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Real Medicine Clinic Yayawatta, Tangalle, Sri Lanka

Date: May 4, 2015 Prepared by: Stephney Minerva Fernando I. Demographic Information 1. City & Province: Tangalle, Southern Province, Sri Lanka 2. Organization: Real Medicine Foundation, Sri Lanka (www.realmedicinefoundation.org) 3. Project Title: Yayawatta Health Clinic 4. Reporting Period: January 1, 2015 – March 31, 2015 5. Project Location (region & city/town/village): Seenimodera, Yayawatta, Tangalle, Sri Lanka 6. Target Population: 94 tsunami-affected families and the surrounding communities in 4 villages: a population of over 4,000. II. Project Information 7. Project Goal: Provide medical care to tsunami-affected families and the less privileged to help build a healthy community. 8. Project Objectives:

1. Support the community with free, high quality healthcare services 2. Help to create a healthy community, especially amongst the younger generation

9. Summary of RMF-sponsored activities carried out during the reporting period under project objective

(note any changes from original plans): The clinic was open 10 days each month to provide free healthcare services to the community of Yayawatta and Seenimodera in Tangalle, Sri Lanka, and the surrounding villages and communities of Palapotha, Kadurupokuna, and Seenimodera.

10. Results and/or accomplishments achieved during this reporting period: RMF’s Real Medicine Clinic was open for 10 days each month. During the first quarter of 2015, we saw an average of 21 patients per day, treating a total of 647 patients.

JANUARY 2015

• 218 patients, 103 male and 115 female, were treated at the Yayawatta Real Medicine Clinic in January.

o 50% of the patients were treated for viral influenza, o 15% were treated for rheumatoid arthritis o 15% were treated for ischemic heart disease, o 10% (especially elderly patients) were treated for hypertension and o 10% were treated for worm infestation.

• There were 140 direct beneficiaries. Patients received treatment mainly for viral influenza,

rheumatoid arthritis, or worm infestation.

• 39 indirect beneficiaries were treated for viral influenza. Direct and indirect beneficiaries were treated for 5 types of diseases, and a total of 78 patients were indirect beneficiaries.

FEBRUARY 2015

• 213 patients, 100 male and 113 female, were treated at the Yayawatta Real Medicine Clinic in February.

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o 20% of the patients were treated for asthma, o 15% were treated for gastritis o 15% were treated for sinusitis, o 10% were treated for dermatitis, o 10% were treated for hypertension, o 10% were treated for joint pains, and o 5% were treated each for ischemic heart disease, viral gastroenteritis, or (especially children)

were treated for multiple skin infections.

• The number of direct beneficiaries increased to 140 this month. The number of indirect beneficiaries was 80, and they came from Palapotha, Kadurupokuna, and Seenimodera to receive treatment at the Yayawatta Real Medicine Clinic.

• This free health clinic is entirely a gift from Real Medicine Foundation, which has a heart to help our communities that suffer from the tsunami’s destruction and from poverty.

MARCH 2015 • 216 patients were treated in March.

o 35% of the patients were treated for viral influenza, o 25% were treated for heart diseases, o 10% were treated for hypertension, o 10% were treated for worm infestation, o 10% were treated for joint pain, and o 10% were surgical cases.

• There were 136 direct beneficiaries from Yayawatta who received treatment, and 80 indirect

beneficiaries obtained medication. Direct and indirect beneficiaries received treatment for 6 types of diseases.

• 28 of the indirect beneficiaries received treatment for viral influenza. They came from Palapotha, Kadurupokuna, and Seenimodara. A total of 80 patients came to the Yayawatta Real Medicine Clinic from these surrounding villages.

11. Impact this project has on the community (who is benefiting and how): This project benefits 2 categories of patients:

1. Community members in Yayawatta, who lost their livelihoods and loved ones in the tsunami 2. Lower income families that live in the villages and communities surrounding Yayawatta

12. Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition): A total of 647 patients were treated at the Yayawatta Real Medicine Clinic during this reporting period. 13. Number of indirect project beneficiaries (geographic coverage): Approximately 4,000 people 14. If applicable, please list the medical services provided: The Real Medicine Clinic was open 10 days each month, from 7:00 AM to 11:00 AM. JANUARY 2015 The most common diseases treated at the clinic in January 2015:

1. Viral Influenza 2. Ischemic Heart Disease 3. Rheumatoid Arthritis 4. Hypertension 5. Worm Infestation

Ø Family Planning Program

Intramuscular injections of Depo-Provera were not administered due to the sudden, related death of a mother in the government hospital. 6 mothers received oral contraceptive treatment for the

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month of January.

