Nearly five years ago, University of Michigan faculty and students and the Grace Girls’ Home in Trincomalee, Sri Lanka teamed up to tackle diabetes care in low and middle-income communities. Now, organizers reflect on the new mentorship programs taking place within the initiative. 

Grace Girls’ Home is a shelter for “at-risk” girls and the elderly displaced by the 2004 tsunami in Sri Lanka that claimed 40,000 lives, as well as the Sri Lankan civil war that ended in 2019, which resulted in more than 100,000 deaths. The shelter provides residents with housing, food, education and medical treatment as necessary. 

Dr. Naresh Gunaratnam, a gastroenterologist at Huron Gastro in Ann Arbor, founded Grace Girls’ Home in 2002, intending to address the needs of girls. In 2004, he started an elder care facility to house elderly people who had no children left to take care of them.

“There’s no place to discharge them, so they would literally give them a mat and sleep on the grounds of the hospital, and the hospital would do their best to feed them,” Gunaratnam said. “You start accumulating a lot of these elders who had no place to go … At our best in 2004-2005, we were taking care of 300 people.”

Grace Girls’ Home also provides residents with vocational training and skills after they leave the home. Sahr Yazdani, University alum and medical student at Loyola University Chicago, started helping out at Grace Girls’ Home when she was 13 by tutoring the girls in conversational skills. Yadzani said this helped her realize the importance of the girls’ transitions from home.

“I realized there wasn’t really a transitory environment for these girls living in the orphanage to living in Sri Lankan society,” Yazdani said. “We renovated these complexes that were existing on the Grace Girls’ home property … and wanted the girls who were older to live in this transitionary environment. We taught them financial literacy and how to go into the market and everything … just to introduce those ideas in conversation and such.”

LSA senior Nikita Bazaj is the president of Grace-Edu, an organization on campus that focuses on introducing these life skills to the girls at Grace Girls’ Home.

“We’re doing a mentorship program with students at U-M and the Grace Girls who are in high school,” Bazaj said. “We’re putting two U-M girls with one girl from Grace, and the fall semester was focused on building a relationship with the girls and this next semester will be focused on teaching the girls individual team topics. We have a different team topic per month and for example, this first month’s is finance.”

In addition to learning life skills, University fellow Anjan Saha has helped implement a recent program to offer the girls at Grace Girls’ Home new employment opportunities as community health workers. Saha said ancillary care providers aren’t always as trusted as physicians in Sri Lanka. 

“A lot of trust is concentrated with the physician,” Saha said. “Ancillary care providers don’t necessarily receive that same level of trust. That’s obviously a very big component of our healthcare system and it allows the system as a whole to offload some of the workload that would otherwise fall under the responsibility of the physician.”

Grace Girls’ Home has also partnered with the William Davidson Institute in the Ross School of Business, a non-profit organization aimed at improving the delivery of care in developing countries. Gunaratnam said together, they will improve physician efficiency in Sri Lanka.

“When we can’t create more physicians, we have to make them more efficient,” Gunaratnam said. “The physician’s role is to deal with the people who are at most risk for dying … We are saying instead of 90 seconds, give those patients five minutes.” 

In August 2018, Medical student Monica Choo went to Sri Lanka to help set up a study examining how effective the community health workers are at providing health care and patient satisfaction. 

Choo also created a curriculum to train the  community health workers in doing their job safely and efficiently.

“I also created a one-year curriculum to train them,” Choo said. “Ultimately, we want it to be a thing where the girls can be accredited nationally and hired by the physicians and actually make a living. To do that, we have to have a real curriculum like any job. I took some time to create a one-year curriculum and we’re in conversation with US Aid right now to see how we can get that leverage and get it pushed through the Ministry of Health.”

Saha said community health workers help alleviate congestion faced in the health system and implementing new vocational skills for those who cannot seek higher education.

“As more and more patients started seeing them and experiencing what it is they had to offer, trust was sort of built over time,” Saha said. “Since then, the operation has seen maybe 400-500 patients in a number of provincial hospitals within the Eastern province.”

Gunaratnam said the future implications of the government’s support in this new vocation will significantly improve patient outcomes.

“The government will hopefully support us creating this new job and get these girls paid and so forth,” Gunaratnam said. “We believe (in) focused intervention, that means engaging with the girls leads to better outcomes … The patients like talking to the girls. They give them more time, they know them personally, there is a higher level of sympathy. When I visited, they said, ‘They give us good advice about the practical things. The doctor doesn’t have time to do that.’”


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