Sri Lanka

Activity Summary as of May 2007

May 31, 2007

Michael Lear

Navajeevana Rehabilitation Center:

In addition to training two new therapists, a PT and an OT, a full review including more in depth material was provided to four of the remaining members of their staff that participated last year. Three have since left. We conducted two weekend long trainings as well as provided individual reviews. Our case study and other clinical sessions provided staff members with a variety of highly effective treatment approaches for conditions such as Ankylosing Spondylitis, Perio-arthritis and Polio which were not covered in the training sessions.

This year, Mr. Samantha Udagama will serve the ongoing training support function. While everyone has a solid grasp of the material, Mr. Udagama exhibited significant understanding of the principles and he served as my interpreter during most of the clinical and the case study sessions. I suggested to Navajeevana founder Kumi, that he be recognized for his participation in all training sessions and the support he provided to me during my visit. In addition to Mr. Udagama, physical therapy department head, Mr. A.T. Arunkumar excelled with the application of this work. Last year after attending one weekend, Mr. Arun successfully applied the techniques to a hemipalegic patient suffering from painful muscle spasms that he was treating while working in the conflict region of Jaffna. This year, the review of the material further anchored his understanding of the principles and increased the effectiveness of his work.


Real Medicine's Yayawatta Village Clinic

Through the support of Real Medicine's Sri Lankan Coordinator, Mrs. Minerva Fernado, I was able to further optimize my time by conducting over 20 sessions at the Yayawatta village clinic. This clinic is highly regarded by the surrounding communities and provides most of the care to this region that otherwise has limited if any convenient care options. Just one trip on the village trail to or from the main road will provide testimony to the importance of this Real Medicine initiative.

On most days I worked in tandom with the visits of Tangalle Hospital's Dr. Chamal, also of Real Medicine Sri Lanka. Because of the severity of some of the cases however, I made special arrangements with Mrs. Fernando to open the clinic at other times to provide care to those patients requiring more intensive intervention .

While working in the clinic I successfully addressed Parkinson's Disease, Post Traumatic Stress related pain, Sciatica, Post Laminectomy back pain, Cerebral Palsy, and pain related to physical trauma. I also had an opportunity to evaluate and work with Madumekala, who receives growth hormone therapy for panhypopituitarism through Real Medicine Foundation's support.

As a result of my involvement at both clinics, I was able to arrange for Navajeevana to provide Psychological and Physical Therapy services to Real Medicine's Yayawatta Village Clinic as part of their field visit activity. Mrs. Minerva Fernando, Real Medicine Coordinator, Sri Lanka is coordinating this effort with Navajeevana. I've provided the PT staff at Navajeevana with my clinical notes from the Real Medicine Yayawatta clinic.

In addition to the training and clinical time, I was able to serve Real Medicine as a liaison and assist Mrs. Fernando with overseeing the installation of the water clay sterilizer at Tangalle Hospital, which was provided for by Direct Relief International at the request of Martina Fuchs, MD, CEO of Real Medicine. Mrs. Fernando also arranged for me to visit other RMF initiatives in the village of Dickwella.

We're grateful to all those who supported this initiative.

Other Activities

In addition to my clinical activities I was able to visit other Real Medicine initiatives and assess their progress and impact on the surrounding communities. My heartfelt gratitude goes out to Real Medicine's Sri Lanka coordinator, Minerva Fernando for her support and dedication to her community. In addition to visiting pre-schools, I worked with Minerva to oversee the installation of the sterilizer for the Tangalle Hospital and the training of the nursing staff responsible for its operation.


My return trip to Navajeevana provided me with a much greater perspective of the overall needs of the community in terms of long term, lasting and effective rehabilitation needs. While there are effective methods being practiced at Navajeevana, I believe that providing Movement Education sessions Self Care classes and Relaxation and Awareness training for the communities being served, could relieve many of the conditions being addressed and or prevent many from developing to the degree that need clinical intervention. (As a note, Dr. Chamal of Tangalle hospital mentioned that 75% of the patients they see are coming for "pain." While we did not discuss the origin(s) of the pain, many of the patients are fisherman, subsistance farmers, and laborers. One may discern from this information that the pain is related to their activity and muscular in nature.

Utilizing Movement Education table work sessions such as Trager®, which may be administered without the supervision of a Physical Therapist, can increase the available treatment options for the community in terms of lasting pain relief. Whereas many of the PT interventions observed utilize electro-stimulation or traction to address pain and require such supervision. Additionally, empowering individuals through group education of Self Care Movement exercises such as Mentastics® or Yoga, may have far reaching benefits. Not only will people learn to relieve their own pain before it becomes problematic, but community members may begin helping one another by sharing their knowledge of what has worked for them.

In both cases, movement education models such as Trager® would leverage therapist time more effectively. Because the tablework sessions are more a lesson for the nervous system/ an education process, treatment regimes can be tapered over a relatively short period of time rather than going on indefinitely, which will free up existing staff resources to attend to those cases where unique interventions are indicated. Although more intensive at the outset this model may provide more efficiency.

The Next Step.

Subsequent trainings have been well received and continue to be requested. The lack of peer support trained in these techniques underscores the short term need (1-3yrs) for follow up trainings and reviews to increase the skill level and. Providing training in group movement education classes and conducting lay care giver trainings will be a larger component of these subsequents initiatives.

As we progress with each visit we come closer to our primary goal to train trainers who can spread this work cost effectively over the long term.

Please direct your questions or comments to Michael Lear at or 484.542.0249

Country Page: Sri Lanka Initiative Page: Physical Therapy Enhancement Training