CMQ - February 2005
THE TSUNAMI - A report
A fanatical Sri Lankan cricket fan, I was glued to the TV from 6am on Boxing Day watching a live broadcast from New Zealand, when a grave faced newscaster interrupted Chaminda Vaas's final over, with the news of the sea flooding Galle town. No one knew the extent of the damage; the gravity of the situation was only revealed as the day progressed, when, between each special news bulletins, the death count rose by thousands.
The Christmas holiday, when I was visiting my father who lives in Kandy, Sri Lanka, was fast becoming a funeral wake. Although we were safe, five thousand feet above sea level in Kandy, there was a palpable sense of death all round as the whole country went into mourning. The following day, when the first local relief convoys started heading to the south and east, I wanted to jump into a lorry with my stethoscope and the Oxford Handbook of Clinical Medicine, received as gifts when I got into Brighton and Sussex Medical School a year ago. However, realising that becoming a private messiah was not quite the way to go about it, I made contact with a medical mission to the Baticoloa district in the east, one of the worst hit areas. The group was put together by a local NGO called 'Care of Health' formed in the wake of the disaster by a very enterprising graphics printer from Kandy. From his client list, he had contacted local pharmacies for medical supplies and bottled water, recruited 14 pre-registration doctors from the Peradeniya Medical School, and persuaded some local businessmen to provide transport. On the bus to Baticoloa I read up the chapters on chest medicine and gastroenterology in the OHCM, and was very glad that my medical school included clinical skills right at the beginning of the course. We'd covered the respiratory and the gastrointestinal systems in the first year. I expected to find plenty of problems in these areas among people who had ingested dirty sea water.
The medics in our group were used to conducting mobile clinics and
confident of tackling whatever the aftermath of the Tsunami would throw
at them. Their collective experience of 14 years' local practice, and
laid back manner, made me glad to be in their company. Sri Lanka gives a
very high priority to health matters; even the poorest villager rushes
to the doctor at the slightest cold or cough. Doctors in Sri Lanka enjoy
a special status perhaps second only to national cricket heroes! In
fact, we were almost mobbed when we got off the bus at our first refugee
camp at a school near the town of Akkaraipattu.
The camp housed about 2,000 displaced people and had just eight toilets. Much of the waste was dumped in a central courtyard. The washing water collected in a large pond around the only well, then seeped back into it.
Conditions were ripe for spread of most GI disease. It was a losing battle to educate people in such a distressed state. The need for maintaining hygiene was paramount. The government or NGOs needed to provide the necessary facilities fast. But it was difficult to establish who was responsible for the running of the camp, as the local police were guarding the camp from outside, and the Tamil Tigers were very much in control on the inside. Refugee camps are not a new phenomenon in the north and the east of Sri Lanka, where for over twenty years a bitter war has been fought between Tamil Tiger rebels and Government forces for control of the area. Almost 60,000 lives have been lost in this senseless conflict (it is interesting to note that the official Tsunami death count so far is also around 60,000), including two heads of state, Rajiv Gandhi of India and R. Premadasa of Sri Lanka. Although a fragile peace has been brokered with the help of the Norwegian government, sporadic fighting amongst the Tamil Tiger splinter groups, and deadlock in negotiations, threatened all out war again. Baticoloa district is land mine country, of both political and antipersonnel variety, so we had to be careful how we trod.
When the clinic began in one of the bigger classrooms at the camp, people rolled in with various complaints. As expected there were many cases of respiratory tract infections which were treated with antibiotics. With no X-ray facilities, auscultation skills were at a premium, but the symptoms presented in very concrete form. Very soon, I was able to get the hang of hearing the obvious bronchial breathing, rhonchi and crepitations and even the occasional pleural rub. On examination, if I heard any such abnormal sounds, I referred the patient to a doctor, in a triage system of sorts. He would confirm my diagnosis and prescribe treatment. Some patients needed nebulising; we had the necessary equipment set up in a corner of the room. Before long everyone wanted a whiff of the gas', but the medics had to firmly tell patients that nebulising wasn't necessary for a wounded knee.
The pharmacists set up shop by the windows of the classroom; everyone who had been given a prescription queued up in front of it. A very impressive operation, it ticked along like clock work. As we were the first medical team at the camp and the number of patients to be seen was considerable, each patient got roughly five minutes with the doctor. Most patients didn't speak any Singhalese or English, while most of the doctors didn't speak any Tamil, which caused a few problems at first; it was overcome with the help of some patients who translated for us. This was problematic at times as one patient would talk to two adjacent doctors presenting separate symptoms, and the doctors had to figure out the translator's complaint from the other patient's problem.
When the verbal jumble became overwhelming, and my triaging was seen as strictly not necessary, I volunteered to help at the wound dressing station, I was shown how to give an intramuscular tetanus toxoid injection just once, and then told to get on with it. I felt sorry for my first patient, who had survived the raging waters, only to have his deltoid muscle pierced by my clumsy technique. But my fortieth that afternoon was all smiles, clearly benefiting from fast gained expertise.
Things were going well when a sudden announcement, about another Tsunami on its way, sent the whole camp running to higher ground. In the melee a woman and a three year old child were apparently run over by a nearby truck. A man banged his head jumping off a tractor next to me, and needed three sutures when things calmed down again. The false alarm was due to a cyclone battering the southern coast of India, and made the sea rough around eastern Sri Lanka. For these people, who had experienced the full horror of the sea, that was incentive enough to start running.
That evening we moved on to another camp further north along the coast, and came to an area known as Marathanmunai. All that was left of this once bustling township was a massive pile of rubble stretching several kilometres along the coast. Survivors described a 30 foot high wall of water that advanced on them smashing everything in its path, and inland wells overflowing with water before the wave arrived. People running away from the massive wave were obstructed by this inland water, and drowned when the Tsunami caught up. I spoke to a young woman who had lost both her children. She told me that, after the first wave hit her house, she started running, carrying them both, but lost them when the bigger second wave hit. She too, jumped into the waves not wanting to live without her children, but was saved by being stuck on a coconut tree. In another incident, a month old baby, the sole survivor of her family, had floated in her bath tub and was rescued by a neighbour.
We travelled to a further four camps during our few days in the area and returned to Kandy when our medical supplies were exhausted. We spent a considerable amount of time on the road, which could have been better used had we stayed in one location and served a fewer number of people rather than attempt to reach as many as we could. The chaotic situation and total lack of co-ordination of the relief effort meant some displaced people were better helped than others. Those who did not want to come into camps, for fear of the spread of disease, were left without help. Currently, however, the army having taken charge of coordinating the process, things have improved considerably.
The need for counselling was clear wherever we visited. 'Care of Health' is currently organising another visit to the region. and plans to take counsellors and train others from the area.
- Mr. K. Wigneswaran who let me join the group
- The Doctors and Volunteers who taught me much
- The people of Baticoloa district who showed immense courage.
Stuart Reiss is a second year medical student at Brighton and Sussex Medical School.