of rear neighbor’s land which has lovely trees & a well. The light through the trees is beautiful in early morning, & also at sunset. It’s a pleasant area, very quiet. One small difficulty is that there are no buses on Negombo road after about 7pm. After about 5 buses are super crowded, and after 6:30 or 7 coming from town or Jayanthi’s from weekly Sinhala lesson have to spring for a tri-shaw.

Negombo Road is 2 lanes, with lots of traffic: buses, trucks, cars, vans, trishaws, motorbikes, bicycles, and an occasional cow wandering. And people walking. The basic rule is bigger faster vehicles have right of way. Drivers honk to let the smaller slower know to get to the side. The cows eat weeds, from piles of garbage by the roadside, and occasionally visit someone’s yard to help keep the grass & weeds trimmed.


It’s hard say whether I’m enjoying myself. It’s interesting. After the orientation & language training ended, was a bit of a shock transitioning to being on my own in Kurunegala. Getting place set up to be functional, adjusting to taking care of my own food, cleaning, starting work, learning where things are and how to get around, etc. At first was very uncomfortably hot, but it’s gotten better. I think in part because I’ve adjusted a bit, and now it is raining more and that cools things down. Mid-March to mid-May is supposed to be hottest time, except for August which is hotter.

The Provincial Department of Health Services is a complex of 1 & 2 story bungalows built by the British, with one more recent 3 story structure. It houses various administrative functions, as well as health education, malaria and rabies prevention programs, a chest clinic, etc. My office is on the 2nd floor of the training center, an old building that seems in process of transitioning from dormitory to offices, or maybe just being both. I like the room – it is very light, and when I complained about old desk that had only 1 drawer which was locked shut with no key, the Provincial Director of Health Services ordered a new desk which arrived amazingly fast. But still waiting for phone extension connection (I haven’t gotten mobile phone & don’t want one, but it may be necessary. 2 weeks ago when I brought my laptop in & plugged it in, the circuit switched off. Took a couple of weeks and eventually having to go to top administrators to get it fixed, but now can work on my computer in the office. I go back and forth between my office and the office of the Deputy Provincial Director of Health Services where I go to get things printed, copies made, make phone calls, ask lots of questions and try to organize things. .

Some other VSO Mental Health volunteers have been very helpful. Angie (at Angoda horticultural rehabilitation program with Basic Needs) is great & very supportive, but leaving at end of June. Astrid, a Psychiatric nurse who was in Colombo to do Psych Nurse training (it apparently didn’t succeed) & finished mid-May gave me a CD of training materials. 2 weeks ago I visited Nivahana Society and the Community Mental Health Resource Center for the Central Province in Kandy for a couple of days arranged by another volunteer Ashley. He gave me more training material, and I collected information on the training and system there, which is considerably more developed than here.


I’ve been trying to sort out my work, which involves concurrence of various parties who don’t necessarily see things the same way & who have different priorities. Until this past week I didn’t have enough to do, and hassling with clarifying my role. The 2nd volunteer position here, which was to help develop the network of services, unfortunately wasn’t filled (maybe in November). Also the Consultant Psychiatrist has changed & isn’t the one who was involved in developing the position. He of course has his own ideas, which at first didn’t seem to include the training at least at this point. And it was very hard to talk with him – he seemed to avoid it. Now things are going somewhat better with Dr. P; I guess he feels more comfortable with me, & I’m learning how to approach him (in bits, with very simple English). However the collaborative development of a training curriculum that I had anticipated doesn’t seem to be happening. (Expectations – must manage those.)



Anyway, big achievement of last week was now there is a schedule for the 7 MOMHs (Medical Officer Mental Health) in Kurunegala Province; will begin June 19th & be 3 Mondays/month. Will also begin regular training for the 4 MOMHs in Puttlam Province, though whether this will continue seems less certain. Case conferences seem off the radar for now, which is disappointing. Hopefully things will fall more into place & feel more satisfying when the regular MOMH training begins. One training for 7 MOMHs will be 3 Mondays/month in Kurunegala, & a separate training for 4 in Chilaw about 1 ½ hours away on east coast. Will be interesting to see how the participants respond.

