KILINOCHCHI, Sri Lanka -- Eight-year-old Koushigan Sivapalasundaram's day begins at 4:30 a.m.

First up is homework, which is supervised by his mother, Jeyanthini, who watches over him while cradling his 6-month-old sister in one arm, and holding a meter-long stick in her free hand. An hour later he is delivering two half-liter bottles of milk, the product of her 15 minutes milking of the family's two cows. Upon returning, he lights the fire to boil some water and collects the animals' excrement with his bare hands for fuel. After rinsing his hands in a plastic container filled with water brought from a nearby well, he dresses for school and brushes his teeth with his index finger.

This is not an uncharacteristic start to the day for many children in rural Sri Lanka. In a developing country that has been ravaged by civil war for more than two decades -- where running water is limited and a liter of homemade milk will earn the equivalent of around 10 yen, basic health and hygiene are not high on the list of priorities. Soap and toothpaste, it seems, are not often found on the Sivapalasundaram family shopping list.

The need to raise awareness of basic behavioral issues in Sri Lanka resulted in a Japan-based medical organization setting up operations there in 2003. The Association of Medical Doctors of Asia (AMDA) was established 20 years ago by Dr. Shigeru Suganami, now president of the Okayama-based NGO. Last year marked AMDA's 20th anniversary, during which time it has opened over 30 chapters in 14 countries throughout Asia, Africa and South America, including Sri Lanka.

In January 2003, Suganami was approached by Yasushi Akashi, special envoy to Sri Lanka, to implement a health project that would also serve as a vehicle for peace in the war-torn nation. A month later, Suganami flew to Colombo to inaugurate AMDA Sri Lanka. "The idea was to demonstrate equality to all parties," Suganami said. "Health issues are important but we also wanted to promote communication between Muslim, Sinhalese and Tamil, with health-related activities being the vehicle for that."

AMDA staff members, including Japanese nurses and nutritionists as well as a Cambodian doctor, emphasize the nationwide reach of their activities. Working alongside local medics, they started a mobile clinic to visit impoverished parts of Trincomalee in the northeast and Vavuniya and Kilinochchi in the north. Seminars aimed at raising basic health awareness were inaugurated at schools in Kalutara in the west and Hambantota in the south.

After the recent Asian tsunami, which destroyed almost two-thirds of the country's coastline, AMDA Sri Lanka expanded its activities to help those affected. AMDA staffers were the first on the scene to assist with medical support, according to Suganami.

"Before the tsunami, AMDA was here and it stayed on even after other NGOs had pulled out," said a public-health official in Hambantota.

Such commitment, along with the hands-on approach of AMDA's activities, has received praise among many local education and health officials. "In our experience, we feel that technical assistance is far more important than financial assistance," said Dr. S. Abraham, deputy provincial director of health services in Trincomalee.

"We are troubled about too much financial assistance from NGOs because, being a developing nation, unless we are careful, in times to come we will fall into the so-called dependency syndrome," Abraham continued. "AMDA's approach is different -- to provide mostly technical assistance, introducing new ideas that we can adopt. They do not preach, like some NGOs, but participate in our development. It's refreshing."

Suganami insists that he is not keen on promoting AMDA as an NGO, preferring instead the acronym BGO -- Beyond Government Organization. "What we do is like any other NGO, but in one sense we are different," Suganami said. "For us, it is not a case of sponsorship. That is the worst thing you can do. It destroys dignity. 'I respect you,' is the most important message. To that end, our basic ideology is that of sogo-fujo (mutual assistance): We will help you in your time of need, but please help us when we need help."