Humanitarian Reflections

Tsunami Revisited

2007-12-13T06:17:00.000-08:00

Run aground
Feb 13, 2007 10:17 AM
Lynda Redwood-Campbell
Special to The Star

Two years after she spent several months in tsunami-ravaged Aceh province in Indonesia, Burlington physician Dr. Lynda Redwood-Campbell, who also teaches in the Department of Family Medicine at McMaster University, has returned for a visit.

Arrival

Here, I am 25 months after the tsunami, back to the place that was so devastated.

I wonder what has happened in terms of development. As we drive by the previous site for the International Red Cross tent hospital, I see that the fields have been replaced with temporary housing. Children laugh and splash in puddles as the rain continues to pound down.

Week One
Days 1-2: We passed by the site where only one house was left standing after the tsunami. It is now refurbished, beautifully painted. The area that was just debris is becoming a community again.

Run aground

Before the tsunami hit, the ship seen in this story -- the PLT Dapung -- was moored off-shore and used as a power generating station.

The waves carried the ship around five kilometres "inland" and dumped it in the middle of this village, where it obviously destroyed everything that had been located where the steel giant now sits.

Dr. Lynda Redwood-Campbell reports that the tanker has been re-painted as a memorial.

Dr. Redwood-Campbell's photos show the Dapung just after the December 2004 tsunami (at the top of the page) and two years later (middle of the page).

After such a disaster, how does a government provide fair distribution of housing? A Rotarian is working on the database in an attempt to help to formally identify affected people. A very large task and it is expected that over 100,000 families will be on the list. There are probably more.

The medical students [we are working with] are half women and men. All have been affected by the tsunami in one way or another. I was most impressed with the women. They were mature and asked good challenging questions. They were getting on with their lives.

The students are having a tutorial using problem-based learning. This is a new model of teaching in Indonesia. Eleven students in a small group, men and women.

The topic is Islam and abortion and contraception. The students have not yet seen a real patient, as they are in their pre-clinical years. The discussion is interesting, as they are only 17 years old.

Wouldn’t it be interesting if we could one day video conference and have students from Canada join them? Imagine the learning for both sides.

Days 3-4: Today we drove to one of the worst affected areas.

I have a bitter feeling as I think about the devastation I saw soon after the tsunami.

It is pouring again. As we get closer to the shore, I see many new houses, many new developments. Men busy hammering and cutting wood in workshops set up every few kilometers.

My friend is driving and explaining the sights. We arrived at a bridge but could not go over it. The road was not good enough, worsened with all the recent rain. I wonder if this weather must be slowing down the building process. Through another direction, the newly build homes are still empty.
The December, 2004 tsunami drove this tanker five kilometres inland and deposited it in the middle of a village. Two years later it is now a memorial.

We pass along through busy neighborhoods, and then, we saw the ship. In the middle of the neighborhood, there stood an oil tanker, five kilometers inland from where it took before the wave engulfed it. It has been re-painted as a memorial.

Most of the destruction is gone, and it is actually very difficult to believe that the tsunami was as destructive as it really was. My Acehnese friend says that people cope by just moving on The shops around it are bustling and bright, the road that was once rubble is now busy.

Days 5-7: It poured again all night last night. The streets were flooded and many people were not able to leave their homes.

Last night we met a man who has been living in Indonesia for almost 30 years. He is an engineer and has been working on a housing project. He is frustrated because he believes that too many of the new homes are not earthquake proof and the next quake will bring them all down again.

I asked about the Canadian efforts. He said the Canadian Red Cross was constructing houses very well. I sighed great relief.

Perhaps the most impressive thing to me is the sense of hope that appears to be here.

Aceh has been an area of political conflict for many decades.

Since the tsunami, a peace accord has been signed. The first democratic election has been held and the new governor will take office in February.

My friend tells me that people are happy for a change. People just need to let him "do his job."

Week Two
Day 5-7: Reuniting is always special. I found a friend. Two years ago, she lost her husband, her parents, family and home. She was stuck on the roof of her house for more than 24 hours watching neighbours get washed up onto the roof and grieving others who didn’t make it. She is re-married and she is expecting her second child.

We visited her temporary home. Her own home is still in rubble: no front wall; debris on the floor; the kitchen is barely recognizable. Her 8-year-old son showed his room where he hopes to be again one day. It was just an empty shell – no bed, nothing. She hopes to have government compensation soon to rebuild her home. In the interim, the three of them live in a small room in a house. She does not know where the baby will be born. It is expensive to go to hospital. I quietly worry about her. Maternal mortality is high in Indonesia, something that we take for granted.

Day 8-9: Yesterday we visited the main general hospital. The fist time I saw it, it was full of debris and bodies 6 feet high. Over the next weeks and months, the hospital was cleaned and slowly started to function again. I see the hospital now. The bodies and mud outside have been replaced with green grass, fuchsia bougainvillea flowers, new gardens and fresh paint. The mosque in the centre of the hospital complex has been rebuilt. It is hard to believe that this is the same place where so many people died a sudden death. Progress is happening but the hospital still does not have the same capacity as before. The beds are there but too many nurses died and still have not been replaced.