[Update as this goes to press – I’ve had the initial training session here and the one in Chilaw, and both went well. I’m busy preparing for the second session and no longer complaining about not having enough work.]

Arriving in Sri Lanka

Here's my first post from Sri Lanka. Hopefully next one/s will be more current.

14 April 2006 Sri Lanka New Years Day
3 weeks and 2 days in Sri Lanka (finishing at the end of April, 5+ weeks)
Kandy – Lake Bungalow

Photos: class of April '06 (+ teachers, cooks & drivers), roadside scene, Sinhala & Tamil New Years treats

Colombo
Arrived in Colombo after 26 hour trip: LA to London, at Heathrow, and London to Colombo. Landed into greenness, groves of coconut palms, lagoons and stretches of water. It is very hot, ‘hari rasneiy’. I was quite jet-lagged with the 10 hour time difference, but more conscious than anticipated. A VSO manager Manchula met us at airport – myself and 2 new volunteers from UK, Ian and Beatrice. After a swerving, jerky ride into the city in VSO van, we arrived at Lake Lodge Guest House about 2:30 in the afternoon. A 4th new volunteer, Nandita who is from India, was there, having flown from Bangalore earlier in the day.

Lake Lodge is down a blacktop lane off a side street off a section of Beira Lake in Kollupitiya, Colombo 3. The lane goes along a large fenced school soccer field, used by children during school hours, and men in the afternoon and evening. Lake Lodge is quite pretty - flowers, 2 square balconies with large pots of bouganvilla and other flowers, huge trees, birds flying and chirping everywhere. Striking black and white birds visit the courtyard, and there are several others. Constant bird calls, and flying, swirling, especially at dusk. Unfortunately Lake Lodge looks better (from a slight distance) than it feels. We are on the very hot second floor, and, except for clean sheets, the rooms are somewhat grubby. No air conditioning, except in 2 rooms used to teach our Sinhala (myself, Beatrice and Nandita) and Tamil (Ian) classes. On the positive side, each of us had individual room, a pleasant surprise. After 3 nights in a stifling room with very little sleep, I felt quite desperate. Thanks to Nandita, who was keeping her windows closed at night due to terror of geckos, I switched to airy lighter room which faced one of the rooftop balconies, and began finally to sleep a few hours a night (always with the ceiling fan going).

The guest house has all male staff: manager, assistant manager, and several ‘boys’ who were mostly teens but included an older man with gray hair. Among them they did all the work – cleaning rooms (somewhat), errands, watering plants, and cooking. They also slept on couches and mats in the office and downstairs hallways at night. All were very friendly, and used to VSO routine, including at times participating for us to practice bits of the language lessons.

The first afternoon we were presented with lovely fruit and snacks, had a welcome talk from the VSO country director, and were given the basic schedule for our language classes and cultural orientation. Next morning we were brought to the VSO office, did administrative paperwork, got more information, met the office staff and had a lovely lunch. The following day began language classes (9 to 1 with a half hour tea break mid-morning), followed by lunch, and at 2:30 or 3 various cultural orientation sessions for a couple of hours, then more tea.

There were 2 Sinhala and 2 Tamil teachers. The following week 2 of the teachers left and 2 more came – to give us different accents (and also likely so all the teachers had the opportunity to work, despite the small group. The lead teacher/organizer Ianthe works with children with speech disabilities in Colombo, the other teachers are all public school English teachers in different cities, each working at multiple grade levels. The classes were very well done, with a variety of approaches and activities and handouts. There was a lot of material; I think it provided a good basic start. There isn’t an English/Sinhala dictionary, so we were supposed to create our own. As I didn’t keep up, that’s one of my projects now. Fortunately one of the Sinhala teachers Jayanthe lives in Kurunaegala, and I will be able to continue weekly classes for a few months. The ‘cultural orientation’ consisted of talks on various subjects, provided by outside speakers, VSO staff, or the language teachers. Some were excellent, some so-so. The very first speaker - one of the best - is on the National Peace Council and spoke about issues in the ethnic conflict.

