Agape Children's Home - Tissamaharama

By the time I got out of the shower and walked down stairs with my bags, the rest of the team had already arrived and was loading the van. There were 5 of us in total. Aunt Eva is in her 60s, but look like she is in her 40s. She has a grandson in the states and is working on gaining citizenship. Uncle Haraine has had many previous jobs, and has a son in Canada. Risley is working on his master's degree, and has spent time in Dubai working in management. Together they make up the cadre of KidzNet - an organization founded about one year ago by Therese to support children's homes in Sri Lanka, and elevate their standards. We were also joined by Nilanka - a 23 year old Lotus Buds child recently home from her 3 year journey as a crew member on a mission ship traveling the world. Our destination was Tissamaharama in the southern part of "out station" Sri Lanka. Our common goal was to start medical records on some 97 children, and do their first well-child exam. One person checked height and weight, another visual acuity, on to vital signs, basic history, and finally to me for a more focused history and physical exam. We would have about 10 hours of total work time to complete this if everyting went according to plan.

We set out of Colombo at 6:30. The drive would take a staggering 6 hours in ideal weather. The same distance on I-5 would take about 2 hours - some 130 miles. Because there are no freeways, the main roads wind through the jungle and rice fields through every small town and village on the way - including police and military check-points. The interesting things about road trips in Sri Lanka are that about every 2-3 hours one stops for tea. After all, just because you are in the jungle doesn't mean one has to be uncivilized.

About 3 1/2 hours into the trip we came across flat grassland reminiscent of the African plains. A thin wire fence lined the roadway; small fruit stands were selling coconut and bananas. The fruit, as it turns out, was not for human consumption. As we turned the corner, there was a giant Asian elephant standing next to the road... waiting for a handout. These were wild elephants, but had grown accustomed to feeding from tourists. We lobbed a coconut over the fence. It swiped the treat up with it's massive trunk and devoured it as though it were a milk dud. It kindly posed with us for photographs, and then we continued on our journey south - but not before having another cup of tea.

When we arrived at our guest house, I was pleasantly surprised. Due to the lack of tourism on the island secondary to the war, many guest houses are lowering their prices. As such, we were able to afford a nicer place on a company budget. We were greeted at the door with cool wash clothes and iced fruit juice to freshen up. After checking in, we prepared our selves for the long task awaiting us at the Agape House.

When we pulled into the driveway, we were greeted by what appeared to be a school yard playground full of children ranging from 4 years to 17. The main pastor of the home, a slender man with full mustache, greeted us with a warm hug and double-sided cheek bump - the customary Lankan greeting. They had prepared for us ahead of time and converted their schoolroom into a makeshift clinic. Two benches with a board across them served as an exam table. A wooden frame had been constructed to hang sheets for privacy during more sensitive exams. Our bare feet quickly became dirty on the concrete floors. The afternoon sun had left its mark in the sweltering room sparing air conditioning or fans. Despite my earlier inclination to wear clinic attire on the occasion, I was thankful that I chose to wear shorts and a button-shirt instead.

We set up our stations, measured out the 20 feet for the Snellen chart, organized the files, and began seeing children. They lined up out the door and around the corner. They started by getting their height and weight plotted on a growth chart. Next they had their visual acuity checked with the help of the older children and one of our staff. Then they Risley checked their vital signs and temperature. Last they came to me. I would open their chart, look over their measurements and vital signs, and then go over their nutrition, development history, past medical history, and current complaints. Most of the children were orphaned from the war, Tsunami, or were born into abusive homes and brought to the children's home. As a result, most of them have no idea about their birth or medical history. I changed my tactics. The health history included, "have you every been in the hospital, had surgery, or taken pills?" It went on from here if we got anywhere.

