When they fall ill, Sri Lankans typically try home remedies first. If these fail, they visit the family doctor or the hospital. There are two systems of medicine in Sri Lanka, Ayurveda and Western; government hospitals for both are free, though a private system also exists. Ayurveda is an ancient form of medicine based on the relationship between the earth's five elements-water, air, earth, ether and light-and the five senses of the human body. These relationships affect a person's dosha, or life force. Ayurvedic healing is slow, as treatments involve using herbs and oils for massage, baths and tea. Ayurvedic doctors undergo five years of formal training and an apprenticeship period before they are allowed to practise. They often make house calls and spend a good deal of time listening to patients and studying their symptoms.
Many Sri Lankans attribute illness to an imbalance of the three bodily humours: wind, bile and phlegm. A further cause can be mental, often the influence of malicious spirits (yakshas). Exorcists called yakdessas or kattadiyas are thought to exert control over the spirits through charms, offerings or threats, and by performing a vigorous dance (tovil) to drive out the spirits.
Sri Lankans enjoy good health care through a cadre of well-trained medical staff and a network of hospitals, clinics and pharmacies. Life expectancy averages 72 years (the highest in Asia), and infant mortality is relatively low (16 per 1,000 life births). The government provides a number of health-related assistance programs, including financial aid to the infirm and their dependents; pensions to seniors; drug addiction rehabilitation programs; and vocational training and appliances for persons with physical and mental disabilities. Women employed outside the home receive paid maternity leave.
Many Sri Lankans prefer Western-style treatment for acute or serious diseases. The population is vulnerable to tropical diseases such as malaria, filaria and dengue, as well as fungal infections, heat stroke and diseases transmitted by insects and animals. Hepatitis A, carried by impure water or unclean eating utensils, is common. In recent years, HIV infection has become a serious concern and is linked mostly to prostitution in tourist areas.