Saving the Children

By Beth Schwartzapfel ’01 / March / April 2006
April 11th, 2007

Sanjay Daluvoy '96 used to watch his mother make sandwiches. In Pasadena, California, where Daluvoy grew up, it was not uncommon for moms to make sandwiches for their young sons. But these weren't for Sanjay. "There were millions of loaves of bread scattered all over the kitchen counter," he recalls. "She and a friend were just making all these sandwiches in little lunch bags and dropping them off at homeless shelters. She never made it a big event, with publicity, or for recognition. It's not like I can Google her. She just does it."

After he earned his bachelor's in business economics at Brown, Daluvoy worked on health-care policy in Washington, D.C., conducted research at Children's Hospital Boston, consulted for health-care companies in San Francisco, started a dot-com called Infinity Markets, and attended medical school in Philadelphia. Through it all, his mother's example stuck with him. So in December 2004, when the tsunami ravaged Sri Lanka, not far from the Andhra Pradesh region of southern India from which his family had emigrated to the United States, it's not surprising that Daluvoy immediately felt a need to do something. "You wake up in the morning," Daluvoy says, "and all the pictures you see are of people that are very similar-looking to you. It just moves you."

It's also not surprising that, even though Daluvoy was in his fourth year at Jefferson Medical School, by February 2005 he was making plans to go to Sri Lanka with two friends, Kanishka Ratnayaka '96 and Pratheepan "Deep" Gulasekaram '96. The three men have been best friends since Brown, regularly talking and meeting whenever they can, even as the obligations of work and family spread them apart. Daluvoy knew that Sri Lanka would need doctors, and so he was sure that he and Ratnayaka, a pediatric cardiology fellow at Children's National Medical Center in Washington, D.C., had skills that could prove useful in the tsunami's aftermath. And Gulasekaram, a lawyer, had lived and worked on Sri Lanka's remote eastern coast; his experience would also be valuable. "The three of us," Ratnayaka says, "just wanted to go help and see what was going on."

It also helped that two of the three men were not far removed from life in Sri Lanka, one as a Sinhalese and one as an ethnic Tamil. For more than twenty years, Sri Lanka has been deadlocked in a bloody civil war between the majority ethnic Sinhalese and the minority ethnic Tamils. In 1956 the government, made up of Sinhalese, passed a decree that, from then on, Sinhala would be the only officially recognized language in the country. At the same time, it restricted Tamil access to government jobs and higher education. By the late 1960s violence targeting Tamils had broken out. Since then, the Tamil Tigers have been conducting a guerrilla war with the Sri Lankan government, resulting in the deaths of 65,000 people and the departure from the country of another 300,000.

Among those fleeing were Deep Gulasekaram and his family. Gulasekaram, an ethnic Tamil, spent the first four years of his life in Jaffna, a city he describes as the "capital of Tamilian Sri Lankans." Gulasekaram's father, a physician, had long been mulling over the idea of taking his family to the United States, but "what hastened the departure," Deep says, "what made it absolutely urgent, was ethnic conflict." By the mid-1970s, he adds, "the writing was on the wall. My grandfather's Sinhalese friends confided to him that if he had the means to get his family out, it would be a good thing." So the family moved to Los Angeles, and Gulasekaram grew up as part of a large Sri Lankan community populated by both Tamils and Sinhalese.

Unlike Gulasekaram's family, Ratnayaka's family arrived in the United States intending to stay only for a short while, while Ratnayaka's father earned a PhD in religious studies at Northwestern University and completed a one-year teaching job at the University of Georgia. A Sinhalese, he intended to return to Sri Lanka at the end of his appointment. But this was the 1970s, when specialists in Hinduism, Buddhism, and other Eastern religions were in demand. When Georgia offered him a permanent faculty position, the elder Ratnayaka accepted. As a result, Kanishka grew up in the American South. "Athens, Georgia, is a very white and black community," he says, adding with wry understatement: "There were not many Asians."

