Monday, August 28, 2006

Maha Nuwara

I saw Superman Returns at Majestic city’s theatre in Colombo. It was mediocre bar the special effects. Kevin Spacey is usually a joy to watch but I could see him cringing as he delivered his dialogue. The curtains came down to signal the 15 minute interlude. I felt like I was at the theatre. The movie finished late and the shopping centre closed at 11pm.

Today I felt sad. A seriously ill child came in and there were no ITU beds. Paediatric intensive care facilities in the U.K are more robust compared to SL. I realise just how valuable the NHS is and the high standard of facilities compared to the ‘developing’ world.

We left at 5:30a.m for the capital of the hill country, Maha Nuwara (Kandy). There were 4 stops on the way, one for breakfast. Yummy fish buns, chicken in breadcrumbs and cheese toast washed down with orange juice. The last 3 stops were at the Gadaladeniya, Lankatilake and Embekka Devale Temples. We wandered the ancient temples with moonstone entrances, carved wooden pillars and rock face inscriptions. The workmanship and detail was astounding especially at Embekka Devale. The carvings are said to be one of the finest in the region. It is mandatory to remove your shoes before entering any temple and although Lankatilake forbids taking pictures, the other temples allow photos. Monks opened the shrines so we could view the Buddhas.

Lunch was a seafood affair at the Hilltop Hotel, known for its scenery. We drove north of Kandy Lake to Sri Dalada Maligawa (the Temple of the Tooth). The temple was created in 1807 and houses the most sacred Buddhist relic in SL, the tooth of the Buddha. On our way back, we browsed the museum showcasing gifts offered from various nations to honour the Temple and the tooth. Another museum pays homage to Maligawa Tusker, the elephant that carried the casket containing the tooth during the Parahera (parade or procession). Rain halted our visit to Peradeniya Botanical Gardens so we drove back to Colombo, stopping to admire the view over Kandy town.

I spent the weekend buying souvenirs, visiting the few sites I haven’t seen in Colombo and tonight we party! Surely it can only get better…..

Monday, August 21, 2006

The King’s Throne



My experience of paeds thus far has been good. There is teaching everyday in tutorials and ward rounds. I have seen a lot of interesting cases including juvenile idiopathic arthritis, a bone marrow biopsy/aspirate, possible Guillain Barre syndrome, Diamond Blackman syndrome, osteogensis imperfecta and microcephaly.

On Friday night I went to a club called Tabou with a group of seven others. The music was a nice mix of r n b hip hop, 80’s and dance. Some for the group got very drunk and decided to show off their moves on the DJ’s stage- I was in stitches. Going out here is very cheap because ladies get in free everywhere.

We left for Sigiriya at 6 a.m, stopping at Pinnewala elephant orphanage on the way. At 9.15 they fed the elephants with milk and we saw a 7 day old baby elephant. Working elephants and those with 3 legs wandered the government run orphanage. The elephants showed off their balancing tricks for the eager audience of tourists. The sun was out and the park scenery was breathtaking.

Our next stop was Sigiriya, the rock fortress built in 477 when King Anuduradhapura was overthrown and walled alive by his son Kasyapa. The queen’s son swore revenge and built a fortress but unfortunately he was deserted by his troops and took his own life or so the story goes. The ancient fortress is 200m above sea level with hydrautic technology, gardening and art. We climbed the rock in the hot midday sun, passing the Royal Gardens, Cobra hood cave, Sigiriya Damsels, Mirror wall with graffiti and the half way point, Lion’s paws. An hour later we reached the 1.6 hectare summit with a view like nothing I have ever experienced. It was so relaxing looking over the town with clear skies and a cool breeze. I will never forget it.

After a nice buffet lunch at the Sigiriya Café, we drove to Dambulla, the home of the cave temples. This rock was a comparatively easier climb with monkeys on the way up. The reward at the top is the temple entrance where you enter barefoot. There are 5 caves with 150 Buddha images. Touts and food sellers line the path down from the temple offering their goods.

Our last stop on the whistle stop tour of the Ancient cities was Kandalama 5 star Hotel which is built on a rock overlooking beautiful landscape. It is 1 km wide with three pools and a spa. We made it back at 11pm after a 4 hour drive. I am proud to say I went in for 8:15 this morning.

