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Physiotherapy, Sports Medicine and Rehabilitation


Revival Physical Medicine Centre
Jawatta Road, Colombo 5
Ayurveda and Panchakarma Treatment Centre
Ayurveda Base Hospital Kappalthurai
Trincomalee
Eastern Province

Acknowledgements
My sincere thanks to the Dean and the elective committee of Faculty of Medicine, SAITM
for giving me this opportunity to be a part of the elective program.
The elective opportunity I had with Revival Physical Medicine Centre and Ayurvedic Base
Hospital Kappalthurai was a great chance for learning and experiencing the diverse aspects of
Alternative Medicine. I am very grateful for having the chance to meet so many wonderful
people and professionals who led me though this elective period.
Bearing in mind previous I am using this opportunity to express my deepest gratitude and
special thanks to Madam. Rajni S. Jayatilake, CEO Revival Physical Medicine Centre, also
extending my gratitude to Dr. Mrs. S. Thusitha, Medical Superintendent Ayurveda Base
Hospital Kappalthurai for allowing me to carry out my elective at the hospital.
I am extremely thankful to Dr. Thayumanavan, Dr. Shekar and Dr. Chamara for their careful
and precious guidance which were extremely valuable in gaining knowledge both
theoretically and practically.
My deep sense of gratitude to Dr. Maheswari, for spending her valuable time, sharing her
knowledge and experience, also for the continuous encouragement and inspiration during my
elective stay.
I express my special thanks to Dr. S. R. Pholtan Rajeev who in spite of being extraordinarily
busy with his duties, took time out to hear, guide and keep me on the correct path during my
stay in Trincomalee. His valuable suggestions and guideline helped me to prepare the report
in a well-organized manner.
During the elective all the doctors and staff I met were incredibly willing to spend time with
me, to teach, to organize placements for me. Between doctors too there existed a real sense
of fraternity and comraderie, a feeling of working in a profession with high standards and a
worthwhile purpose, and of wanting to contribute to that profession. Extending my sincere
gratitude to all of them as well.
Last, but not least, Id like to thank my parents and family for the support especially during
my stay in Trincomalee financially and emotionally.
Any omission in this brief acknowledgement does not mean lack of gratitude.
Thank you all.

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Table of Contents
Acknowledgements
Revival Clinic (Physiotherapy, Sports Medicine and Rehabilitation)

Introduction 3
Health system in Sri-Lanka 3
My Elective Placement

4,5,6

Strengths and Weaknesses 6


Ayurveda Base Hospital Trincomalee

Introduction and History of Indigenous Medicine 7


Vision, Mission and Objectives 7
Organizational Structure 8
Functions9
Future Plans
9
Why Trincomalee? 9
My Elective Placement

10,11

Strengths and Weaknesses 12


Conclusion

12

References

13

Appendix

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Physiotherapy, Sports Medicine and Rehabilitation


Revival Physical Medicine Centre

Introduction
My first elective placement took place at the Revival Physical Medicine Centre which was
established in 2008 to provide service to the diverse needs of a multitude of patients from
various walks of life. Since November 2008, the facility has continued prestigious 7 years
treating patients with great love and care.
In speaking of the dynamics of the organizational infrastructure, Revival Physical Medicine
Centre is spearheaded by Dr. R. S. Jayatilake. In his role as Founder Chairman and Director,
he is ably supported by his Directors Jeevantha Jayatilake and Rajni S. Jayatilake, who acts
as CEO to Revival.
Revival Physical Medicine Centre homes a dynamic team of medical professionals with
world-class training. It is housed in a 4,200 sq. foot building to provide ample parking and
privacy including a gym; the facility delivers a very welcoming, child-friendly environment
for its patients and visitors. It is located in the heart of Colombo and open through all
weekdays and weekends including Poya days.
Revival Physical Medicine Centre focuses on 3 main areas of Physical Medicine:
1. Physiotherapy
2. Rehabilitation
3. And Sports Medicine