And so it was with two very different experiences that Gulasekaram and Ratnayaka arrived on College Hill as high school seniors in the spring of 1992. They'd both been admitted to Brown and were deciding where to go. Gulasekaram took the campus tour pretty much convinced he would be attending UC Berkeley in the fall. He was pleasantly surprised, however, to see another Sri Lankan in his tour group. "It was very easy for me to tell that he's Sinhalese," Gulasekaram recalls. "But for me, I was just more excited because he's Sri Lankan." Having just returned from an exciting weekend at the University of Virginia, Ratnayaka was also looking at Brown more or less as a formality. But on the tour the two young men hit it off and spent a fun weekend together. They then parted ways, assuming they wouldn't meet again.

In the end, both men did enter Brown, which they realized only after they ran into each other during their first week on campus. Soon the pair had met Daluvoy, and the three developed a friendship, Ratnayaka says, that became as much a part of their education as their classes and textbooks. Daluvoy's family is ethnically Telegu, and though he says he doesn't have the same connection to Sri Lanka as do Gulasekaram and Ratnayaka, he nevertheless sees many similarities between his family's culture and theirs. The language of Telegu, for instance, sounds a lot like Tamil. When he is in Sri Lanka, Daluvoy's south Indian features lead people to mistake him for a native of that country. Recently, he says, on a visit to Gulasekaram's family, "Deep's mom was just grilling him about not being married. 'It's important before you get too old' " -he raises the pitch of his voice to mimic hers-" 'You've got to be practical about it, you can't wait till the love of your life.' And I felt like if I just closed my eyes, it would be the exact same thing my mom would be saying."

Although they also had many other friends at Brown, the three men-and particularly Ratnayaka, who grew up around very few Asians-were drawn to the South Asian Students Association on campus. "It was very empowering," Ratnayaka says. "It was emotional." After Brown, Gulasekaram, who had concentrated in English and American literature, taught middle school for two years in New York City. He then earned his law degree, clerked for a judge, then practiced corporate law for two years. But the work was not satisfying, Gulasekaram says; he found himself having to "search for the goodness in what I did." He became a teacher, first at Loyola Law School in New Orleans and more recently at NYU, where he is an acting assistant professor. Ratnayaka, meanwhile, went directly to Emory Medical School from Brown and then moved to Washington, D.C., for his residency in pediatrics. Daluvoy describes himself as the wanderer of the three, having taken time to fool around before beginning medical school. He is now in the first year of his surgery residency in D.C.

Yet, even with the demands of medical school, residencies, fellowships, and law school, Ratnayaka says, "basically, all our holidays, we were trying to get together. We'd use any excuse to get together." Observing the three men together is like watching a comedy routine among brothers: endless good-natured teasing, goofing off, inside jokes, and lots of laughter. But underlying the laughter is a restlessness and an idealism. Each man's parents instilled in him a belief that with privilege comes the responsibility to give back, which may in part explain why each has been drawn to fields like teaching and medicine. From the time they met, recalls Gulasekaram, the three "had always talked about doing something, about creating a vision for how health care and education for children would run." But school and careers got in the way, and they always said to themselves: maybe later.

Later came in February 2005, when the men spent two weeks in Sri Lanka. They started in Hikkaduwa, the town where Ratnayaka's mother had been raised. Two of her cousins still lived there, in a brick house Ratnayaka had often visited during his childhood and to which he had brought Gulasekaram on recent visits. The tsunami had killed one of Ratnayaka's uncles, and the house had been destroyed.

The three friends hopped from city to city, from south to east, from Sinhalese areas to Tamil ones, setting up ad hoc medical clinics in churches, schools, and tents along the way. People formed long lines, waiting for help. The men noticed that most of the ailments they saw were a direct result not of the tsunami but of the infrastructural chaos that followed in its wake. A lack of medications, for example, meant that children choked with asthma. The doctors treated burns and infections and the sickness that came from a lack of shelter, shoes, and clothes.