Tuesday, August 15, 2006

Welcome to Surgery

Today we started surgery and jumped form the frying pan into the fire. We had heard rumours about the head of surgery rinsing medical students so when we met a calm man with glasses we thought it was all hype. He was the registrar. The Prof. welcomed us and said I would only get a sniff of medicine in a week. We are part of a group of about 20 final year students. He picked apart every statement emitted from our naive inexperienced mouths in an effort to make us learn. Then there were the surgical gems he insisted we write in our notebooks. I do not know my surgical signs. I had to stop myself from giggling because this is all I've ever known especially of surgical teaching and everyone was frightened of him. His bark is worse than his bite. Anaesthetic teaching on nutrition and feeding in surgical patients. We return after lunch for teaching on DVTs.

Renal? What's that?

Thursday 10 August
Today we saw classic infective endocarditis with mitral valve prolapse on examination, stroke, IgA nephropathy/ AV fistula bruit, cellulitis, and I heard my second pericardial rub ever. We attended some lectures for the medical students on metabolic bone disease. To be frank, it was all repetition so we buggered off. The interesting long case this Friday centred on a possible pulmonary renal syndrome (Wagener’s or polyarteritis nodosa). We have had 4 sessions of renal teaching with an awesome consultant bringing my renal knowledge from non-existent to vague recollection.

This weekend’s trip to Sigiriya and Dambulla has been postponed to next week. Today one of the neurologists sidelined us on her ward round after we waited 45 minutes for it to commence. We went back to our old stomping ground, the general medical ward where we saw a linguinal lobe pneumonia and Haemophilia A. I am feeling a bit weird today. I miss home cooked food and I just want to get on to the rest of Asia. Another confirmed bomb explosion in front of a shopping centre close to us this afternoon.

Thursday, August 10, 2006

Explosion




Tuesday 8 August
Today we saw mitral valve prolapse, suspected TB, pneumonia following a stroke, weight loss/ dysphagia 2º to oesophageal stricture, alcoholic liver disease, exophthalmos/goitre, suspected Ehlers Danlos and hepatosplenomeagly. I also saw P pulmonale on ECG for the first time.

In the afternoon we saw thick black smoke rising from buildings in the next postcode. Someone in the flat suggested it was an explosion and this was later confirmed by the news reports. The Sri Lankans we were with seemed undisturbed by this and life carried on as normal.

Wednesday 9 August

Poya is a public holiday which celebrates the day of the full moon so we had today off. Wetraveled on the most crowded bus ever to get to Fort station in Colombo at 6 am and caught the 6.45 am train to Galle in the south. The ticket cost 58 rupees one way and the three hour journey was eventful. There were many traders offering everything from food and drink to colouring books, interspersed with the songs of beggars asking for donations. It was an experience I will never forget.

The port of Galle (gawl) is the setting for the 36 hectare fort built by the Dutch in 1663. Our travel guide warned us about the con artists. Low and behold after we left the train station we were harassed by at least 3 different male touts offering maps or being a nuisance. We made a hasty exit towards the fort. On our tour of the fort, we passed the old gate with the letters VOC ( Verenigde Oostindische Compagnie), Flag Rock and many buildings with Dutch architecture e.g. the museum, library and Dutch Reformed Church. The light house is beautifully set on top of a hill overlooking the sea. We waded on the beach in clear blue green waters and visited my host's grand uncle who was very sweet. Our air conditioned bus ride Hikkaduwa on the west coast, cost us 40 rupees (vs 20 rupees for no air con). The driver made pedantic requests for us to move to the front of the bus or he would throw us off. We obliged scowling and muttering under our breaths. Lunch was a more pleasant affair at the Coral Gardens Hotel, overlooking the beach and where the reef runs from the shore. Afterwards we went on a glass bottom boat ride where we saw coral, fish and turtles. We discovered that the boats and bleaching in 1998 have ruined the coral and I felt awful for going on the boat ride.

The train journey from Hikkaduwa was picturesque. I kept snapping away with my camera. We were in second class which made for a more peaceful and cooler journey despite the repeated stares from some tourists.