In the late afternoon/early evening we wandered around the neighborhood, going to the internet, finding places to eat, and checking out nearby 2-3 floor shopping malls. The closest Crescat is very upscale, with super air conditioning, a pricey but very fast internet place, and in the basement a food court and supermarket. Liberty Plaza a few more blocks away, was more basic with smaller but interesting shops. We also went to Pettah, Colombo’s main market area one weekend day. There is a covered market, street vendors and streets filled with shops including many clothing and fabric stores. It somehow reminded me of New York’s Lower East Side/garment district. In one direction we pass a small lake with a Buddhist temple (pansela) on an artifical island. There were egrets and pelicans in the water and on the shore, and the ever-present crows and other smaller birds. Walking the other way we see government offices, security guards, roadblocks, mosque, churches, temples. We found several good places to eat, including Indo-Ceylon, a Sri Lankan/South Indian restaurant, and Carnival ice cream parlor.

While in Colombo we attended the VSO ‘Launch’ of the new 5 year country plan. The plan has actually begun, but due to the tsunami effects, Launch event delayed. There were various speakers, including Dr. Ganeshan, the consulting psychiatrist in the Eastern area (not where I’m going) who talked about the development of mental health services there and was very inspiring. It was also a chance to meet more volunteers, and some staff of partner organizations. One Sunday afternoon went to the Holiday Inn swimming pool, meeting several Colombo volunteers. Although the water was tepid, the swim was a lovely relief from the heat, and the afternoon relaxing. Connected with 2 other mental health volunteers, Angie an occupational therapist and Astrid a psychiatric nurse. One day I visited Angie at her placement, a horticultural rehab program, and another met with Astrid who gave me a CD of training materials. After 2 years here, Astrid is leaving at the end of April, and Angie leaving in June. I’m sorry, for myself, but will meet other mental health volunteers at the (every 3 months) sector meeting at beginning of July.





Kurunegala visit
Our first Sunday here, each volunteer went off with our own van or car and driver for a placement visit. As Kurunegala is just 2 ½ - 3 hours from Colombo, I was to stay over only one night, meet with my Sri Lankan colleagues Monday, and then return to Colombo. It felt strange and ostentatious having a whole van for 1 person. The driver spoke little English, but made an effort to point out places as we passed. The road (Colombo-Kandy road for more than half the way) was crowded with traffic. After crossing over the river and leaving Colombo, we went through a series of towns, all busy with shops and Sunday markets. In between the towns we began to see rice paddies, coconut groves, and more greenness as the road gradually climbed into the low hills. There is a special coconut, taembili, only used for drinking. The meat of other coconut is used in most curries, and the milk discarded. We stopped at a roadside stand to buy taembili, a lovely drink which is said to help with managing the heat and have various health benefits. At one point we passed 2 huge elephants standing trunk to tail on a flatbed truck.

The road branched off going through rolling land, no longer climbing. Now traffic was light and the landscape rural. Kurunegala, named after large rock formations surrounding the town, is a crossroads with a large lake (‘tank’). There are several traffic circles, many shops, a market and much street commerce. My driver was not familiar with the town, so we made our way to the hotel slowly. It turned out to be quite elegant, with huge rooms, lovely beds and AIR CONDITIONING! It also had a swimming pool, but frustratingly I hadn’t thought to bring my bathing suit. I found out later that Dr. Samantha Wijesundera the Medical Officer of Mental Health who is my counterpart for the placement (primary contact colleague) had decided this hotel would be best because local elections were imminent and he thought some of the “more interesting” places might not be safe (due to presence of members of different political groups who sometimes clash).

