“Insights into my nursing internship in Sri Lanka” – Report by student Batu

☝️ The most important information in brief

• My trip for the nursing internship in Sri Lanka began on February 23, 2022, with a group of students.
• After a long flight via Dubai, we arrived in Colombo and continued on to Galle.
• We were assigned to various wards at Karapitya Teaching Hospital, including neurosurgery.
• In addition to the internship, we spent our free time at beaches, exploring local sights, and socializing with locals.
• The internship provided me with valuable medical experience and cultural impressions that had a lasting impact.

After a long flight with a short stopover in Dubai, I arrived at Bandaranaike International Airport in Colombo, the capital and only major city on the island. I still remember very well how we landed and I saw an airport full of palm trees for the first time. I knew I was now in the tropics and could hardly wait to feel the air on my skin. I really wanted to see for myself how humid the air is in the tropics. And yes, the air is very humid at first. When you travel 8,000 km from Düsseldorf to the tropics in February, you are overwhelmed by the heat.

Fortunately, our taxi, which was already waiting for us outside the airport, was air-conditioned. And it stayed that way for the entire journey. We took a taxi from Colombo to beautiful Galle, a city in the southwest of Sri Lanka, which is just under 100 km from the airport. Since the transport infrastructure is not necessarily on the same level as in Germany, these 100 km took a little longer than they would in Germany. But that was perfectly fine, because it gave us a first impression of the country, the vegetation, the people, and the beautiful beaches. And ultimately, it made us even more excited to get out of the car and explore the island. 

When I arrived at my accommodation, I put my luggage in my room, put on my swimming trunks, and ran to cool off in the water at the beach. At that moment, I knew that the month ahead of me would be full of unforgettable memories. But here's a quick tip: wait a few minutes longer and put on some good sunscreen. With a UV index of 10 and above, it's not something to be taken lightly. And even if we want to get a healthy tan in the tropics, I wouldn't take the risk. In a whole month, you'll have plenty of beach days to build up your tan!

We arrived slowly, unpacked our things, and started looking for a place to eat. On our first evening, we decided to go to Galle Fort, an old castle complex built by the Dutch and Portuguese. 

The place is known not only for its history but also for its charm. There were all kinds of restaurants and souvenir shops hidden in the small, picturesque alleys. My first dinner was actually a simple curry. However, thanks to the fresh ingredients and authentic cooking style, this curry was hardly comparable to what you would find in Germany. 

Our coordinator, Javindu, was also there that evening. He introduced himself warmly and told us a lot about the healthcare system in Sri Lanka and asked us about our preferences regarding the various wards in the hospital. I decided, along with three other friends, that I wanted to gain my first experience in the neurosurgery ward.

Javindu also explained to us the special role that Sri Lanka's healthcare system plays in Asia due to its accessibility to the population. Sri Lanka's healthcare system is accessible to all citizens of the country and is largely financed by state resources. Healthcare is largely free of charge or heavily subsidized, especially in public institutions. The roots of the healthcare system lie in the British colonial era. For this reason, patients usually pay only small fees for medication or services provided.

On the first day, we went straight to the beach.

The next day was our first day at Karapitya Teaching Hospital. Founded in 1982, the hospital has 69 wards with over 2,000 beds, making it the largest tertiary care facility in the southern province of the island. On the day of the internship, we all had breakfast together in the morning and got into our taxi, which picked us up at 7:45 a.m. so that we could start on time at 8:00 a.m. 

There we were, a group of German students, all wearing our blue pants and tunics. I really had no idea what to expect. That's why I had pretty much no expectations. We got out and walked towards the main entrance. It was very hot that day. And since it was the first day, I hadn't had time to get used to the heat yet. The locals, on the other hand, had no problem wearing long-sleeved tops in the heat. Inside the hospital, however, the temperature was actually bearable. We were first called into the director's office, where we were given our name tags and assigned to the various wards.

As planned, I was assigned to neurosurgery in a small group with three other friends. Due to the small group sizes, we were basically offered private lessons. The doctor explained the procedure to us at the beginning. He asked us about our previous knowledge and explained what we could expect. He explained the most common clinical pictures and the surgical procedure to us. 

Before we were allowed to enter the operating room, we had to change in the changing rooms. We were able to pepper the doctors on site with our questions. They were always careful to explain the procedure in detail. I also learned a lot about the various cases. From brain hemorrhages to tumor resections, we were able to gain insight into the different cases. In most cases, we only watched the operating doctors, but with a little initiative, we were actually able to help assist. The students who were present during the operation also explained a lot to us.