FEBRUARY 2015 The most common diseases treated at the clinic in February 2015:

1. Asthma 2. Gastritis 3. Sinusitis (Headache) 4. Dermatitis 5. Hypertension 6. Joint Pain 7. Ischemic Heart Disease 8. Viral Gastreoentitis

Ø Family Planning Program

Intramuscular injections of Depo-Provera were not administered. 5 mothers received oral contraceptive treatment for the month of February.

MARCH 2015 The most common diseases treated at the clinic in March 2015:

1. Viral Gastroenteritis 2. Heart Diseases 3. Hypertension 4. Worm Infestation 5. Joint Pain 6. Surgical Cases

Ø Family Planning Program

6 mothers received oral contraceptive treatment for the month of March.

15. Please list the five most common health problems observed within your region.

• Respiratory Tract Infections • Arthritis • Gastrointestinal Tract Infections • Heart Disease • Skin Diseases

16. Notable project challenges and obstacles: N/A 17. If applicable, plans for next reporting period: Continue clinic operations, and continue reporting clinic attendance, disease prevalence, and family planning utilization for the second quarter of 2015, April – June. 18. If applicable, summary of RMF-sponsored medical supply distribution and use: Monthly lists of medicine are attached in Appendix C. 19. Success story(s) highlighting project impact: JANUARY 2015

MISS NANDASEELI lives in Yayawatta. She is 24 years old and unmarried. She had come many times to the Real Medicine Clinic with recurring lower abdominal pain. When RMF’s doctor examined Miss Nandaseeli on her previous visit, he found an unusual tenderness in her lower right abdomen. She also complained of irregular menstruation. She looked pale, and the doctor advised her to get an ultrasound scan of the abdomen. The ultrasound revealed that Miss Nandaseeli had a fibroid cyst on her uterus. We therefore referred her to the Senior Visiting Obstetrician & Gynecologist at the Base Hospital in Tangalle.

FEBRUARY 2015

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NILESH (as seen in his picture on the left) is 5 years old and overweight for his age. Since his last checkup

6 months before, Nilesh’s weight had increased from 10 kg to 15 kg. We advised his parents that this weight gain required investigation, and referred them to the Children’s Clinic at Base Hospital in Tangalle. The family took our advice and pursued investigation for Nilesh’s weight gain. Nilesh’s father is a fisherman, his mother is a housewife, and the family lives in Yayawatta. The family members are all beneficiaries of RMF’s Yayawatta Clinic. Nilesh’s story was highlighted in our report from April 2014. Now Nilesh is 6 years old (as seen in his picture on the right). He attends school and his weight is normal for his

age: 24 kg. When we referred Nilesh to the Pediatric Clinic at the Base Hospital in Tangalle, the Health Authority gave his parents some dietary advice. The Senior Pediatrician instructed Nilesh’s parents to feed him fewer sweets and carbohydrates, and more fruits, vegetables, and proteins. MARCH 2015 Please see Appendix A for more photos showcasing stories from the Real Medicine Clinic in Yayawatta and Seenimodera in Tangalle, Sri Lanka. I III. Financial Information 21. Detailed summary of expenditures within each budget category as presented in your funded proposal

(file attachment is fine). Please note any changes from plans. Monthly expenditures of the Real Medicine Clinic in January, February, and March 2015 are attached with this report.

Appendix A: Project Photos

JANUARY 2015

Dr. Chamal at his desk with a young patient. A fisherman complains of abdominal pain.

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A mother and her daughter seek This elderly community member enjoys frequent visits to medical assistance. the Real Medicine Clinic.

Children are most affected by viral influenza. The clinic door is open to everyone. FEBRUARY 2015

Dimuthu and Lasanthie attend to business. Lasanthie checks a boy’s weight.

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Mothers and fathers wait with their children. Nilesh and his sister in the waiting area.

A mother and her young child visit the Real Medicine A mother and child wait for their medical consultation. Clinic for the first time. MARCH 2015

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2 elderly patients wait for their medical consultations. An elderly patient with our medical staff.

Dr. Chamal sees a mother and her young children. Dr. Chamal carefully examines a 1-week-old baby boy.

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The 1-week-old baby boy. Real Medicine Clinic staff hold a discussion.

