Hemoglobal: Sri Lanka Program

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Sri Lanka Program

An 18-year-long civil war between government troops and Tamil rebels led to the death of more than 64,000 people and had severe repercussions on every aspect of Sri Lankan life. The economy was in shambles, the education system had totally shut down for more than three of the last ten years, and the health care system, without any resources was overloaded with wartime casualties.

Where, in an atmosphere of such turmoil, would you expect to start making a difference? In 1995, amid the bombing and malaria, Dr. David Weatherall and Dr. Nancy Olivieri decided to start with what they were best at.

Thalassemia has long been identified as a major health burden in Sri Lanka, but years of civil war had arrested the medical profession's ability to properly treat the condition. In the mid-nineties, a single thalassemia transfusion unit existed in the country. It was the physician in this unit who first invited Dr. Weatherall to help assess the hundreds of thalassemia patients this clinic was treating. Dr. Weatherall quickly came to the conclusion that this responsibility required more help, and lots of it.

There is much that is not understood in the management of thalassemia, particularly in emerging countries with a high prevalence of malaria. For instance, the question facing us is:

Does malaria worsen the course of thalassemia? Is splenectomy safe in a malarial area of the world? Is liver biopsy safe and practical to obtain in a village hospital?

For nearly seven years, Drs Weatherall and Olivieri have helped the Sri Lankan pediatricians diagnose and treat some of the 400+ thalassemia patients seen at the Kurunegala Teaching Hospital and we are still examining some or all of these questions, among many others We have visited thalassemia clinics from Anuradapura to Badulla, provided DNA diagnosis for more than 700 patients, and we have worked to educate doctors around the country about the clinical management of thalassemia.

Since Dr. Weatherall's arrival to the country, he has been working to raise money to build a hospital in Kurunegala. In June 2003, The new Kurunegala Hospital Thalassemia Unit was opened. The unit hosts a laboratory for blood sample analysis, a library of materials for doctors and patients, a hall for patient meetings and education sessions, and separate floors for pediatric and adolescent patient care.

This building is an outward sign of the motivation and determination of Sri Lankan physicians to promote thalassemia care and management and the start of an effort, which we hope will continue for decades in an extension of collaboration and friendship between Canada and Sri Lanka.

Clinical care for thalassemia patients worldwide has benefited from the research program which developed in this clinic. A number of papers have been published due to joint efforts of Sri Lankan, UK, and Canadian expertise. A 5-year comprehensive analysis has been done of the natural history of E Beta thalassemia. In the past, this condition has been treated in variable ways all over the world due to lack of understanding about how it works.

Over 100 patients with E Beta thalassemia in the Kurunegala clinic have allowed for an in-depth examination ofhow this condition progresses and the best way to treat it and we are presently analyzing these findings and drafting our initial reports.

Many initiatives to improve the quality of life for Sri Lankan thalassemia patients have been pursued by these two doctors inside and outside of the laboratory. Although the oldest thalassemia major patient in the Kurunegala clinic is only 19 year of age at this time , due to the past absence of pumps to deliver deferoxamine, a program to provide pumps (innovatively designed at very low cost by a local craftsman) has now provided safe and effective chelation to most of the patients on the island.

This success is reflected in the fact that the liver biopsies of the 100+ patients sampled already show a 50-80% decline in iron! Sri Lankan patients and their parents appear to have -- for the most part -- great determination in administering deferoxamine. With the ongoing leadership of Drs Weatherall and Olivieri coupled with funding from developed healthcare systems, Sri Lankans can expect a constant improvement in the quality of thalassemia care in the future.

For more information on how to help please visit our webpage about the Sri Lanka Sponsorship Program in the How To Get Involved section.

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