Nestled along the windswept coastal road from Kankesanthurai to Point Pedro, with the glimmering northern sea to one side and parched, palm-fringed fields to the other, lies the quiet village of Myliddy. Here, away from the hum of busy towns and the spotlight of health policy debates, a small team continues to deliver care at the Myliddy Primary Medical Care Unit (PMCU)—an under-resourced but vital outpost of Sri Lanka’s public health system.
On Wednesday dated 21st May, 2025, my colleague and I, both Senior Registrars in Family Medicine, journeyed to this rural clinic as part of our ongoing commitment to community-based care. Our purpose was simple: to see patients attending the outpatient department and offer what help we could with the tools at hand.
Assisting us was a young demonstrator from the Department of Family Medicine at the University of Jaffna. Acting as both interpreter and eager learner, he facilitated communication with patients who spoke only Tamil, while also engaging with the family medicine consultation model we employed—an approach rooted in empathy, continuity, and whole-person care.
Consultations were held in a humble hall within a separate building, outfitted with just a table, a few plastic chairs, and a waiting area. There was no examination bed, and privacy for sensitive cases was minimal. Yet, the spirit of service was unmistakable. Despite the language barriers and material constraints, the patients—ranging in age from 30 to 70, mostly from economically struggling households—shared their stories with openness and trust.
Many of the elderly lived alone, their children having migrated for work or resettled abroad. It became clear that this community, like many others across the country, is grappling not only with illness but with the social consequences of migration, economic hardship, and aging.
Musculoskeletal complaints dominated the day—aching backs, frozen shoulders, stiff necks—likely the result of years of manual labor and poor ergonomics. Without access to even basic analgesic ointments, we leaned on physiotherapy advice, posture correction, and traditional home-based remedies. Our approach was less about prescriptions and more about empowering patients with knowledge they could act on.
We took the opportunity to screen for non-communicable diseases and provided preventive education, especially regarding cancers—breast, cervical, and oral. Chronic habits like betel and areca nut chewing had left telltale signs in some, and we promptly referred these patients to Base Hospital Tellippalai for further care.
Two female patients stood out—one suffering from vaginal candidiasis, another with a history of recurrent miscarriages. Without private space or examination facilities, managing their care respectfully and effectively was challenging. It was a stark reminder that dignity in healthcare often begins with infrastructure.
The Medical Officer in Charge, a committed and compassionate doctor, worked alongside us with quiet determination. She shared her frustrations: the absence of essential drugs, an overburdened team of just four—including a dispenser, two health assistants (one on prolonged medical leave), and a security guard. She spoke candidly about the endless uphill battle with authorities for more staff and resources—pleas that too often fall on deaf ears.
Even as she contemplates postgraduate studies to become a consultant, she worries aloud about who will hold the fort in her absence. Her words echoed in my mind later in the day as I read a headline quoting the Health Minister at the 78th World Health Assembly of World Health Organization: over 4,600 Sri Lankan healthcare professionals have migrated abroad. The consequences—deepening shortages, overworked staff, and underserved patients—are painfully evident in places like Myliddy.
Our visit offered a sobering yet inspiring glimpse into the realities of rural healthcare. It reaffirmed our belief in the value of primary care, but also raised troubling questions: Can facilities like this remain sustainable in the face of migration, resource scarcity, and an aging population? Can digital solutions like telemedicine bridge the gap? Could artificial intelligence play a role in triaging and managing care where human resources are few?
These are not hypothetical questions anymore—they are the pressing challenges that must be addressed if we are to protect the fabric of our healthcare system.
As the sun dipped low over the northern coast and we made our way back from Myliddy, I carried with me not just the clinical cases of the day, but the faces, stories, and unspoken hopes of a community that deserves better.
Points to ponder, indeed.
By Dr. Shane Halpe - Senior Registrar in Family Medicine
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