We had a very nice meal in the vast almost empty dining room, the driver took a nap; then we went to see where I will be living. It is a 3+ room annex of the landlord Mr. Alagoda’s home, on a residential street off the Kurunegala-Negombo (on the west coast north of Colombo) road. Next door is the home of Mr. A’s mother and sister, where he grew up. It is set among plants and trees, and all concrete which seemed relatively cool (welcome, the area is very hot). It is all in a row – entry room, middle room with a kind of half room to the side, and then the kitchen with bathroom to the other side. The landlord is a friend of Dr. Samantha and speaks English. He and his wife, who speaks only Sinhala, seemed very nice, but a bit apprehensive about renting to a foreigner. It was completely empty. VSO will bring basic furnishings and provide an allowance to buy linens and cooking utensils to start. After this we went back to the hotel, I went out and bought sweet bread, bananas and yoghurt for dinner, ate, showered (have never had so many showers/day) and went to sleep at 8:30. I slept 11 hours thanks to the air conditioning, waking up too late for breakfast before we went to the Provincial Health Department at 9:15 the next morning.

The Provincial Health Department on Negombo Road is a complex of pastel stucco buildings built by the British. After some confusion finding where I was supposed to be, a nurse helped me to locate Dr. Samantha, Dr. Rajamanthrie, the Deputy Provincial Director of Health Services (who I think ??? is the person I actually report to), Dr. Pandavavela, the new Consulting Psychiatrist and Dr. Neelani, the medical officer of planning. Dr. R seemed to be in charge and gracious, Dr. P (who was not involved in developing the position request) cautious and reserved, and Dr. N friendly. They went over several organizational charts and a map of the district showing the clinic areas, and asked me about my previous international experience.

There was a very ambitious schedule planned for the day, with visits to various programs, which almost immediately seemed unrealistic. It became more unrealistic after we went to the General/Teaching Hospital and had to wait for about 45 minutes to meet with the Director there to introduce me and get his permission for me to visit the psychiatric inpatient wards. While waiting I observed a very crowded morning psychiatric clinic – 280 people that day saw 3 doctors! By the time we met with the director it was after 12 noon and time to go to Arunalu, the Rehabilitation Center (developed by the previous VSO volunteer and Dr. Samantha) for the midday meal. Arunalu is on the edge of a small town a few kilometers west of Kurunegala. There are only 10 patients, half men and half women who each stay for a few months. The program is basically rehabilitation activities, primarily horticulture and various crafts. The patients also take care of the daily living activities, including cooking, cleaning and maintenance. The staff members were very warm and welcoming.

After lunch we drove out to a small rural medical hospital. It was a small bungalow structure with one male and one female ward, each with about 12 beds, but only 2-3 patients that day. There were a couple of nurses and a Registered Medical Officer ‘doctor’ who is not a doctor (maybe more like a Medical Tech or Physicians Assistant). It had been planned to go farther to another rural hospital about 1 hour away, but it was eventually decided that there wasn’t time and we returned to the Teaching Hospital instead to see the psychiatric inpatient facility. The Teaching Hospital is a large complex covering at least a couple of blocks; many buildings, little open space. There were 2 large psychiatric wards, male and female, with a small corridor and 1 office between them, and a small outdoor courtyard. The wards, intended for about 35 patients, had over 70. There were rows of beds, and a smaller area enclosed with mesh wire for violent patients. Absolutely no privacy in the living situation, no space for recreation or activities, and only the one office to meet with patients/families separately (for the Consulting Psychiatrist and 3 Medical Officers of Psychiatry). A priority for the CP is getting more space, and he asked if I could help with proposal writing (part of my position?). Patients come to this inpatient unit when they cannot be treated/managed in the rural hospital general medical wards, or the outlying mental health clinics. Another priority for the CP is to decentralize services, so patients are seen in closer to home, and the Kurunegala clinics and inpatient are not so burdened.

Kurunegala is named for the huge rock formations that were thought to resemble animals. The rocks absorb heat during the day and unfortunately radiate it back. Thankfully my home is outside of the town to the west, away from the rocks, as this additional solar heating system is definitely not needed here. The surrounding countryside is beautiful with tall trees, extensive coconut groves, and here and there rice paddies with egrets and other birds and the occasional cow. There is a lake (‘tank’) to the north of the town, with small guest houses and a view of the temple and large Buddha on top of one of the rock formations. You’ll be hearing lots more about life here soon.