Health System in Sri-Lanka

Sri Lanka provides free universal healthcare and it scores higher than the regional average in
healthcare having high Life expectancy and a lower Maternal and Infant deaths than its
neighbors. Health of the population has made great strides, with life expectancy rising from
around 60 in 1960 to 74 in 2012, according to the World Bank. The mortality rate for children
under five has fallen from 98 per 1,000 live births to 9.6 per 1,000 births in 2013.
Over the years the Sri-Lankan government has taken necessary steps to sustain the general
health of the population. One way in which this occurred was when the Institute of Sports
Medicine was established for the maintenance of physical and mental health of the Sri
Lankan Sportsmen and Sportswomen and also for the prevention of diseases. This
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establishment which was initiated in the year of 1991 as the Sports Medicine Unit and in the
year of 2006 it was named as the Institute of Sports Medicine under the Ministry of Sports.
As you may be aware, the Sports Ministry announced a Sports and Health promotion week
since 25th to 30th January 2016, which is still happening as I type. This arrangement is to
promote sports and aerobic exercises among the public and to prevent Non Communicable
Diseases (NCDs).

My Elective Placement
Colombo has become the Sports capital of Sri-Lanka, in both watching and participating in it.
This provided great insight into the endless sports fanatics that filled the Revival Physical
Medicine Centre during my placement. The patients ranged from children to grandparents,
from professionals to enthusiasts. However they were all similar in their desire to get back to
participating to the maximum in their chosen activity.
My placement at Revival was spent sitting in clinics, mostly with Physiotherapists but also
with visiting consultants and Sports physicians. This gave me a good all-round
multidisciplinary feel for Sports medicine and Rehabilitation. One of the senior
Physiotherapists Dr. Thayumanavan, highlighted how knee dislocation due to ligament tear is
common among basketball players. During the few weeks I spent there, I noticed several
patients with knee dislocation, all subjected to post-operative rehabilitation.
I noticed a basketball player, who was recovering from an ankle and knee injury. He
complained of chronic pain around the injured area and Dr. Shekar, one of the experienced
Physiotherapist performed Deep Transverse Friction Massage (DTFM) which is a deep
tissue technique that is performed at the site of the injury in order to breakdown scar tissue
and remodel it to be a more flexible, pliable, and a more functional tissue. He explained
DTFM directly affects the manner in which tissue heals. When an injury occurs it is healed
by the formation of scar tissue, this scar tissue covers the damage in all different directions
and therefore is not very flexible or functional. DTFM breaks down the scar tissue that
naturally forms when tissue is damaged, either by an acute injury or by repetitive micro
trauma. This tissue breakdown allows the tissue to heal in a more functional way. This is
accomplished by combining tissue breakdown with muscle lengthening procedures and
specific rehabilitation exercises.
Later I was told that Transcutaneous Electrical Nerve Stimulation (TENS) can also be
performed on the recovering knee injury with chronic pain. TENS is a form of electrotherapy
which uses a convenient device that applies an electrical current through the skin to stimulate
sensory nerves and trigger the release of endorphins, hormones with a pain relieving property
that provide very effective relief to chronic pain. The main highlight about TENS is that it
uses natural pain relieving mechanisms, and hence has minimal side effects. Drug therapies
involves introducing foreign chemicals to achieve the same end, but in doing so alter the
metabolism and bodily function, hence causing more potential side effects. But in
physiotherapy for TENS is as a means of relieving chronic pain without the risk of drug
interactions and/or side effects.
I was also interested to know the most common condition that takes patients to a
physiotherapist. Turns out, Low back pain is an extremely common problem that is often
poorly managed. Back pain is a particular challenge, demanding of medical resources and a
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major cause of physical, psychological and social disability. As many as 40% of people will
get Sciatica, or irritation of the sciatic nerve at some point in their life. I observed patients
with low back pain being treated from hot and cold packs, exercises by strengthening,
stretching, and aerobic conditioning. It was very clear to see that in addition to sporting
injuries, the majority of those attending the clinics possessed an array of co-morbidities and
non-communicable diseases such as Obesity, Hypertension, Parkinsons, Diabetes mellitus,
Osteoarthritis and even some Neurological defects. Other common presentations were of
acute and chronic muscular, ligamentous and tendinous pathologies and osteoarthritis.
One thing I realized during my elective period at Revival is that private Sri-Lankan health
care system meant that patients referred themselves or were referred by a GP or
physiotherapist, and hence I was able to get a feel of how a privately run health care system
works compared to the government funded hospitals and institutions.
Due to the variety of patients that were seen at Revival, I was able to experience some
Pediatric sports medicine which is an area I have had little exposure to in the past. It was
interesting to witness the dynamic between doctor, child and parent, which was sometimes
difficult due to a parental desire for the child to return to sport. It was clear to me that
managing this is a skill that comes with experience and is one that I hope to develop in the
future. I saw a little Maldivian athlete with her mother complaining of shoulder pain and she
was advised to perform certain upper limb exercises. What I found interesting is the
negotiation of this management plan with the patient. She was a highly motivated individual
who clearly valued her sport. Educating her into the importance of the Rest period in the
management and more realistic long term training strategies to prevent further injuries was
essential in providing her with a good recovery.
At Revival, many students and sports enthusiasts drop by to get fitness trained by
professionals rather than just go to a Gym. Dr. Chamara acts as a personal trainer involved
in exercise prescription and instruction. He motivates them by setting goals and providing
feedbacks. Their strengths and weaknesses are measured with fitness assessments and also
educate them in many other aspects of wellness besides exercise, including general health and
nutrition guidelines.
Along with the routine work related postural low back pain, facet joint pain and Parkinsons,
some interesting cases in the clinic for me were of Neurological abnormalities in children.
This is where I met Dr. Maheswari, another senior Consultant Physiotherapist who really
inspired me. Maumood Mubeer, three and a half years old boy who is diagnosed of
congenital Motor Neuron Disease (MND) characterised by signs and symptoms of
degeneration of upper motor neurons (UMN) and lower motor neurons (LMN) in the cerebral
cortex, brainstem and spinal cord, which has led to progressive weakness of his bulbar, limb,
thoracic, abdominal and respiratory muscles. Other brain functions, including oculomotor and
sphincter functions, are relatively spared. I was able to identify some features of UMN
lesions such as spasticity, hyper-reflexia, and hypertonia including Babinskis reflex which
was positive. He comes every other day with both his parents for treatment, which includes
performing a series of exercises including upper and lower limb control, hip rotations,
balance and posture, in order to keep the weakened muscles as strong as possible. Later I
realized that physiotherapy to such patients helps them achieve their maximum functional
mobility, to promote independence, opportunity, control and dignity within the limits of their
condition, so they could live a life on their own.
I also met this really cute one year old IVF baby Swaathi. She is diagnosed with Global
Developmental delay with regression of milestones. She also has symptomatic epilepsy
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involving pyramidal and extrapyramidal tracts including bilateral sensorineural hearing loss.
She receives similar physiotherapy treatments to enhance her balance and posture, mainly
exercises involving head and neck as she struggles to lift her head on her own. It was really
heart breaking to see such innocent lives undergo medical care everyday as they battle against
their conditions. This really helped me personally to develop empathy and caring attitudes
towards patients despite their social background, status, ethnicity and race.
I ran into another very interesting case. Kamelia, 28 years old young lady, who had had a fall
from the balcony and fractured her spinal cord at L2 level which left her in Coma for 3 days.
She had undergone several major surgeries while she was paralyzed and bed ridden for
months. Apparently surgeons had told her that she could never walk again, but Dr. Maheswari
had helped her for almost 3 years and Kamelia is walking again. She comes regularly for
physiotherapy to improve her range of movements.
My placement at Revival introduced me to several treatments I had not encountered in
routine use before, such as Dry needling, Aqua therapy, cervical lumbar traction, Short wave
therapy, Infrared therapy, Ultrasound therapy and strapping and tapping. This gave me an
opportunity to experience and gather knowledge which would be of use to me in the future.