"Really, all we did was put a Band-Aid on a gushing wound," Gulasekaram says of their two weeks in the country. Soon, he says, they found themselves asking: "How can we have a serious long-term impact on children? We can always say we're going to do something, but by that logic, we could literally wait forever. The time is now." The men saw their opportunity in a statement released by the Sri Lanka College of Pediatricians about Matara General Hospital (MGH). Located in the southernmost part of the country, seven miles from the Indian Ocean, the crowded city of Matara was far enough from the brunt of the tsunami to escape the worst, but because it was one of the places to which people fled, its already stretched resources were quickly overwhelmed. Matara General Hospital is the largest of several area hospitals; patients are referred to it from all over the region. Even before the tsunami, MGH did not have enough beds for sick children; in fact, it had no separate pediatric ward for children with contagious diseases. The hospital often turned away ten to fifteen patients a day, even though the nearest hospital to MGH was two hours away by bus. The patients who were lucky enough to be admitted often had to share beds or sleep on mats on the floor. "You could go to the hospital with a cold," Gulasekaram says, "and come back with something really bad."

As Gulasekaram remembers it, the pediatricians' statement following the tsunami said, "had this hospital been fully equipped and functional, it could have been the point of care to save the lives of thousands of children in this area." The men latched onto MGH as the cause they'd been searching for. But with typical zeal, they resolved not only to help this one hospital but to do it in a way that would serve as a model for treating sick children throughout the developing world.

"A lot of governments and NGOs [nongovernmental organizations] look to rebuild and restore," says Gulasekar-am. "Our thought here is, this was tragic, but out of that tragedy is a remarkable opportunity to make this hospital better, not just restore it." And so the men founded the World Children's Initiative, whose mission is no less ambitious than "rebuilding the medical and educational infrastructure for children in developing areas across the globe."

The MGH project, which the men have christened Project Peds, aims to raise enough money to tear down and rebuild the pediatrics wing of MGH. They quickly enlisted the help of the MGH staff and the Sri Lankan government. As a reminder of what they are working toward, Daluvoy keeps photographs of MGH on his computer. The pictures show a cluster of one-story buildings sprinkled around a sprawling courtyard just off a busy city street. Here is an old woman in a maroon skirt standing in the dusty parking lot, her hair white, a child holding her hand. Here is another child, maybe five years old, his brown eyes huge. Here is the pediatric ward, ward number 15, yellow paint peeling off its walls. Metal-framed beds, painted white, are lined up in a row along the wall. Each has a number printed onto a square of white paper and taped to the wall behind it.

These are among the beds the men hope to replace over the coming months. They hope that the new MGH will have the equipment and facilities needed to offer the best medical care in Sri Lanka. In addition, plans include the building of new conference rooms, classrooms, and study spaces, as well as easy Internet access. The team has recently secured enough pediatric medical journal subscriptions to rival a state-of-the-art medical library. But, Gulasekaram emphasizes, the hospital must not lose its Sri Lankan identity. The hope, he says, is for "a nice blend of best practices from the West [while] still maintaining some of the cultural character" of the region. The Project Peds team is particularly concerned about avoiding the mistake that Western do-gooders often make: in Gulasekaram's words, "these methods work here [in the United States], so let's transplant them." Rather, the team has forged close connections with the Sri Lankan ministry of health, the Sri Lanka College of Pediatricians, and the existing MGH staff, as well as with various NGOs and physicians in the area. The team has also received support from two of the United States' most respected children's hospitals, Children's National Medical Center in Washington, D.C., and Children's Hospital of Pittsburgh, both of which will help guide the project and provide funds, credibility, and "expertise on problems that they [the Sri Lankan community] want us to solve," according to Ratnayaka.

In addition-and here's where the MGH project ties in with the three friends' larger ambition-the new wards at MGH will become a hub for learning, ideally a place where health-care providers from all over Sri Lanka can exchange ideas. And if that is successful, the men believe the model could easily be replicated all over the developing world. "Money can be raised to build anything and to bring in whatever instruments you need," Ratnayaka says. "But in terms of knowledge, the kind of mind-share that we're trying to promote through this project-that's how this is going to be a model pediatric health-care institution. And that's how it's going to benefit other facilities throughout the country."

