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Lack of antibiotics force doctors to re-amputate patients in Vanni

The medical care system Vanni is on the verge of complete collapse and the doctors are in deep despair due to lack of lifesaving medicines and necessary equipment required treat patients, according to the Regional Director of Health Services (RDHS) in Mullaiththeevu district.
Full text of the letter, dated 15 February, 2009, follows:

Ministry of Health

Dear Sir,

Situation Report for the current week

I am in deep despair, much same as my colleagues with me, while starting to write this letter as we have been cursed to witness yet another pathetic scene of scores of dead and injured brought to the Puthumaththalan Hospital following shelling attack at Ampalavanpokkananai, the adjoining village situated well within the new safety area. We are confused and clueless on how to confront this situation of mass causalities with bare minimum facilities available.

Our health care system is on the verge of complete collapse with the abandoning of all the rest of temporary hospitals functioning at Udaiyarkaddu, Suthanthirapuram and Thevipuram, leaving Puthumaththalan as the only operational health facility. Being a small school building transformed into a primary surgical care unit, there is little space and poor infrastructure, hardly sufficient to provide even basic standards in emergency surgical care to the large influx of war wounded daily more than a hundred on average – sometimes as high as 200.

Though we are working round the clock despite being physically and mentally exhausted, lack of lifesaving medicines required for surgical operations and post operative management-parenteral high potency antibiotics, anesthetics esp. Ketamine, intravenous fluids, surgical consumables and accessories – and on top of all, absence of an aseptic operation theatre, seriously affecting the outcome in many cases. We were in total frustration when we had to re-amputate the limbs at higher levels in days after initial lifesaving amputations, just because of lack of IV penicillin and other antibiotics essential to prevent fatal sepsis. If we are not going to receive at least IV antibiotics, anesthetics and surgical consumables in minimum amounts ASAP, we may not be able to provide even emergency first aid to the war wounded. Therefore, it is mandatory to maintain a stable and safe transportation service, via land or sea route, to transfer the war wounded and of course other acutely ill medical patients including obstetric and paediatric emergencies, in order to reduce high mortality and morbidity rates.

I have to mention with pain that we have recorded at least 04 child deaths due to diarrhoeal diseases and death of 02 elders due to acute respiratory distress during this week indicating the high vulnerability of the IDPs living under most tragic conditions with out any basic amenities or adequate healthcare support. The safety area declared during this week compression of a narrow strip of coastal land approximately 10 sq km, with thick resident population now, with the additional 2 lakh IDPs taking refugee in the area, drinking Water and dispose refill we going to be problems. The preventive health services have been inadequate: The ante natal and well baby clinics are really held; EPI vaccination program’s got disturbed due to inability to maintain the vital cold chain; water and sanitation facilities are hardly sufficient and poorly supervised; acute and chronic malnutrition are very much likely soon as unemployment and starvation are the rules of time. If this situation continues further, control of communicable disease, especially water borne, may become impossible and could thus cause havoc.

Therefore we as medical officers remain here to rescue our own people from disaster despite the risks, would like to urge you to use your good offices to support and strengthen us to deliver our noble services with dedication.

Thanking you
With kind regards,