Strengths and Weaknesses


Revival Physical Medicine Centre is easily accessible to everyone in and around Colombo. It
has ample parking and a very welcoming, child-friendly environment for its patients and
visitors. All members of the team of therapists are professionals in the fields of physical and
sports medicine, while the supporting staff has also received sufficient training.
One of the major strength of Revival is Personal training. In Colombo the personal trainer
industry is booming. There has clearly been a big increase in the proportion of gym-goers
wanting to work with a personal trainer on their fitness programs. Although there are new
gyms popping up all over the place, Revival has got the professionals trained in Sports
Medicine; hence they come in handy for sports enthusiasts.
Revival also has an arrangement of Home visits. In several cases of chronic health problems
the treatments are managed more effectively when treatment is carried out in a home setting
where practical problems can be dealt with head on. Physiotherapy at home also enables
other members of the family to be involved and to gain a better understanding of the
condition and how to help.
In order to help more people in their quest for optimal health, Revival offers patients a weight
loss program package. The package involves Initial Health assessment, diet program,
supplementation program, and exercise program, Follow-up consultation, body composition
analysis and Personal trainer assisted gym sessions. They also conduct diabetic exercises,
exercise programs for elders, spine care classes and wellness consultations.
Most of the work here is computerized. Hence more efficient and less paper work. Patients
could conveniently make appointments through phone calls or channel physicians online.