Appendix B: Morbidity Report

Beneficiaries

Direct Beneficiaries

Village Year Month Patients Male Female Average Yayawatta 2015 JANUARY 140 64 76 14

FEBRUARY 134 61 73 13.4 MARCH 136 63 73 13.6

TOTAL 410 188 222 41 Indirect Beneficiaries

Villages Year Month Patients Male Female Average Palapotha, Seenimodera Kadurupokuna

2015 JANUARY 78 39 39 7.8 FEBRUARY 79 39 40 7.9 MARCH 80 37 43 8

TOTAL 237 115 122 23.7

Disease Chart for the Real Medicine Clinic in Yayawatta, Tangalle, Sri Lanka JANUARY – MARCH 2015 JANUARY 2015 Disease Type PERCENTAGE PATIENTS MALE FEMALE 1. Viral Influenza 50% 109 53 56 2. Ischemic Heart Disease 15% 32 14 18 3. Rheumatoid Arthritis 15% 34 15 19 4. Hypertension 10% 21 9 12 5. Worm Infestation 10% 22 12 10 TOTAL 218 103 115

FEBRUARY 2015 Disease Type PERCENTAGE PATIENTS MALE FEMALE 1. Asthma 20% 44 20 24

Place Year Month Patients Male Female Percentage Real Medicine Clinic 2015 JANUARY 218 103 115 21.8

FEBRUARY 213 100 113 21.3 MARCH 216 100 116 21.6

TOTAL 647 303 344 64.7

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2. Gastritis 20% 42 19 23 3. Sinusitis (Headache) 20% 42 21 21 4. Dermatitis 10% 21 10 11 5. Hypertension 10% 20 9 11 6. Joint Pain 10% 22 10 12 7. Ischemic Heart Disease 05% 11 5 6 8. Viral Gastroenteritis 05% 11 6 5 TOTAL 213 100 113

MARCH 2015 Disease Type PERCENTAGE PATIENTS MALE FEMALE 1. Viral Gastroenteritis 35% 76 32 44 2. Heart Diseases 25% 54 22 32 3. Hypertension 10% 21 11 10 4. Worm Infestation 10% 22 11 11 5. Joint Pain 10% 22 12 10 6. Surgical Cases 10% 21 12 9 TOTAL 216 100 116

Patients Per Village Village JANUARY FEBRUARY MARCH Total Yayawatta 140 134 136 410 Palapotha 29 29 31 89 Kadurupokuna 31 33 32 96 Seenimodera 18 17 17 52 Total 218 213 216 647 Total Patient Numbers by Age and Gender

Appendix C: Medicine Expenditures for the Real Medicine Clinic January – March 2015 JANUARY 2015 NAME QUANTITY COST CAPSULES & TABLETS 1. Buscopam (10mgs.) 300 Rs. 3,018/= 2. Brufen (200mgs.) 300 Rs.819/= 3. Diclofenac (50mgs) 300 Rs.453/= 4. Dexamethasone (0.5mgs) 1,000 Rs.530/= 5. Emitop (Domperidone) 300 Rs.555/= 6. Flagyl (Metronidazole 400mgs) 300 Rs. 2,277/= 7. Hydro Co Thalazide 200 Rs.116/= 8. Iron (Ferrous Sulphate) 300 Rs.261/= 9. Mebandazole (100mgs) 300 Rs. 1,200/= 10. Omeprazole(20mgs.) 300 Rs. 1,360/= 11. Piriton (4mgs.) 1,000 Rs.900/= 12. Paracetamol 1,000 Rs.670/= 13. Prednisolone 200 Rs.290/= 14. Vitamin C (Ascorbic Acid.) 1,000 Rs.840/= 15. Atorustatin (20mgs.) 200 Rs. 1,300/= 16. Pyrentin (125mgs) 300 Rs. 2,400/= 17. Salbutamol 1000 Rs.440/= 18. Dianil 300 Rs.945/= SYRUP 1. Aminoplus 6 Bottles Rs. 2,760/= 2. Derripyilline 12 Bottles Rs.1,440/= 3. Fersovits 6 Bottles Rs. 1,080/= 4. Phenycof (Junir) 6 Bottles Rs.690/=

Age JANUARY FEBRUARY MARCH Total Male Female 0 - 5 50 45 42 137 63 74 6 - 15 43 41 44 128 59 69 16 - 24 30 33 38 101 47 54 25 - 49 49 46 47 142 66 76 50+ 46 48 45 139 68 71 TOTAL 218 213 216 647 303 344

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5. Phenycof (Adult) 6 Bottles Rs.828/= OINMENT & CREAM 1. Betnovate N 6 Tubes Rs. 1,560/= 2. Jonac Gel 6 Tubes Rs.492/= 3. Mycoral 6 Tubes Rs. 1,020/= 4. Soframycine 6 Tubes Rs.576/= 5. Cipolex 6 Bottles Rs.450/= 6. Chloramphenicol 6 Bottles Rs.269/= INJECTIONS & OTHERS 1.Mithuri 6 Rs.600/= TOTAL (PAID) Rs. 30,139/=