Although we were assigned to the neurosurgical ward, we were allowed to rotate on a weekly basis. In addition to neurosurgery, there are also operating theaters a+b and c+d, where general surgical operations are primarily performed. What was special about this was that, in addition to one main operation, two additional minor operations often took place. This meant that we were able to watch three different operations at a glance. Anyone who has ever been allowed to attend an operation knows that there are moments when not much happens. For this reason, it was actually advantageous to take a look at the smaller operations as well. If the surgeon performing the main operation was able to show something new or tell us something, we could just turn around briefly and have it explained to us.

During the surgeries, the attending physicians explain a lot about the anatomy, the underlying pathophysiology, the respective medical history, or the diagnostics to be performed before the surgical procedure.

In the case of emergency surgeries in the afternoon, you could also watch in the casualty theater. This also means that those who wanted to stay in the hospital longer than 12:00-12:30 to see or learn something were allowed to stay longer at their own request. In the meantime, you could get something to eat in the cafeteria for a little change. There is something for every taste here.

The fourth station is pediatric cardiology. There, you will mainly see echocardiograms. And you will actually be allowed to perform echocardiograms yourself. I saw typical congenital heart defects such as ventricular septal defects and persistent ductus arteriosus, which I had heard so much about at university but had never seen for myself, as well as an exciting case of Kawasaki syndrome. Surprisingly, the doctor was very keen to explain the clinical pictures to us in detail, so we also produced a few diagrams to help us understand the physiology or anatomy behind a disease more precisely. Even though the medical history was more complicated here, as the patients often only spoke Sinhalese, we were able to learn a lot from the attending physicians.

The hospital in Sri Lanka looks quite different from hospitals in Europe or Germany.

Most days, my workday ended at noon. I would usually stop by my accommodation briefly before heading straight to the beach. That meant taking off my pants and smock and slipping into my swim trunks and T-shirt! 

The three of us would usually hop into one of the charming little tuk-tuks and drive to Sahana Beach. That's where our surf club was located, where we could relax on sun loungers under the sun at over 30 degrees Celsius. After a "hard half-day," that was definitely necessary ☺

On some days, I probably just lay on the lounger most of the time and simply turned over every half hour, and on others we either played flunkyball with good old Lion Beer from Sri Lanka and/or we played volleyball. We also met lots of other young people there who played with us. I have rarely been to a place where it was so easy to make new friends. With lots of new friends, we went out one evening, went to a beach party, or invited everyone back to our accommodation to play a few rounds of beer pong. 

The surf club, where we often stayed until sunset, also offers surf lessons. I think that helps some people who are trying a surfboard for the first time. And no, no one needs to be embarrassed if their surfing doesn't look like the tanned influencers in their Insta reels. I actually underestimated how difficult it is to even stand on the board in the first place. Of course, this makes the sense of achievement all the greater once you've managed it. To avoid getting sunburned, you should make sure to buy a surf shirt. If you don't have one with you, you can also buy one at the surf club. In fact, most of us did just that. You don't have to worry about food either. The surf club offers a decent selection. I also recommend all the mixed juices. My favorite was definitely mango-passion fruit. Every now and then, I also opted for one of the orange King Coconuts, which are common in Sri Lanka. As the name suggests, this drink is one of the best coconut drinks around. They also help prevent hangovers ☺

Here is a group photo from the hospital.

Otherwise, you can also stroll along the beach promenade and eat at the Shack, which is a little further west but also more expensive. Or you can eat like the locals in the Medina, just around the corner. Sri Lanka really impressed me with its cuisine. And there's definitely more to the cuisine than just curry. So try it out. You won't find many of these flavors in Germany, especially not this fresh. And what could be better than enjoying your meal with a sea view, a pleasant breeze, sand under your feet, and palm trees swaying in the wind? 

Even if it seems complicated to many, dare to network with the locals. One evening, I was approached by three Sri Lankans when I ordered kottu. As a European, you are often a little skeptical and perhaps a little "too" cautious. Maybe it's also the belief that strangers aren't nice to you without asking for something in return. Later, we sat on the beach, they shared their food with me, and we drank beer and arrack (careful, it's strong!) together. One of them played his guitar and the other two sang along. We talked a lot about cultures and cultural differences between Sri Lanka and Germany. They told me a little more about Buddhism, which most people in Sri Lanka belong to.

I spent a nice evening with the locals.