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However infrastructure has room for improvement. I personally noticed many children
coming for treatment, it would have been better if there was a separate childrens unit, where
they could play around and engage in activities.
Overall I loved my time in Revival.

Ayurveda and Panchakarma Treatment Centre


Base Ayurvedic Hospital Kappalthurai

Introduction and History of Indigenous Medicine


I continued my elective adventure at the Base Ayurvedic Hospital in Kappalthurai
Trincomalee, where I experienced working in the different fields of Indigenous Medicine.
This Base Hospital functions under the Provincial Ministry of Health and Indigenous
Medicine of Eastern Provincial Council. The Department of Indigenous Medicine supervises
3 Base Ayurvedic Hospitals (BAH), 4 District Ayurvedic Hospitals (DAH), 5 Rural Ayurvedic
Hospitals (RAH), 45 Central Ayurvedic Dispensaries (CAD), 3 Panchakarma Hospitals (PH)
and 3 Indigenous Drug Manufacturing Centre (IDMC) contributing to the health service with
the Indigenous concept.
Sri Lanka is a country of rich heritage, one of which is its indigenous system of Medicine,
which has been practiced by the people since time immemorial. The Sri Lankan Ayurvedic
tradition is a mixture of the Sinhala traditional medicine, Ayurveda and Siddha systems of
India, Unani medicine of Greece through Arabs and most importantly the Desheeya Chikitsa,
which is the indigenous medicine of Sri Lanka.
Sri Lanka developed its own Ayurvedic system based on a series of prescriptions handed
down from generation to generation over a period of 3,000 years. The ancient kings, who
were also prominent physicians, sustained its survival and longevity. King Buddhadasa (398
AD), the most influential of these physicians, wrote the Sarartha Sangrahaya, a
comprehensive manuscript which Sri Lankan physicians still use today for reference.
Ancient inscriptions on rock surfaces reveal that organized medical services have existed
within the country for centuries. In fact, Sri Lanka claims to be the first country in the world
to have established dedicated Indigenous hospitals. These places have come to symbolize a
traditional sense of healing and care, which was so prevalent even at that time.
Historically the Ayurvedic physicians enjoyed a noble position in the country's social
hierarchy due to their royal patronage. From this legacy stems a well-known Sri Lankan
saying: "If you cannot be a king, become a healer."

Indigenous Medicine Eastern Province


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Vision
Preserve traditional medicinal practices for healthier living in Eastern Province.
Mission
To provide indigenous medical services in the Eastern Province by strengthening the
traditional practices through preventive, curative and primitive healthcare ensuring sustained
healthy living in a professional way.
General Objective
The objective of the Dept. of Indigenous Medicine is to provide better health care service to
the people of Eastern Province by treating with herbal medicine.
Specific Objectives
To promote primary health care activities through herbal medical concepts in Ayurvedic
hospitals
To promote herbal awareness health activities to public
To develop herbal medicines from Indigenous Drug manufacturing Centre
To promote herbal research activities with Scientific methods
To improve herbal health care services through special clinics
To provide and improve infrastructure facilities in Ayurvedic Institutions for better
herbal health care services
To promote capacity development of Medical and Non-medical staffs who attached
with Ayurvedic Institutions.
Organizational Structure (2016)

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Commissioner of Indigenous
Medicine
Eastern Province
Dr. Mrs. R. Srithar

Medical Superintendent
Trincomalee District
Dr. Mrs. S. Thusitha
MOIC
O.P.D
Dr. Mrs.
Nihara

