Since the last time

I have felt quite disturbed the last week or so realizing that the Sri Lankan know very little about the world, past and present.  When asked about my religion (since people have noticed my interest in Buddhist shrines), I talk about being raised Jewish and they look at me with blank faces.  Few of the staff including RNs, know what Judaism is .  I had one of the staff who did know say the word in Sinhalese and still nothing.  I went into Hitler and the millions killed.  They had heard of Hitler they had no idea about what happened.  I felt somewhat eased when someone pointed out to me that I probably hadn't learned that much about Asian and African history and I think that is true.  I wonder if now kids are learning in school about the horrible massacres that have occurred and continue to occur in Africa or events in Asia.
Last weekend I went to Ella and it was glorious.  There is a huge Gap (think much larger then the Delaware Water Gap).  There are two landmarks when standing looking at the Gap, one is a mountain on the left called Little Adam's Peak and the other is called Ella Rock.  Ancy and I climbed both, one on each day.  I was so proud, LAP is not very difficult but Ella Rock requires a guide and is very difficult and steep.  It took 5 1/2 hours with a rest at the top.  I was very proud of myself and pleased with my accomplishment.  Of course when we got back and went to eat Ancy asked me what was wrong with my feet.  Before I tell you this, I had been reflecting during my hike up the mountain, on my childhood days at Camp Weetamoe in Center Ossipee, New Hampshire.  There we had climbed Mt. Shikorawa and that's probably the last time I climbed a mountain of this magnitude.  The other thing that used to happen in the lake at camp is that we would come out of the water with leeches on us and we would be squealing and yelling while the counselors would have to put salt on them to get them off.  You got it, I had had leeches on my feet from going through the forest that had dropped off somewhere but had left holes that were bleeding all over..ugh..gross huh?
This week I went on a bunch of home visits with the 2 psychiatric nurses.  The purpose was to give Modicate which is equivalent to our Prolixin, an antipsychotic med.  This is good.  There is a system to medicate chronic patients who wont come into the clinic.  The staff of the inpatient unit are the ones who do the home visits, also the ones who run the clinic..The location of where we visited is amazing.  many people live in the tea estates which are up mountains with switchback roads, back and forth, a very long time to get up there.  Apparently there is no health accommodation on the estates to cover medications. An issue is that there is never a reevaluation of the patient to see if they continue to need this drug, many of the patients seemed misdiagnosed, there is no system to get in touch with the patient so if we show up and the patient isn't there they don't get there injection unless a family member can get them into the clinic, some months apparently this drug and others just aren't available in the country so they have nothing or something they have never had before, and so some end up back in the hospital.  The hospital is supposed to be acute care but if there is a family or placement problem they just keep the patient until they have straightened it out yet because they don't have time supposedly to wait while patients improve on drugs they use a lot of ECT to create a "cure".
I have read the ten year mental health plan for the country which is now half over.  It is a good plan with the idea that the patient is central and a move toward community mental health and less in-patient.  However the entire plan hinges on  the consulting psychiatrist to be involved in every decision in every area of the plan for the entire district which is huge.  Badulla district for example is one of two districts in Uva province.  We are talking the equivalent of states, so one psychiatrist is in control of half of Massachusetts  (Ma. being Uva Province). A huge issue also is that the patient is not at the center still.  As I said this is a huge hierarchical system and from what I can see the patient is at the bottom.  Anyway,  I shall slowly see where I fit.  I asked for a meeting this week with 5 key people which happened around planning what is possible, like setting up various groups that might be useful to patients on in-patient, rehabilitation unit, out patient settings and I felt good about that.  What I don't feel good about is the number of patients who seem to have head lice..I am sceeved about that and am encouraging the staff to do something about it...I am so itchy now!!   It does seem that the majority of time spent with patients is with the attendant staff.  I am definitely going to try to work with them.  The language problem however is huge..only one attendant speaks English and he is in the clinic..
Patients carry their records with them.  They have a notebook that they bring to the clinic and when they get admitted.  Nothing is wasted anywhere, nurses' journals, logs, planning whatever are in books made of cardboard that are taped together to make a front and back.  Nurses give medication right out of the bottle yet everyone is very concerned about washing their hands before eating and using the right hand!
I think I'm ranting.
 I just left to wash and hang up my towels.  I have spent the morning washing clothes and putting them out on the drying rack.  I finally washed my sheets having only bought one set, I needed to wait until a beautiful day when I knew they would dry.  I also went to make a cup of French Roasted, french pressed coffee..anyway, have I mentioned the weather.  I have lucked out, it is so lovely here sometimes at night and in the morning it is breezy and cool and it's rarely very humid even when hot during the day.  We have some rain but less then I expected.  Today and tomorrow I am cleaning and washing and writing this but I have lot's of time because we (VSO volunteers) have been ordered to stay indoors on Tuesday and Wednesday due to the election.  Previously there has been some violence around elections and they are being very, very cautious with us which I know will please my sister Roberta immensely.  I have been cooking a little and trying things with chilies and chili powder which I love.  I have discovered however that it is much cheaper for me to buy my meals which range between 80 SLR (78 cents) and 140 SLR ($1.37).
I bought a beautiful shiny red motorcycle helmet so that I can ride on the back of Ancy's cycle.  They are very strict about helmets here as they are about smoking on the street.  It is so unpaved here yet I have very little if any dust in my home.  This is very nice.  I have been thinking however about this push for tourism now.  I know the NYTimes is writing a lot of articles about SL.  I really wonder if the country is ready for tourist and if the tourists are ready for SL.  I don't picture most of the people I know using toilets that are holes in the ground, maybe having some hot water once a day for a shower, eating in restaurants were the norm is to use your hands etc.  I am sure the touristy places will be more "westernized" but you still have to travel for many hours on terrible roads to get to your destination, private driver or bus or train.  It takes forever to get anywhere.  I am trying to arrange to get to Kandy for next weekend.  It is very complicated.
Have I mentioned the women's clothing.  Some women wear Saris, Indian type or Sri Lankan type.  Some wear Shalwars which are long tops with matching pants, most wear skirts, below the knee or long with a blouse type shirt.  Tops are made without darts for the breasts and bras are like we wore before seamless was invented.  Men mostly wear slacks and a regular button shirt but many men wear sarongs on the bottom either full to the ankles or half to above the knee.  Women do not wear makeup here and nails are kept short.  I have seen a few women with toenail polish on.  Everyone uses umbrellas, they are carried at all times, if it is sunny it is open, if it is raining it is open.  
I keep having this experience where I think myself and another person, anyone, a colleague, a trishaw driver, anyone, have an understanding, we know what each other is saying, we have a plan and then the Sri Lankan will repeat the original question all over again as if we hadn't just gone thru this process.  It must be a cultural thing.