Tsunami Report
Marc Timothy Malcolm Shaw, FRNZCGP, FACTM, FFTM, B.Med.Sci., DCH, DRCOG, Dip.Trav.Med. (Glasgow)
One of the most powerful earthquakes in a century hit Asia on Boxing Day. The radio announced the details " … 8.9 magnitude underwater earthquake … off Sumatra … walls of water … 10 metres high … 11 countries affected…" I was in bed when I heard of the disaster, day off, comfortable, and wondered just what the horror of it all would have been like.
As the number of dead and dying rose higher and higher, I wanted to help. Helping is the first response for us in the medical profession. After all, it's our training. Saw the re-runs on TV and decided that I wanted to get there. Who to call? All the humanitarian organizations want `experienced personnel' for their work, but how do you get experience? An old mate rang. He'd been thinking the same. He called a TV reporter mate of his, figuring that TV exposure could raise the profile and funds would follow. `Did I want to go?' Don't get a chance like this again.
Four days later the three of us were sitting with a TV cameraman in an Air New Zealand plane on the way to the island of Nias in Indonesia. We had no idea what we were going to do, but we had accumulated 30 packs of medical supplies and we had a determination to use them where they were needed. We had got caught up in the spirit of it all; cowboys flying in to help, that's what it felt like. When I look back on it, you need to be more than a cowboy, much more.
It was a remarkable trip and I learned so much about what it means to be in a disaster. More than a radio comment, more than a newspaper article read with a cappuccino in the morning before work, and much more than life for many a person involved in the smashing, swirling horror over a few hours.
Our itinerary: one day travel to Indonesia, then two days to get to the troubled area in a small boat that seemed to chug with a beguiling rhythm that shut out the terror images that we were anticipating. Arrived at 0700 and went ashore to what had been a flourishing community. The town of Sirombu was balanced on an out-jutting into the sea, and the tsunami had whipped around and hit the town from both sides, taking out the market, the jetty road and the whole of the seaside section of the town. Ten kilometers further towards the equator, and some real damage had been done. A couple of towns, one by the sea and its sister just 1 kilometer inland had been completely annihilated by waves that came in over 6 meters high. You could tell it was 6 meters because at that height the coconuts had been sheared off by the force of the water. The 15 meter trees still had them attached.
Silence in the remains of the towns. No one talking, nothing to say. Quiet. Respect. A man in a yellow T-shirt sat looking at his hands; recalling former life now gone. The towns had lost over a third of their population of 500. One hundred died trying to get to a church for shelter. He hadn't lost his family but everything else had gone. No house, no village-folk, no more history. His affect was flat, and I was reminded that death was not the only loss in such communities. Photos of families, smiling, lay in dried mud beside wrung-out toys and children's shoes. It actually felt uncomfortable to look at them initially. Then I reminded myself that the best way to salute these unknown lives was by studying them in some sort of prayer. What does one give to a man who has lost everything… money (how much is enough?), clothes, food and water? I don't know.
Six clinics in four days, our packages of medicines and wound care product soon went. Lines of folk to see, but of course there would be with only 6 doctors on an island the size and population of Bali. What did we see? Lumps and skin conditions festering over 5 years. We saw common family medicine in all its colours, children in Nias with ear problems who still scream when they are examined, corrupt officials demanding to `jump the line' to have their servicing. We smile and do it… easier to go with the rhythms than go against them. After all this we saw tsunami victims, but very few for those that survived strangely had little disorder about themselves. The thing that got me was the line of over 100 folk waiting to be seen. Whilst we were there this line got bigger, never smaller, and personal exhaustion would force us to call it a day. I wonder how much use I really was. Being a cowboy is too easy, needs a little more honesty than this-for the work is hard and long. It needs planning and a structure.
Disaster Medicine Preparation:
Many of us want to go to help with such emergencies, either through compassion or personal need. For those that get to go, it is essential that they are aware of the risks and know the measures to be taken to minimize those risks. Little doubt that they should inform themselves regarding immunizations, prophylactic medications and appropriate disaster-relief education. I ensured that all of us were up-to-date with: tetanus/diphtheria, hepatitis A and B, typhoid, polio, measles, and cholera. We all took doxycycline as an antimalarial, for its added protection against leptospirosis, plague and a variety of other disaster-potential diseases. Rabies and Japanese encephalitis were risks in the region, but there really needs to be a 3-week lead in for them to be adequately protective. We didn't have this luxury, so I advised our group and told them to run if they saw a mad dog approach! Mossie bites? Repellent, 30% DEET, that's the `go' for us!
Then there was all the other stuff we needed to be aware of: food and water protection (hand alcohol-cleanser and handwipes are good for this), sunscreen (very hot and humid there, protection essential). Packing a personal kit is an individual experience, and familiarity flourishes a mind that answers to the need of a travel occasion. We all do it, we all know stuff we tell others to take, but, boy, when you have to sit down and do it for yourself! I tried my best to do this, and did pretty well actually only forgetting to take a photo of my wonderful partner! We still talk, but I have to say there were a few issues!
Because the risk for injury during and after a natural disaster is high, folk who travel to tsunami-affected areas or to other disasters will need sturdy footwear to protect their feet from widespread debris present in these areas. I can vouch for the calamity underfoot that you walk upon. Tetanus is a potential health threat for persons who sustain wound injuries; witness the outbreak in Banda Aceh.
Psychological/Emotional
Because of the tremendous loss of life, serious injuries, missing and separated families, and destruction of whole areas, I feel that it is essential to recognize the disaster situation as extremely stressful. Keeping an item of comfort nearby, a family photo, favorite music, or religious material, for example, can often offer personal and professional comfort in such situations.
With this trip, I had learned the first lesson in disaster care. Just going to assess what is required is not enough; it is essential that those that go to help do so with a purpose and with good organization. In fairly basic and sometimes primitive conditions, we ran health clinics for four days seeing folk who simply just don't get to see a doctor. Some benefit we gave to a few at least. And there was huge personal reward of practicing day to day tropical medicine.
Marc is also a traveller and observer of fine humour.
He has recently been appointed Associate Professor at James Cook University, Australia. He is the Medical Director of the Worldwise Travellers Health Centres of New Zealand.