MOIC
Male Ward
Dr. M.
Varmenthiran

Medical
Officers

Ward Clerk

Nurses

Labourers

Ticket
Clerk

Masseurs

MOIC
Female Ward
Dr. Mrs.
Karthika

MOIC
Pharmacy
Dr. Mrs.
Anusha

Ward Clerk

Pharmacist

Labourers

Labourers

MOIC
Herbal Garden
Dr. M. A. Hassan

Labourers

MOIC
Yoga
Dr. S. R. P.
Rajeev

Assistants

Labourers

Masseurs

Dispenser

Labourers

Functions
The role of Provincial Commissioner of Indigenous Medicine (PCIM) is an Executive
Management of the Indigenous Medical Services under the Ministry of Health & Indigenous
Medicine through the patients care services by overall supervision and ensured natural health
services to all communities in Eastern province. The entire Provincial Indigenous Medical
Services are monitored by each respective Regional Directorate of Health Services (RDHS)
officers and Division offices in each District respectively.
Some of the important functions are:
1. Construction of building facilities such as OPD, Wards, MO Quarters building for
Ayurvedic institutions in Eastern Province.
2. Renovation and fulfillment of facilities in Ayurvedic institutions in Eastern Province.
3. Establishment of Panchakarma Ayurvedic Centre for tourism destinations in Eastern
Province.
4. Establishment of Herbal Gardens in Eastern Province.
5. Facilitated with Special medical Equipment and furniture for Ayurvedic Institutions in
Eastern Province.
6. Nutritional intervention programs and awareness programs for public in Eastern
Province.
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7. Mobile medical services through Ayurvedic medical system to ensure the healthier
living in Eastern province.
Future Plans
1.
2.
3.
4.

Establish an Acupuncture treatment centre


Establish an Ayurvedic Surgical unit
Establish a Special care unit for children (Pediatrics ward)
Implement herbal knowledge to schools and communities through mobile Ayurvedic
services

Why Trincomalee?
I chose Trincomalee for many reasons. It provided an opportunity to witness rural diseases
that are not so common in Colombo. I was also interested to see how the alternative medicine
differed between a rural area like Trincomalee and commercial capital like Colombo. The
most striking difference between the two lies in their attitudes towards health. In
Trincomalee, people believe in the ancient herbal treatments and their little secrets to pain
relief, asthma, gastrointestinal disorders, etc which have been passed on from one generation
to the other. Although this might look like a blind practice in ones view, it certainly is very
effective.
Also part of my childhood was spent here, and I used to return here for several weeks during
school vacations. As a consequence of those visits, I have been able to observe people and
understand their views on alternative medicine.

My Elective Placement
My first day at the Ayurveda Base Hospital, I learned many things. It is located about 15 km
away from the Trincomalee town on the Trincomalee-Kandy Highway (A6). This hospital is
equipped with Out-Patient department (O.P.D), In-Door department (IDD Wards), Pharmacy,
Yoga medication centre, Panchakarma treatment centre, Indigenous drug manufacturing
centre, Pharmacy, Administration setup and a Kitchen. In addition to all this, the hospital
oversees a 3 acres herbal garden, in which herbal crops are cultivated every year to supply for
the drug manufacturing centre.
During the few days I spent in Kappalthurai Base Hospital, Dr. Pholtan Rajeev taught me a
huge amount! I came away with a practical experience of ancient indigenous medicine, but in
a much broader sense than Id ever imagined. I learnt the fundamental lesson that healthcare
in this setting involves far more than performing traditional doctor roles in a clinical setting.
It means approaching the healthcare of the people in a truly holistic way. I was amazed by the
detailed knowledge and skill demonstrated by practitioners; requiring familiarity with the
properties, actions, functions, and applications of different components of over 1,000
different plants, knowledge regarding the composition and formation of 40 different
commonly prescribed medicinal formulas; and the indications, preparation and application of
different treatment modalities.
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I also learned that there are 32 types of Internal medicine in many forms; Liquid (Arishta,
Asawa, Quwatha), Powder (Mathirai, Watti, Rasa, Goggulu), Semisolid (Kalka, Leha) and
32 different external medicine in the form of Oil, Paste, Powder and Fermentation. The
preparation of ayurvedic medication is usually a cumbersome and tedious process. Minerals,
for example Mercury, Arsenic, Sulphate, Iron and many other salts extracted from herbal
plants are subjected to high temperatures before being ground with herbal juices in a pestle
for a prescribed period of time. Herbal extracts are made by boiling parts of plants such as
leaves, root, bark, bud, flowers, latex, resins including ash and then allowing the resulting
liquid to simmer until it is reduced to a fraction of its original volume.
While I was going on ward rounds in the morning, they served me with Kanji, it is a
traditional Sri-Lankan porridge made of indigenous leaves commonly Gotukola, Karapincha,
Polpala with local rice, green gram and water. It is also served to all patients, doctors and
staff every morning on a regular basis. The fresh dark green leaves enrich in Caronene,
Ascorbic acid, Riboflavin, Alphalinolic acid, Vitamin K and Folic acid. It is believed that this
food is useful to prevent some diseases such as constipation, high blood cholesterol levels
(Hypercholesterolemia), Diabetes mellitus and urinary calculi.
What I noticed when I was on ward rounds was that patients are completely treated and cured
using herbs and ancient medical treatments. I met a patient named Mrs.Thangapulla aged 66,
apparently she had had a fall and she was brought to the hospital with a hip joint fracture and
knee injury. She had been in the hospital for less than a month, and they treated her with
Paththu; its a traditional bone setting practice. When a patient arrives in with a damaged
joint, skilled practitioners ascertain the nature of injury. They feel the arm or leg for
dislocated joint or fracture. Once they are sure about the diagnosis, they bound it with a green
paste of medicinal herb and tie it around the area of dislocation or fracture. After seven days,
Paththu is removed and then tied around again freshly. This is repeated several times during
the treatment procedure depending on the nature of injury.