FEBRUARY 2015

NAME QUANTITY COST CAPSULES & TABLETS 1. Amoxicillin(250mgs.) 300 Rs.864/= 2. Cloxacillin (500mgs.) 300 Rs. 1,500/= 3. Orron 300 Rs. 3,000/= 4. Dexamethasone (0.5mgs) 1,000 Rs.530/= 5. Vitamin A & D 500 Rs.460/= 6. Ciprofloxacin(500mgs) 300 Rs. 2,427/= 7. Cephalexin(250mgs.) 300 Rs. 2,361/= 8. Digene 300 Rs. 1,001/= 9. Diazepam(0.2mgs) 200 Rs.70/= 10. Dulcolax(5mgs.) 300 Rs.984/= 11. Famotedene (20mgs.) 300 Rs.300/= 12. Multi Vite(500mgs.) 500 Rs.265/= 13. Mebandazole (WORMIN – 500) 30 Rs.900/= 14. Vitamin B Compound 500 Rs.225/= 15. Augmentin(375mgs.) 30 Rs. 1,440/= 16. Glicozide(80mgs) 200 Rs.500/= 17. Mefanamic Acid 300 Rs.345/= 18. Cephalexin(125mgs) 300 Rs. 2,700/= 19. Zinnef (500mgs.) 30 Rs. 3,270/= SYRUP 1. Amoxicillin 6 Bottles Rs. 1,620/= 2. Derripyilline 6 Bottles Rs.720/= 3. Salbutamol 750mls. Rs.290/= 4. Piriton 750mls. Rs.235/= 5. Paracetamol 750mls. Rs.320/= 6. Mumfer 6 Bottles Rs. 1,890/= 7. Belcid 6 Bottles Rs. 1,187/= 8. Domtic 6 Bottles Rs. 1,560/= 9. Cephalexin 6 Bottles Rs.846/= 10. Erythromycin 6 Bottles Rs. 2,100/= OINMENT & CREAM 1. Betnovate N 6 Tubes Rs. 1,560/= 2. Jonac Gel 6 Tubes Rs.492/= 3. Mycoral 6 Tubes Rs. 1,020/= INJECTIONS & OTHERS 1.Mithuri 6 Rs.600/= TOTAL (PAID) Rs.37,682/=

MARCH 2015

NAME QUANTITY COST CAPSULES & TABLETS 1. Cloxacilline (500mgs.) 300 Rs. 1,923/= 2. Brufen(200mgs.) 300 Rs.819/= 3. Calcium Lactate 200 Rs.58/= 4. Dexamethasone (0.5mgs) 1,000 Rs.530/= 5. Deriphyilline(300mgs.) 300 Rs. 1,125/= 6. Diclofenac(50mgs) 300 Rs.330/= 7. Erythromycin(500mgs.) 300 Rs. 2,100/= 8. Emitop(Domperidene) 300 Rs.540/= 9. Flagyl(Metrinidozole400mgs) 300 Rs. 2,250/=

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10. Mebandazole(100mgs.) 300 Rs.700/= 11. Famotedene (20mgs.) 300 Rs.300/= 12. Omeprazole(20mgs.) 300 Rs, 1,350/= 13. Paracetamol 1,000 Rs.670/= 14. Prednisolone 200 Rs.350/= 15. Pyrentin(125mgs.) 300 Rs. 2,400/= 16. Vitamin B Compound 500 Rs.403/= 17. Vitamin C (Ascorbic Acid) 1,000 Rs.842/= 18. Atorvastatin(20mgs) 200 Rs. 1,300/= SYRUP 1. Amoxicillin 6 Bottles Rs. 1,530/= 2. Derripyilline 6 Bottles Rs.720/= 3. Becadex 6 Bottles Rs. 1,350/= 4. Amino Plus 6 Bottles. Rs. 2,760/= 5. Fersovite 6 Bottles Rs. 1,080/= 6. Phenycof(Junior) 6 Bottles Rs.642/= 7. Phenycof(Adult) 6 Bottles Rs.792/= 8. Phenagan 500mls. Rs.450/= OINMENT & CREAM 1. Soframycine 6 Tubes Rs.570/= 2. Ciplox 6 Bottles Rs.450/= 3. Chloramphenicol 6 Bottles Rs.294/= INJECTIONS & OTHERS 1.Mithuri 6 Rs.600/= TOTAL (PAID) Rs.29,228/=

Clinic Staff Payments

JANUARY FEBRUARY MARCH Total Rs. 50,080/= Rs. 50,080/= Rs. 50,080/= Rs. 150,240/=

Medicine Rs. 30,139/= Rs. 37,682/= Rs. 29,228/= Rs.97,049/= Other Expenses Rs. 3,052/= Rs.2.280/= Rs. 2,935/= Rs. 8,267/= Photo Copy, Internet Rs. 1,355/= Rs. 1,310/= Rs. 1,266/= Rs. 3,931/= Total Rs.84,626/= Rs. 91,352/= Rs83,509/= Rs. 259,487/=