A Return to the Glittering Gem of the Indian Ocean

Danielle Wilkins  - School for Environment and Sustainability



All roads may lead to Rome, but for me, all air routes lead to Sri Lanka. Over the past few years, first thanks to a number of work assignments and later thanks to some great friends, Sri Lanka has become something of a home away from home.  After approximately 24 hours that included a number of tiny seats, movies, questionable airline food, a croissant in Paris, a samosa in Mumbai and a stroll through the refrigerators and washers for sale in the duty-free section of Sri Lanka’s Bandaranaike International airport, I finally walked out of the airport and into the humid Negombo morning.  A few minutes later and my drivers and I took off down the road heading northeast. Driving in Sri Lanka is always an adventure that can be loosely described as a well-coordinated game of chicken. Honking and overtaking are a way of life. Honking in and of itself is the island’s fourth unofficial language. There is the “overtake honk”, short, urgent, to the point. The “blind turn honk”, performed before making a turn on one of Sri Lanka’s millions of blind turns, this honk has prevented countless collisions. The “hi honk”, occurs when passing a friend’s tuk tuk or roadside shop. Admittedly all the honking can become grinding over time, but today it was a familiar welcome. Finally, after several stops along the road to accept food and drinks from school children celebrating Poya (monthly Buddhist new moon festival), five hours after leaving airport in Negombo, and 31 hours after leaving the U.S., I arrived at Grace Care Center. My home for the next three months.

Grace girls welcoming me on my arrival

Grace Care Center is a girls home and elder care center located in Trincomalee, Sri Lanka. Trincomalee has seen its fair share of upheaval over the years. As one of the world’s deepest natural harbors it is a strategic military installation that was prized by both the British and Japanese during WWII. More recently the city has seen the decades of ethnic strife as post-independence Sri Lanka struggled through a 30-year conflict between the dominant Buddhist Singhalese in the south and the minority Hindu Tamils in the north. At the outset of the conflict Trincomalee was a predominantly Tamil city built around a Sinhalese-controlled naval facility. The violence in the city was not as intense as cities further north, but residents still tell stories of fleeing in the middle of the night to avoid the fires set to their shops and nearly every Tamil family knows someone who was arrested by the government. The conflict was finally brought to a close in 2009, but not before Trincomalee was further devastated by the tsunami of 2004. Today the city, located near within close proximity to some of the world’s best whale and dolphin watching, is a slowly growing tourist destination. While the population today is heavily Muslim, the beautiful Hindu temples sitting alongside of Buddhist pagodas and Islamic mosques provide the backdrop for a diverse country that is learning to live together once again.

The Grace Care Center was established in 2002 as a haven for the young and old most affected by the war, and later, by the tsunami. The facility currently cares for 24 girls and 21 elders. Education is the predominant focus of Grace Care Center with all girls receiving after-school tutoring in addition to their normal class schedule. The goal of the Center is to mold independent young women who are able to make their own decisions in life. To this end the Center seeks to identify suitable vocational training opportunities for its residents. A series of studies conducted by students at the University of Michigan identified an opportunity to provide employment for young people who are not able to qualify for the very limited number of spots in public universities, or pay for education from a private university. This opportunity comes in the form of assisting in the care of diabetic patients.

Diabetes is one of the world’s most prevalent chronic diseases and left untreated, or improperly treated, is deadly. To date nearly 8% of the Sri Lankan population, 1.6 million people, are diagnosed diabetes patients. This number is only expected to grow as Sri Lanka’s economy evolves away from manual agriculture to less physically demanding employment and disposable income allows more people to adopt Western styles of eating.  While Sri Lanka does provide health care free of charge in the country’s public hospitals, the lack of trained medical staff means that for poor patients who have diabetes, their disease is managed through a 2 minute monthly interaction with the doctor to renew their prescriptions, and the occasional blood test. The Grace Care Center thinks there is a better way. 

Dr. Naresh Gunaratnam, the Director of Grace’s Board of Directors in the United States, has partnered with University of Michigan medical faculty and students to design a conceptual model that combines the roles of a Medical Assistant and Diabetes Educator. This new role is supplemented by the development of a web application that uses a patient’s basic vital information to assess the individual’s risk for diabetes-related complications. Now that this concept has been developed, my role is to figure out how to implement it. I will be working with young women from Grace who have begun training for this position, as well as the medical faculty at the Trincomalee General Hospital and medical faculty at the University of Michigan to develop a comprehensive training curriculum and path forward to improving diabetic care in Sri Lanka.