Next I spend some time with Dr. Pholton, as he took me around the hospital showing how
little things commonly found around us are used in the Ayurvedic treatment. He showed me a
type of Jasmine flower (Pavala Mallikai) which apparently is used to treat hemorrhoids. He
also took me to the Yoga treatment centre, in which he conducts Yoga clinics every week
educating patients to relax their body and mind as he is a trained Yoga professional himself.
When I was in the Male ward, I saw many patients with partial paralysis of the limbs, lumbar
pain and severe headaches. They all had come from faraway places for special treatments.
One treatment I found particularly interesting was Kati basti, which is a medicinal oil
treatment for relieving tensions of the lower back. The patient lies down on their stomach; a
ring is fixed on their back with a paste made of special flour and water. I also noticed some
patients being handled by trained masseurs who use Ayurvedic Oilments (Sarasapathi,
Pinda, Karappan) and massage different regions of the body to ease pain and cure them
eventually. It was really fascinating to see how it was done (I would say it looked very
professional and healthier than the modern Spa Massages you get in Colombo!)
Later I visited the Panchakarma Treatment centre (This was the first time I ever been to
such centre) which also is a part of the Department of Indigenous Medicine. I stood there
gazing at all the posters they had about the peculiar treatments, when Dr. Shobanaa explained
to me how they came to be. Apparently, Panchakarma is Ayurveda's primary purification
and detoxification treatment. Panchakarma means "Five Therapies". These 5 therapeutic
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treatments eliminate toxins from the body, they are: Vamana, Virechana, Nasya, Basti and
Raktamoskshana.
i.
ii.
iii.
iv.

v.

Vamana (Controlled vomiting or Emesis therapy) is administered for kapha related


disorders like bronchitis, colds, breathlessness, chronic asthma, diabetes, indigestion
Virechana (Purgation therapy) is applied to relieve excess Pitta (in the form of bile)
accumulated in the gall bladder, liver, small intestine etc. The result of accumulation
of excess toxic materials will be rashes, inflammations, fever, nausea and jaundice.
Basti (Enema therapy) is used to flush out fallen doshas through intestinal tract.
Constipation, kidney stone, acidity, sexual disorders, arthritis, rheumatism are the
common diseases curable with Basti.
Nasya (Nasal administration) is used to eliminate kapha related problems affecting
eyes, ear, nose and throat. Migraine, sinusitis, bronchitis are the main diseases curable
with Nasya. The life energy or prana enters our body through nose. It is also
connected to brain and consciousness.
Raktha Moksha (Blood Letting) is the technique to eliminate toxic substances
accumulated in the blood stream. It is a process of purification of blood. Skin
disorders like rash, acne, itching etc are due to impure blood. It regulates the action of
pitta.

