- Shannon with her Sri Lankan colleagues in the hospital -
I chose to do my Mental Health nursing placement with Work the World, as I was immediately attracted to the destinations on the website and felt there was a good selection to choose from! I also read a couple of case studies from students who, like me, were studying mental health. I decided Work the World was the best organisation to go with, as they have experience coordinating mental health placements. I found it difficult to find another company who could organise my placement in mental health with as good reputation as Work the World.
I chose to undertake my placement in Sri Lanka after a discussion with an Elective Consultant about what each destination had to offer. Sri Lanka had everything I was interested in for a mental health placement; inpatient wards, community and hospital clinics.
The journey to Sri Lanka was long and tiring. I was met by a Work the World staff member at the airport at 4am Sri Lankan time and slept through most of the journey to the house. Before I fell asleep, I was told about what my first couple of days in the house would consist of. We were also told that because we were driving at night, at some parts of the rural roads we may see wild elephants. You would have thought this would be enough to keep me awake. It did, for two hours, and then I drifted off.
As soon as we arrived at the house, we were greeted by all the Work the World staff. We were then introduced to ‘Uncle’, the house chef, who had already cooked us a wonderful breakfast of pancakes, chocolate spread and fruit, and put it on the table ready for us. After a nap and some unpacking, some other students arrived. We spent the day talking about our courses and what departments we had requested to go to. That evening - when the students who had already been in Sri Lanka came back to the house - we introduced ourselves and spent the night playing charades and card games. It was such a fun end to my first night and made me feel right at home.
The house itself was amazing. The staff bent over backwards to help us all. My housemates were lovely, too. I joined them at the weekends to experience travelling through the beautiful Sri Lankan countryside.
When I first saw the hospital, I was taken aback by how huge it was. I got lost all the time, and I was still getting lost in my fifth week! There were people everywhere, in the waiting areas outside and walking, and standing around the wards - the hospital was always very busy.
The way in which patients are seen is different to back home, it's done on a first come first serve basis. Some patients would wait all day, from 6am, and not be seen until the next day. Everything is done on paper; there are no computers or laptops. All patient notes and information is written in patient books, which the patients bring with them to whichever department they attend.
The staff on the Psychiatric Wards were lovely, and as interested in me and my work back home as I was in them and theirs. The consultant I worked with was fantastic. He took me under his wing and treated me as a trainee psychiatrist. He explained patients’ cases to me, asked my opinion and got me to explain how I came to my conclusions. Working closely with this consultant advanced my skills on assessments and documentation writing.
Thanks to the twice-weekly language lessons I had at the Work the World house, I was able to ask a number of questions. The consultant asked me to talk to patients in assessments and ask them questions. This was his way of developing my speaking skills and getting me more involved. If a patient spoke English, he would ask me to do the assessment and give me feedback on how I did. I could not have asked for a better person to work with and learn from whilst I was there. He also took me on prison visits, where we conducted ‘mental state’ examinations, which are used in courts with regards to patients’ upcoming trials. I did all the documentation during these visits.
- A hotel I stayed at on the beach in Trincomalee -
One man we saw was 87 years old. When the consultant had finished talking to him, he explained that the man had severe dementia and that nothing he said made sense. He didn’t know where he was, and couldn’t comprehend anything the doctor said. It turned out that he had been arrested because he was found wandering the streets, speaking incoherently. He went missing from his family 6 months prior after he walked out one night whilst everyone was sleeping, and never came back. The consultant explained they had to arrest him to put him in a place of safety, instead of allowing him to wander the streets. In Sri Lanka, sheltered housing for the elderly isn’t common, so there was no other option for the police but to put him in prison.
I also saw women on the prison visits. Many of the women we saw reported domestic violence as a reason for their actions, as well as financial and environmental stressors. While being assessed, family members were allowed in to sit next to their relative, the consultant asked them questions to help find out more about the patient. The assessments in total took around 10 minutes for each patient. After this they were led back to their building.
We would see a considerable number of patients in the outreach clinic before going on to see patients in the prisons. Throughout all the assessments and conversations, the office door was left open during patient consultations. Patients stood in the doorway waiting their turn, well within hearing distance of ongoing consultations.
Treatment and medication were similar to what we offer back home. However, in Sri Lanka where you live has an effect on the medication you can take. If a patient needs medication that isn't available in their town, they have to buy it. If they can't afford to buy it, which was often the case they couldn’t have it, unless they travelled to hospital every time it ran out. For some patients, travelling to the hospital isn't an option due to lack of money and limited transportation.
I came to realise how lucky we are to have the services that the UK provides to support those with mental illness. However I also realised that there are still things that need to be looked at back home with regards to mental health care. For example, the hospital wards in Sri Lanka always had at least 5 staff on each ward, where understaffing is a problem in England. By contrast, Sri Lanka has a problem with a lack of services, which is something that the UK has, by comparison, an abundance of. I think it's important to focus on the positives in both countries, and there are positives in everything!
I also was able to do two weeks in Paediatric Nursing. For my degree, I have to complete a portfolio of evidence within 8 different sectors of nursing such as mother and baby, child and paediatrics and surgery/theater, which I’d not yet been able to experience. So what better time but to experience them in Sri Lanka? I spent time on paediatric thalassemia, antenatal, the labour room, Obstetrics and Gynecology, theater, and the Postnatal Ward. All of these were amazing, once-in-a-lifetime experiences.
I travelled across the whole country during my 6-week stay. I spent two of my weekends in Trincomalee (white sand and turquoise sea), where I spent my time sunbathing and relaxing, away from the hospital hustle and bustle. I also went snorkeling where I saw sharks, turtles, and starfish! We also rented bikes and cycled between Hindu temples, sampling all the local foods along the way. I also travelled to Galle Fort, where we did more sunbathing and tried out surfing. I also visited Matale and Kandy, where I had the chance to bathe and feed elephants—one of the highlights of my trip. I also travelled to Colombo, Negombo, and Hikkaduwa where I saw baby turtles. Jaffna and Passekudah are great if you want a beach to yourself away from the masses.
One of my favourite memories from my trip was the last day working with mental health. After the patients in the clinic had all been seen for the day, the consultant and all the nurses threw a "going to another department" party for me! They brought in homemade Sri Lankan food, played music and we took pictures together. I got to know everyone so well, it was like leaving my work-family.
The consultant took time out of his schedule to write a letter of recommendation, explaining all of the things I did whilst I was there. He gave a wonderful reference regarding my professional character and my work. He told me I could use this for job interviews back home and put it in my university profile folder. It was such a nice gesture and I couldn't have asked for a better last day in the department!
If you’re considering a Work the World placement, my advice would be to pick the destination based on what you want to learn and what you want to gain from the experience! I wanted to gain an overall experience of mental health in different areas (wards, community, clinics), which is why I chose Anuradhapura. I had an amazing time and learnt so much from the experience!