In addition to the Sri Lankan physicians, nurses, technicians, and social workers who will be participating in this "mind-share," physicians from MGH will participate in ongoing scholarship exchange programs with experts from Children's National and Children's Hospital of Pittsburgh. The Sri Lanka College of Pediatricians has an "extensive, exhaustive list of ideas," says Ratnayaka, of what they would like to achieve with this new project. Topping it is an annual conference for health-care providers from all over the country and the world.

The cost? About $2 million, according to Daluvoy. Almost all of this money will cover such onetime expenditures as bulldozing the old pediatric wards. The hospital's day-to-day operating budget will come largely from the government, as it always has, and will be comparable to what it always has been. "It's not true that they would have to spend more money," on the new units, Gulasekaram says; rather, "it would have to be spent in different way." Fearful that the Sri Lankan government will see this influx of Western money as a reason to slash allocations for MGH, the Project Peds team has already negotiated a memorandum of understanding with the Ministry of Health. "Basically what we are asking for is a non-reduction in funds," Gulasekaram says. Of the $2 million, the team has so far raised almost half, including about $400,000 in grants from the Sri Lanka Medical Association of North America and the health-care behemoth Kaiser Permanente. In late February, the group learned that the Bush-Clinton Tsunami Relief Fund had approved a $400,000 grant for the effort.

Bulldozing is scheduled to begin in July. All construction work will be by Sri Lankan firms, and all of the building materials will be local. In addition, the Project Peds team is hoping to set up a local foundation to ensure that the hospital continues to receive whatever it needs. Working in conjunction with community leaders in Matara, the team has invited local business owners, celebrities, and wealthy individuals to join Project Peds' board of directors, with the aim of eventually turning them into an organized group that can provide both community involvement and a financial safety net. "When we leave," Ratnayaka says, "this is their hospital. This is their gem. They need ownership."

It is a Sunday afternoon earlier this winter, and Daluvoy, Ratnayaka, and Gulasekaram have just finished watching a televised football game in Daluvoy's apartment in Washington, D.C. Somehow during the game they managed to set off the smoke detectors while making pizza. Now it's time for business.

"I'm pretty sure the outcome of that conversation is going to be positive," Ratnayaka says of a meeting he has planned with a potential funder.

"No chickens before they've hatched," Gulasekaram warns as he absentmindedly clacks a stack of quarters between his fingers.

Ratnayaka points to Gulasekaram and raises his eyebrows playfully at Daluvoy. "I've been dealing with this for fourteen years," he says.

Each of the friends says that the range of their personalities is a big part of what makes their collaboration successful. Ratnayaka is "the perennial optimist," says Daluvoy. "It's like, 'Do you really think we can do that?' And he does. He's not just saying it." Gulasekaram, on the other hand, "cleans up a lot of raw ideas," while Daluvoy brings the real-world experience of establishing and running a business.

Eric Hess, an executive at Children's Hospital of Pittsburgh, admits that he was initially wary of teaming with an organization like WCI, which, he says, doesn't have "the bandwith and the history that a big NGO has." But he was soon won over: "They're just energized for a cause. They're young and energetic and wildly smart, and I know they're going to do whatever it takes to get it done."

In addition to creating a model for health care, the friends want their partnership to be a model for mending ethnic rifts in their broken homeland. Because Matara is a largely Sinhalese area, Gulasekaram has felt some resistance from members of the Tamil community for his participation in WCI. Naturally, it hasn't stopped him. "It's important," he says, "to have a lot of projects that are cross-ethnic. It gives a good model for people to follow. And I think our hope is that in the future, if we have the opportunity to do something in a largely Tamilian population, that we would do it there as well." Their hope, the friends say, is that Project Peds will help overcome the sadness that Gulasekaram believes arises from "two people fighting on a very small island when they don't really need to be fighting."

Beth Schwartzapfel's article about student radio appeared in the January/February BAM.

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