The series of these five therapies help remove deep rooted stress and illness-causing toxins
from the body while balancing the doshas (energies that govern all biological functions). She
added according to Ayurvedic theory, physical and emotional traits are classified as three
doshasVata, Kapha, and Pitta. Each individual has all three doshas with one
predominating. If an imbalance occurs, diseases/conditions appear. Panchakarma rebalances
the doshas, bringing them back to equilibrium and the individual back to good health.
According to her, Panchakarma is effective only if special detoxification diet is consumed
along with the treatments. And therefore every individual undergoing Panchakarma receives
special diet which is monitored every day by the doctor. She continued saying that this
treatment involves some cost to the patients (But very affordable of course), as this type of
treatments are mainly seeked by the foreigners.

Strengths and Weaknesses


During my few days I spent here, I happened to find out several Strengths and weaknesses of
this Ayurvedic Base Hospital.
One of the major strengths about this place is the location; it is located in the outskirts of
Trincomalee on the Trincomalee-Kandy Highway (A6) and so its very reachable even by
public transportation. Hence patients from Trincomalee Town, Nilaveli, China-bay, Kanniya,
Mutur and even Kinniya can come by and stay in the Wards for treatment.
When I went on ward rounds, I realized how much patients really appreciated the treatment
given by the experienced doctors in the hospital. The hospital has several trained Ayurvedic
doctors working around the clock and their treatments are very successful. The doctor patient
relationship is something that comes very natural in this community. However patient consent
doesnt really happen here (or elsewhere in the country for that matter) as it is assumed that
what the doctor wants is the best thing. State provided health care is a luxury that many Sri
Lankans are still very grateful for, especially those from lower socio-economic backgrounds,
so they are very happy to have them treated.
The initial infrastructure of the hospital is very much appreciated, as they have a wellfunctioning male and female wards with bathrooms and kitchen, a Yoga centre, Panchakarma
treatment centre, Indigenous drug manufacturing centre with a 3 acres Herbal garden. But
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over the years however the maintenance cost provided by the government to meet the patient
demands is poorly funded; hence they are struggling to carry on with their day to day
activities as the number of patients seeking alternative treatments such as Ayurveda has
increased significantly since 2009.
As a functioning hospital, it lacks Emergency beds, Ambulance, Dress changing rooms,
physiotherapy equipment and also there is room for better Infrastructural development.
One of the major weaknesses I perceived was the amount of paper work involved. Everything
was manual, from accessing the controlled drugs to maintaining patient database. This not
only suppressed efficiency but also increased wastage.
I was given the opportunity to access their drug inventory, And Dr. Pholtan highlighted that
certain drugs havent been delivered for several months and that they are forced to reduce the
dosage for patients in order not to run out stocks.
But overall, this hospital has very happy and welcoming staff. They took great care of all the
patients including myself.

Conclusion
In summary, my placements both at Revival and Ayurveda Base Hospital allowed me to
experience a branch of medicine which is barely, if at all, covered in undergraduate medical
training, communicate effectively with the patients, brush up on my joint examination skills
and also develop empathy and caring attitude towards inmates. Also Im now able to recall
some of the medicinal properties of plants and flowers I come across. This was a great
experience in both confirming my passion for sports medicine and Ayurveda, hence
broadening my horizons in considering the possibilities of working abroad in the future. I was
also able to satisfy all objectives of the elective program and my time there had definitely
improved my skills as a medical student.

References
http://www.revivalclinic.com/services/elderly-exercise-programs.aspx
http://www.nhs.uk/ipgmedia/National/Motor%20Neurone%20Disease
%20Association/assets/Physiotherapyforpeoplewithmotorneuronedisease.pdf
http://www.tops.uk.com/Neuro-Physiotherapy/motor-neurone-disease.html
http://www.colombopage.com/archive_16A/Jan25_1453709278CH.php
http://easyayurveda.com/2014/10/09/vamana-therapy-right-method-side-effectsmanagement/
http://www.keralaayurvedics.com/diseases-diagnosis-andtreatment/treatments/panchakarma/panchakarma-the-five-types-of-treatment-andrejuvenation.html
http://sl-ayurvedicmedicine.blogspot.com/2009/06/ayurveda-history-in-sri-lanka.html
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http://www.projects-abroad.org/how-it-works/volunteer-stories/?content=electives-formedical-students/medicine-electives/sri-lanka/peter-connell/

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