Sri Lanka Poison Control: Toxicology Case Studies in Narrative

Sri Lanka. A tear-shaped island in the Indian Ocean, this is an ancient land with a long, incredible, and sometimes unfortunate history. Several decades of civil war have left the social infrastructure feeble and the general populace vulnerable to both physical and mental illness. Rebuilding efforts of the last few years were set back even further when the devastating 2004 tsunami struck and clashes between the military and rebels—the Liberation Tigers of Tamil Eelam (LTTE) or Tamil Tigers—intensified. During completion of a fellowship in medical toxicology in San Diego, I traveled to Sri Lanka for a rotation in that country’s only poison center. The burden of disease from poisoning in Sri Lanka, and throughout South Asia, is staggering—the number of severe poisonings and fatalities many times greater than in industrialized countries. I met many doctors who are involved almost daily in managing difficult poisoning and snakebite cases without access to many basic medical resources. The following passages are from my journal and e-mail notes.