On the same day, I drove to the tourist town of Mirissa at night. This is where Coconut Tree Hill is located, which is well known from many pictures on the internet. We spent a few nights there at Cheeky Monkeys (more precisely, this beach club is located in Weligama). The place is really something special. You simply have to see it for yourself. Doctor House is also worth a visit. It is a site that houses a 200-year-old Dutch hospital. In 2016, the entire site was converted into a bar/restaurant with a shop and a hotel. 

Another trip I fondly remember is to Turtle Beach in Hikkaduwa. The beach gets its name from the numerous sea turtles that lay their eggs here, making it an important sanctuary for these endangered animals.

Here you have the opportunity to observe sea turtles in their natural habitat. Early in the morning or late in the afternoon, when the turtles come ashore to lay their eggs, you are often lucky enough to see them up close. The beach is also perfect for swimming, snorkeling, and sunbathing. If you want to learn more about sea turtle conservation, there are facilities such as the Turtle Hatchery near Turtle Beach.

After our second week of nursing internship, we decided to travel to Kandy. The trip there began with a hike to the surrounding hills, which offered us breathtaking views of the city and the surrounding countryside. We followed the paths, passing lush tea plantations and hidden waterfalls, and enjoyed the peace and quiet of nature. In the afternoon, we immersed ourselves in the history and culture of Kandy by visiting the Temple of the Tooth, one of the most important religious sites in the country. The sight of the temple's golden roof and the spirituality of the place left a lasting impression. In the evening, we decided to explore Kandy's lively nightlife. We strolled through the bustling streets, sampled local delicacies at street stalls, and mingled with the locals in bars and clubs. 

From Kandy, we took the famous tea train to Ella. The train route is considered one of the most beautiful in the world. Here you can enjoy the beautiful mountain landscape of Sri Lanka. The route covers about 140 kilometers and leads through lush tea plantations, green hills, and along steep cliffs with the most beautiful views. It was hard for me not to pull out my phone and take pictures at every stop. I just wanted to enjoy the view. The train ride from Kandy to Ella usually takes about 6 to 7 hours (admittedly, it was a bit exhausting ☺). One of the highlights of the train ride is crossing the famous Nine Arch Bridge, an imposing railway bridge that rises in the middle of the landscape. At this point, I had to take my phone out of my pocket to capture a few memories. 

Ella is not only known for its breathtaking scenery, but also for its numerous hiking trails. We decided to climb Little Adam's Peak, one of the most popular viewpoints in the area. The climb was challenging, but when we reached the summit, we were rewarded with a breathtaking panorama. The green hills stretched out everywhere and in the distance we could see the imposing Ella Rock. In the evening, we strolled through the picturesque streets of Ella, past small shops, cozy cafes, and restaurants.

The next excursion took us to the Kanneliya Rainforest. Thanks to our tour guide, we were able to see many different animals, including mammals such as monkeys, insects, and many different reptiles. One highlight was the little green snake, which we were even allowed to hold in our hands. To be honest, I was quite impressed when our guide spotted this snake in the dense forest. Because the rainforest really is as green as you imagine it to be. At the end, we arrived at a small waterfall where we could cool off a bit. Be sure to pack enough water and snacks. In the end, we shared a packet of cookies between ten people 🙂 

Here is a picture of the little green snake.

On the last weekend of my internship, we drove to Yala National Park. We had to get up at 5 a.m. because the best animals can be seen early in the morning. Our jeep tour began at sunrise. Our guide skillfully steered the jeep through the park while we eagerly scanned the landscape for animals. We soon spotted the first animals: herds of elephants roaming the countryside, a wide variety of bird species, and crocodiles basking on the banks. We even saw a leopard lying on the road.

My nursing internship went by so quickly, and I wish I had had more time to explore the island. Even though I saw a lot and had many experiences that I fondly remember, there is still so much to discover. The trip had a profound impact on me in many different ways. The warmth and hospitality, and especially my evening on the beach with the three locals, showed me how positive the people there are. However, the country is definitely not as developed as Germany. Whether it's healthcare, infrastructure, or the living conditions of the locals. Here in the West, we are far ahead of Sri Lanka in most respects. Nevertheless, I believe that the local people are much happier and more positive than people from Western countries. And that's despite the fact that people in Sri Lanka own/have much less than we do.

The internship was definitely very educational for me. Thanks to the various medical cases and the doctors' great commitment to explaining things, I was able to learn a lot for my medical career. Rotating through the wards meant that I was shown much more within a month than would have been possible in a hospital in Germany.

To sum it up: I regret not having completed my previous internships abroad and look back on my time in Sri Lanka with a smile on my face.