On my first day at The Centre for Sight, Kandy General Hospital, I observed an enucleation. The surgeons worked with quiet precision, preserving the extraocular muscles for prosthesis placement. But when the time came, it became clear that the prosthesis was too large.
The patient had been blind for over 20 years, and orbital tissue contraction had left little space. One by one, more senior surgeons arrived to assess the situation. There were no alternative prostheses available – this was the only one. After some manoeuvring and applied pressure, they managed to fit it at an angle and close up. It wasn’t ideal, but it was the best possible outcome given the constraints.
That sense of adaptability became a defining feature of my placement. Sri Lanka was facing its worst economic crisis since independence, with severe shortages of fuel, electricity, medicines, and basic hospital supplies. Resources were stretched thin – yet clinics and theatres continued to function with remarkable efficiency. Like the NHS, care is free at the point of need, but the pressures are different, and often more acute. Slit lamps were rusted but functional. Instruments were sterilised and reused several times a day. Optimal sutures were often unavailable. Patients were routinely given antibiotics before and after surgery due to the increased risk of infection in settings without disposable equipment.
It made me realise how much I take for granted in the UK. The surgeons were under constant pressure – not just to deliver care, but to do so while managing shortages, higher infection risks and ageing facilities. These competing demands must make it far more difficult to fully focus on their patient and the operation at hand.
With no formal primary care system, patients travel straight to the hospital and queue outside from early morning. The waiting room fills quickly. There is no digital system for notes – just handwritten paper booklets that patients carry from visit to visit. Clinics are intense, as one ophthalmologist might see 40 to 50 patients in a morning, with barely a minute or two per consultation. There was little time for patient-centred care or shared decision-making. Patients rarely asked questions, and explanations were brief. I reflected on how this more paternalistic model might affect patients’ understanding and expectations – and how, in this context, receiving a treatment or prescription might be seen as a sign that they had been cared for.
I encountered conditions familiar to the UK – cataracts, trauma, chalazia – but also many I had never seen before, like rhinosporidiosis, pterygium, and ocular complications of systemic disease such as thyroid eye disease and SLE vasculitis. Seeing these broadened my clinical knowledge and gave me a deeper appreciation of global patterns of health and disease.
My experience in theatre was mostly observational. The environment was busy, with several trainees often scrubbed in. However, I gained valuable hands-on experience examining patients in clinic and triage. I was fortunate to be attached to two Sri Lankan A&E registrars undertaking a placement in ophthalmology. Most patients did not speak English, but the registrars kindly translated for me, which allowed me to take histories and ask questions during assessments.
My elective was flexible, and I also spent time in the emergency department. Even more so than the ophthalmology unit, A&E was fast-paced and chaotic. Patients were wheeled into a single large open space on Victorian-style gurneys. Many arrived critically ill; I saw two women die within hours. There were no private areas for end-of-life care or space for families to say goodbye. One registrar explained that palliative care was still in its infancy in Sri Lanka. Again, I reflected on how, when resources are stretched and demand is high, ideas like patient choice or dignity in death can be difficult to uphold. Everyone was doing the best they could, with what little they had.
All the doctors I met spoke excellent English, and many had spent time training overseas in the UK or US. Medical school is state funded, and several doctors described a strong sense of duty to return and serve the public system. It made me think about how our perceptions of working conditions are shaped by context – and how much more we expect in the UK in comparison, both as patients and as healthcare staff delivering the care.
Several other UK elective students at Kandy General Hospital had arranged their placements through a company (Work the World) which provided food, accommodation and transport to the hospital in the morning. Whereas I organised my elective independently by contacting the hospital directly (dirnhkandy@health.gov.lk), paid a nominal fee on arrival, and arranged accommodation via Airbnb and Booking.com. This saved me a lot of money, and I ended up in nicer accommodation – but the others had the benefit of everything being organised and the social side of staying with a large group. I still met plenty of people and ate in different restaurants each night – food was delicious and very affordable. Both places I stayed included breakfast (which is the norm in Sri Lanka), and I bought lunch at the hospital canteen. My first Airbnb was further from the hospital, but it was easy to hail a tuk-tuk each morning. The second had no air conditioning, which was a mistake – it was very hot at night!
Kandy has a train station, and from there I explored many popular tourist spots on my days off. After the elective, I travelled to the south coast, went on safari, and took surfing lessons.
This elective not only broadened my clinical experience but also deepened my understanding of how healthcare systems function under pressure. Sri Lanka was a beautiful and welcoming place to visit, and the experience left a lasting impression on me.
Declaration of competing interests: None declared.