Each child received a screening exam, just as with traditional well-child checks. Many kids had complaints warranting more focused exams. We found an astounding degree of undiagnosed pathology in these children, many of which have never seen a doctor. Findings included: significant and symptomatic heart murmurs, abdominal masses, hernias, un-descended testicles, severe asthma, skin rashes, severe otitis media, dental abscesses, pneumonia, and varying degrees of eye pathology. At least 70% of the children had dental caries in >50% of their teeth, and about 15 of the children had significant dental abscesses with rotten teeth causing chronic headaches and malnutrition due to dental pain. They have never seen a dentist. The government dentist assigned to this area is on "permanent leave" in Colombo.

We pushed on well into the dark, and after finishing about 50 kids our first day, we called it a night. The pastor insisted that we stay for dinner. In this home were each child is fed for a mere $1.50 per day, they prepared for us a lavish meal with multiple dishes. We ate more food than the pastor probably had in a week. I was deeply honored by the gesture, and at the same time saddened that we consumed so much of their resources. During dinner, the pastor shared with us his testimony as to why he started the orphanage.

One day one of the women in his village came to him and pointed out a child, a small boy, who was being beaten by his stepfather. He said he would look into it, but in traditional Sri Lankan style, chose not to be confrontational and let things lie. Several months later, a man came to his door with a boy in his arms, asking the pastor to take his son to the hospital. The boy had ingested kerosene and was lifeless. 10 minutes into the drive to the hospital - the boy stopped breathing and died. Later that week he learned that this boy was the same boy that he heard about several months ago - the one being beaten by his father. Apparently the boy had become so depressed that he drank the kerosene in suicide as an escape from this horrible life. After learning this, the pastor asked God for a second chance and was fearful that his inaction cost this boy his life. He has been taking in children ever since, and now has 97 at this home.

The next morning we ate breakfast at the guesthouse - toast, scrambled eggs, juice, and coffee. I couldn't help but to imagine what the children were having for breakfast, and felt guilty for being served such a lavish meal by the poolside. When we arrived at the home, things had been just as we left it so we could get to work. We switched off so my interpreter would be of the same gender as the group of kids being seen. When we had a group of boys, a male interpreter would explain and chaperone more "sensitive" exams.

When we finished with the children, one of the housemothers asked if we could look over the staff. Many of them had medical complaints, and hadn't seen a doctor in many years. We of course agreed, and spend another 2 hours seeing the entire staff. We created charts for them as well, but gave them their own chart to keep instead of putting them in the new filing cabinet we brought down with us. Some of the women had "feminine" problems - causing a great deal of embarrassment for them. Not only did they not want the chart to fall into the hands of one of their colleagues, but also it prevented many of them from seeking medical attention in the first place. Because we were not local - and I was a "western doctor," they felt comfortable coming to us with their questions. At the end of the day, we saw 115 patients! Now not even halfway into my trip I have seen somewhere >400 patients since I have been here.

After we had seen the last house staff, we were ushered outside where the children had been assembled. They had little to give us as a token of appreciation, but what they did have they gave. A song. I don't know what the words meant, but it didn't matter. I held the camera to my face, taking pictures, hiding my effort to fight back tears as I watched them clap and sing. I wish I could stay for weeks. I wish I could finance a dentist to come and fix these broken, but beautiful smiles. I wish, I wish, I wish...

Once the song had ended, they circled around us and played with our cameras. I held the camera up to a group of them to take their picture, and one by one they filed behind me to see what it looked like through the screen. In a few seconds, the entire group was behind me with nobody to take a picture of. Many of the small kids wanted to hold our hands and be held. The older boys wanted to arm wrestle.

The long drive home brought us along the coastline. We made it just in time for me to see Tangalle bay and the Indian Ocean. Beautiful! I wish we had more time so I could dip in the 80-degree water. We stopped at a old colonial British guest house for evening tea. Black and white photos of old time hung on the wall as a memory of days past when English people would stay here on their way to safari after landing in Tangalle Harbor.

By the time we got home to Colombo, it was 11:30 PM. We were all exhausted. With barely enough energy to brush my teeth, I crawled into bed. I couldn't stop thinking about all the children we had seen. They accompanied me in my dreams off to sleep. Now I understand how Therese could give up her life in the 'States' and live 23 years in Sri Lanka to start a children's home.