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One-Doctor Hospital

Desperate times call for desperate measures—and heroic efforts

By Pamposh Dhar
External Relations Specialist

CHEDDIKULAM, SRI LANKA

" I’m always on call for inpatients and for any emergencies "

- B.G. Arulranjan, doctor on call 24 hours a day, 7 days a week

For 6 months, a young doctor in northern Sri Lanka has run an entire district-level hospital with the help of one nurse and one midwife. The Cheddikulam District Hospital serves Cheddikulam town, with a population of 30,000, and the surrounding villages. There is a dispensary about 10 kilometers (km) from the hospital, but no other hospital for 35 km.

Treatment is free at the government-run hospital in Cheddikulam, and patients steadily stream in. But doctors are obviously hard to find. Perhaps the history of conflict in this northern region of Sri Lanka generates a sense of insecurity for government doctors from other parts of the country. Perhaps it is the hard work that gives them pause. Whatever the reason, the Government has been unable to post another doctor to the hospital for several months.

The Cheddikulam hospital has 56 beds, 20 of which were occupied when an Asian Development Bank (ADB) team visited it in May 2003. In addition to the inpatients, Dr. B.G. Arulranjan sees 100–120 outpatients every day. During the rainy season, this number rises to 150–200 a day, says the hospital’s lone doctor.

Diarrhea and infections are the most common complaints, says Dr. Arulranjan as he examines 3-month-old Suwenita and reassures her mother that the baby’s diarrhea can be easily treated. The hospital has three wards: a general medical ward, a pediatric ward, and a gynecological ward.

Complicated cases that cannot be treated here are sent to a better-equipped and staffed hospital at Vavuniya, 35 km away. He says the new ambulance provided by the North East Community Restoration and Development (NECORD) Project comes in handy for that, as well as for fetching patients from surrounding areas. The old ambulance had broken down thrice recently while bringing patients to the Cheddikulam hospital.

NECORD will also provide a connection to a water tank that will give the hospital a steady supply of water. “We are a hospital. We need water 24 hours a day,” says Dr. Arulranjan, who seems much too engrossed with the problems of the hospital to dwell too long on his own.

EXAMINING A YOUNG PATIENT Diarrhea and infections are the most common complaints

“I asked for a transfer to Cheddikulam,” says Dr. Arulranjan, who moved here from Colombo. That’s because his parents live in Mannar which, like Cheddikulam, is in Sri Lanka’s Northern Province. When he moved here, he was one of three doctors. One left to move abroad and the other was transferred away from Cheddikulam. “They were not replaced,” says Dr. Arulranjan somewhat ruefully. “I have been alone for the past 6 months.”

His grueling schedule does not permit him to see much of his parents after all. But the Government does send a replacement doctor once or twice a month so that he can go and visit his wife and 10-month-old daughter in Colombo. “I manage to take 4–5 days’ leave a month to visit them,” he says.

But when he is in Cheddikulam, he is on duty 24 hours a day. Outpatient hours are from 8 a.m. to 4 p.m., with a 2-hour break for lunch. “But I’m always on call for inpatients and for any emergencies,” he says.

He rests when he can. He has already been informed of his transfer to another district, but the Government has yet to find a replacement for him. Small wonder, given the daunting task that awaits any doctor here. To Dr. Arulranjan, however, it appears to be all in a day’s work.

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