Caring for the wounded: the job of MSF caretakers in Vavuniya hospital, Sri Lanka

Every day in the hospital is a busy day for Sivananthan, and today is no different. A 25 year old electrician from Vavuniya, Sivananthan is one of the MSF caretakers working in the Ministry of Health Vavuniya General hospital, northern Sri Lanka. Today he is working in wards 9 and 10, two of the busiest surgical wards in the hospital. Some missing a leg, others missing both, a few paralysed from the waist down and many with fractures unable to move from their beds, 200 patients fill up these two wards. Wounded in the conflict raging in the north east of the country between the Liberation Tigers of Tamil Eelam (LTTE) and the Sri Lankan military, many of the patients are alone because their relatives are either dead, have been left behind in the conflict zone or are living in one of the camps for displaced people. 

Alongside the Ministry of Health doctors, nurses and two ward attendants, 26 MSF caretakers work in these two wards around the clock. The early hours in the morning are always the busiest: the needs are high and there is little time to waste. Sivananthan started his shift today by changing urine bags and nappies for the elderly patients and those unable to walk. After that he spent time feeding the patients, giving them water, bathing them, combing their hair, helping them walk or transporting them in a wheelchair to the X-ray room or the operating theatre. 

 “This morning,” he says “I spent a long time with one of the patients: an older man in his fifties, he has a wound in his backside and he is paralysed from his waist down. He arrived at the hospital a month ago with nothing else other than the sarong he was wearing. He has lost all his family, and all he keeps saying to me is ‘I’ve lost all my family and now I am alone.’ So I spent some time with him this morning, changing his urine bag, feeding him, helping him with the toilet, washing him...”

Sivananthan has been working as a caretaker for two months. “At first I found it difficult because I didn’t have any experience, especially with wound dressing,” he explains. “But I got some training from MSF and I was taught how to talk to the patient, how to identify the most urgent cases, how to lift the patients, clean their wounds... Now I find dressing wounds quite easy!”

The caretakers’ programme started three months ago and the man behind the idea is Voitek ASZTABSKI, the MSF project coordinator in Vavuniya. It all began on the 29th January, when 232 dehydrated, exhausted and severely injured war-wounded arrived at the hospital from the conflict zone.

 “I remember getting our team together to help at the hospital with triage and first aid,” explains Voitek. “I stood there in shock watching all these people arriving from the conflict zone being offloaded from buses and ambulances. They were arriving in terrible condition, with nothing or just a few possessions in a plastic bag or bundled up in a piece of clothing. There were some volunteers from the Sri Lankan Red Cross Society helping in the hospital at the time and that is when I first had the idea that MSF could help with the distribution of basic items.”

So that same day the MSF team started distributing travel bags for patients to carry their belongings, along with a donation of 1,000 rupees (around 8US$) for patients to buy things like food or a calling card to phone their relatives.

“It’s fantastic. This is how MSF works,” says Voitek. “There was no time for planning, it was a real emergency. We have learnt along the way, improving things in the programme as we went along.”

Three months on, the programme has grown to include 84 caretakers working in shifts 24 hours, seven days a week. When the hospital had 1,850 patients at the end of April, the work of the caretakers was even more crucial.

In addition to looking after their basic health needs, the caretakers go round all the wards every day checking the patients’ more general needs and distributing clothing for children and adults, bags, thermoses, flipflops, sheets, plates, nappies, and one cash donation as required. 

Mohan ACHANDRAN was working as a guard at the MSF office when on the 29th January he came to the hospital with Voitek and other MSF staff to help with the arrival of patients. At that time, Voitek asked him for help in selecting and training the caretakers and soon after he was offered the job of supervisor.

 “I didn’t have any experience of working in a hospital,” says Mohan. “When I came to help all those wounded patients arriving at the end of January I saw a lot of injuries. Those first days I couldn’t eat or sleep because I was thinking of the wounded people. But then we attended a training programme where I learnt a lot and MSF gave me some support. When Voitek offered me the job as supervisor I was very happy because I haven’t got the funds to do humanitarian work on my own. But now I have the opportunity to do it.”

 “The caretakers really are doing a wonderful job,” he adds proudly. “They wash the patients, dress their wounds, feed them, comb their hair and even cut it sometimes, brush their teeth, shave them...These things, for a patient who is alone and has no legs or arms, are very important.”

MSF medical teams currently provide surgical and lab support in Vavuniya hospital and supplementary feeding in displaced people’s camps in Vavuniya and in Menik Farm. MSF is in the process of setting up an emergency field hospital on the outskirts of the displaced people’s camps in Menik Farm and  starting post-operative care activities in Pampaimadhu Ayurvedic clinic, 5km away from the town of Vavuniya.