Running an ETU in a newly established IDP camp in Sri Lanka

Abstract

Large numbers of internally displaced people (IDPs) have been a problem in northern and eastern provinces of Sri Lanka for several years as a result of the long-running conflict between government forces and the Liberation Tigers of the Tamil Élan (LTTE). The authors worked in a field health centre set up inside a camp where IDPs who had fled intense conflict between government forces and the LTTE in May 2009, which resulted in the defeat of the LTTE, had settled. There, the patients, resources and organizing structure were quite different than what we have seen in a typical Emergency Treatment Unit (ETU). While working at the ETU of this health centre, we encountered several common health conditions. Some of them were typical and related to the displaced and disorganized lifestyles in the camp and previous places where people had lived during the war. These conditions included diarrhoeal diseases, acute asthma, acute gastritis, septicaemia, hypoglycaemia, hyperglycaemia, hypertension and seizures. The physical and human resources were not optimal in the field health centre where we worked, which provided services for about 52,000 IDPs. We faced a number of challenges in running this ETU due to the disorganized conditions, and lack of staff and equipment. The ETU did not have proper monitoring and investigation facilities for the patients, and we relied on translators which led to misunderstanding, misdiagnosing and privacy issues. This experience leads us to review the duties of a doctor in this type of critical situation with limited physical resources, lack of other health care workers, overcrowding and different administrative restrictions. While working for the maximum benefit and comfort of our patients, we had to adhere to some nonstandard medical practices, as well as respecting the security of the country. We propose that these health and administrative problems identified were unique to this structure, and that our experiences will be beneficial for health administrators as well as health professionals in planning and implementing the health services in a similar environment in the future.