Tuesday, August 08, 2006

Hill Billy

Friday 4 August 2006

This week we have seen:
Lots of fevers
Miliary TB
Suspected typhoid
Dengue fever
Malaria
Possible non Hodgkin’s lymphoma
Beta Thalassaemia/ 2º Fe overload
Sudden onset cough and dyspnoea in a 15 year old
Chronic cough/clubbing
Pleural effusion/suspected lung ca
Pleural effusion/encysted lesion
Printzmetal’s angina
Post MI angina
Hepatomegaly/epigastric mass
Obstructive jaundice
Chronic diarrhoea
Idiopathic chronic renal failure
Glomerulonephritis
Chronic headache
Wrist drop
Paracetamol overdose
The grand round centered on an interesting case with a large list of differentials to exclude. Tonight was our elective night out. A group of 10 of us met at the 5 star Taj Samudra Hotel near Galle Face and had drinks in the hotel bar. I had a Lion beer which came in huge bottle equivalent to two pints and a local drink suggested by a Sri Lankan, which tasted like cough mixture. The guests were all middle aged tourists or locals with cash to burn. ABBA resurfaced again and the house band played Elvis and 80’s classics. We moved on to the basement club called Onyx which is equivalent to a trendy London club playing r’n’b and hip hop. I was actually convinced I was in London and it took a while to adjust. It was a blast and I left at 2:30a.m because we planned to set off for Nuwara Eliya (Hill Country) at 5:30 a.m.

Although I slept through my 5a.m alarm our ride did not show up till 6:45 a.m so I wasn’t pleased. It was a 5 hour journey from Colombo to Nuwara Eliya on steep winding roads. We had several near accidents and one collision with a black Toyota which thankfully left no obvious damage to our vehicle. We stopped at scenic spots on the way to take pictures. The scenery is full of luscious greenery, tea plantations and waterfalls steeped into the hills. We stopped for breakfast at Kitugala Rest House with views over the river, Kelaniya Ganga where Bridge on the river Kwai was filmed in 1957. We also stopped at the entrance to a Buddhist temple where I obliged in removing my shoes to take photos. Nuwara Eliya (City of Light) with its colder climate has many British country houses with large gardens befitting its nick name ‘Little England’. We passed the golf club with its luscious greens, the 5 star Grand Hotel and the race course where wealthy locals take their children for pony rides. Our hotel, the Windsor in the centre of the town overlooked the luscious hills. After a wander round the town we had dinner at the Grand Hotel. The meal can only be described as the best in SL so far. Starter: Melon and bacon (I was skeptical but it works), salmon, feta cheese and squid salad. Main: Spicy fish and Cajun prawns in white butter sauce with mashed potatoes. I had no space for dessert despite drooling over the dessert cart. It got very cold at night and I was shivering in the car despite wearing a summer jacket.


Our day began with pastries at the Milano Restaurant in the centre of town after which we visited Victoria Park Botanical Gardens. I was disappointed because my hosts were more into dining and wandering the town than visiting the tea plantations and Horton Plains as discussed. The 5 hour journey back could account for the bias or the complacency of having visited these sites on childhood holidays. Lunch at the Hatton Rest House left a lot to be desired. I have to return to Nuwara Eliya to visit these famous sites. As we drove back to Colombo, I felt I hadn’t seen as much as I wanted- lovely scenery and food but not enough site seeing. This has been a learning experience thankfully early on in my stay in SL. I will sight see in Kandy, Galle and the rest of the south before I leave.

Thursday, August 03, 2006

No More Kandy

On the ward round we saw a patient with classic cor pulmonale and the most prominent ronchi in all the lung zones. A consultant in renal medicine met us on the ward round and offered to teach us. We saw interstitial nephritis and idiopathic chronic renal failure. The one thing I love about this elective is the spontaneity of the teaching. The consultants come and find us but not a small proportion of consultants are not as open. There was an interesting lecture on metabolic syndrome by a Prof.from New Jersey as part of the National Endocrine Society of SL meeting. The air conditioning did not prevent me from feeling sleepy so I doodled. I couldn't remember the last teletubby Dipsy but my friend helped. There is talk of an elective night out. Due to the threat from the Tamil Tigers, many locals have advised against going to the parahera in Kandy. So we are going to region with picturesque tea plantations and scenery instead.