Batticaloa, trapped in the east Batticaloa, or Batti as it is often called, was in the middle of an â€˜unclearedâ€™ area in eastern Sri Lanka. Already, 50km before the town, the military presence was clearly visible with ever frequent checkpoints on the road linking it to the rest of the island. Although the town, and the road that led to it, were controlled by the army, the surrounding area was in the hands of the Tamils. Frequent fighting made all travel and transport of goods extremely difficult. The entire zone was blocked: as a result thousands of people had no access to healthcare, the clinics were closed, and to get to the only hospital still running people had to obtain endless authorisations and then succeed in getting through the various military checkpoints. MSF opened its programme in the hospital in 1987 and was the only foreign presence until 1989. Right from the start, our programme was essential in order to provide healthcare to the population, but also to speak out about the violation of humanitarian law. We first started working in the surgical wards as almost all the surgeons had fled the region: those that had remained were not able to cope with the influx of wounded during emergencies. MSF therefore provided the hospital with help, essentially surgeons and paediatricians. In October 1990, given the escalating violence which isolated the populations around Batticaloa even more and prevented them from having access to healthcare, MSF decided to set up mobile teams. These teams had to overcome numerous security problems: apart from the medical assistance these teams provided in the isolated villages, our very presence was a comfort to these popu-
lations who could talk to us about their problems, express their fears. Our visits were therefore not only useful, we were also the only foreign witnesses there. It was only in 1997 that MSF increased its mobile teams, in close collaboration with the Ministry of Health.
TO IMPROVE THE QUALITY HEALTH CARE For many years MSF focused on war and emergency surgery: however in recent years it has concentrated on improving the conditions in which surgery is performed. Since 1998, the objective has been to improve the hygiene and asepsis around surgery. The combination of MSF renovating the operating theatre in 1999 and the government renovating four or five surgical wards, has led to improved hygiene conditions. This work continued through 2000 and 2001 with hospital waste management activities. MSF has also worked with the nurses and doctors on the organisation of patient follow up. The improvement in surgery conditions meant MSF was able to send specialists (plastic surgeons, orthopaedic surgeons) for specific cases the teams could not operate, but that we could follow-up. We thus introduced hand surgery and in 2000 improved the case management of burn victims (of which there are many in Batticaloa). Sri Lanka has one to the highest suicide rates in the world, and self-immolation is frequent, leaving considerable sequelae. From the start, MSF began to improve the case management of the burn patients. In 2002 we helped burn victims with a pain management programme, plastic surgery and general case management.
Facts and figures Batticaloa Programme > Opened in 1987 > Closed in June 2003 > Population covered in the region: 500,000 people, (two thirds are Tamils, one third Muslim).
Batticaloa Hospital > 600 beds, including 165 for surgery > 13,354 admissions in 2000: 9,180 operations between September 2000 and September 2001, including 845 major surgery, 254 emergencies and 50 war victims. > International staff : 4 permanent > National staff: 11