The traffic is crazy and unsafe. It’s a problem in many developing countries. Families of three and four on one motorcycle, no helmets. A woman lay on the road, unconscious after she fell off her motorbike today. The tsunami and earthquakes are not preventable, but these injuries are. The public health students were with us today. I encouraged the students to seriously consider doing a project to try to reduce head injuries in their community. They smiled. I hope that they do think seriously about it.

Day 10: We visited a grandmother in her home in a village today. Her typical Achenese home is built on stilts, made of wood and is more than a century old. She was as old as her house, we were told. This lovely 100-year-old woman lay comfortably in her bed. Her’s is a simple life in the village. She never had a birth certificate so her age was estimated. Without a birth certificate you have no identity. Without identify one cannot access many services. Midwives now are being trained to try to get birth certificates completed for all the new babies born. Seemingly small things to us but a basic human right.

A thought that a colleague reflected on today is that the tsunami brought together all sorts of people who would not normally interact together. Doctors and store owners, teachers and villagers. I wonder if they will stay friends because of the experience that they had together or in time go back to interacting with their old ways. Time will tell.

Departure: As I reflect on Aceh two years after the tsunami, I do feel hopeful. I feel better than I did two years ago. I feel like progress is happening, albeit sometimes slower than expected. Life must move on. In many areas of the city there is little physical memory of the event. I still can not really begin to imagine what it was like when the tsunami wave roared through the city taking everything in its path. I still cannot imagine the pain of losing so much in just 15 minutes. The sea of mud and debris out my plane window in now replaced with green, lush areas and scatterings of new communities and houses. There is a sense of peace. Let’s hope and pray that this is the beginning of rebuilding of a province that has been rife with conflict and disaster for decades.

Departure – December 1, 2005

2005-12-01T08:00:00.000-08:00

As I start my return journey home, I reflect on my time here. I think about all the suffering, the stories, and all the very sick people. I always feel torn when it is time to leave. Of course, it is time to go home, but at the same time, there is still work and aid that needs to be continued. Over the next month and with time, more organizations will leave, but there will still be humanitarian workers there to continue to provide shelter, food and medical care.

The freshly fallen snow in the mountains exemplifies the utmost in beauty. The mountains look grand and majestic. The irony is that it also means more hardship for thousands and thousands of people. Every day of colder weather means more difficult delivery of much needed supplies. It is estimated that thousands of people will descend to lower altitudes over the next month. I wonder how many will actually make it.

We did see illness and injury related to the earthquake. Fractures, old infected wounds and vague physical symptoms related to the stress and mental health trauma. All this as a result of just 45 seconds. Yes, just 45 seconds. Women and children were mostly affected. Unfortunately, we also saw the inevi

table. All the illnesses that are related to and are caused by poverty. Malnourished children, measles, diarrhea, pneumonias causing death and many more. We couldn't prevent the earthquake but we can prevent many diseases and we can better address the issues of poverty. Why is only 10% of the global health research budget allocated to 90% of the global burden of disease? I ponder.

As I arrive at the stopover in Manchester, I enter the airport and hear Christmas songs and see vibrant Christmas decorations galore. I wonder if this is the same world as the one I just left? Improving health can never be approached in a silo. The global implications of understanding and responding appropriately to disease, illness, poverty and disasters are more compelling than ever.

As my plane lands in Canada, I think about that little girl who looked up to me with the eyes of pain, sorrow and utter trust. Her eyes said, “please don't forget about us, and all those around the world who also suffer from all preventable causes.” I shed a little tear. “OK,” I said, aloud, as I stepped off the plane, we owe it to you.

November 28, 2005

2005-11-28T08:03:00.000-08:00

We are hearing reports now of hypothermia and more respiratory illnesses. A refugee camp will be moving to a ‘better location' 10 km from the city.

This particular camp had an outbreak of acute watery diarrhea, which is now controlled. This camp was not set up in a planned way so moving it ensures a better camp layout, including the better la

yout of latrines. Public health is paramount in the situations. But what about the people who have to move 10 km away from the town? How will they get to town? What if they are fortunate to have a job right now? How will they get to and from their jobs? Disaster situations are very difficult, always harboring a challenge to every decision that is made.

November 27, 2005

2005-11-27T08:04:00.000-08:00

Today the rain fell hard in the valley. It was the first rain here in a few weeks. The helicopters were grounded for the day. This means that a day of much needed relief supplies was halted. The morning was greeted with more snow in the distance, a sign that winter is closing in and time is once again, of the essence. It is likely that in the next few weeks, more people in need will descend into the valleys and towns in need of relief.

November 26, 2005

2005-11-26T08:05:00.000-08:00

There are long lines of men lined up in some of the northern affected cities. They are lined up in hope that they are eligible for financial assistance from the government. Their homes have been destroyed, their families killed or displaced, their livelihood remains uncertain.

A young boy came to the hospital with his mother. He had multiple fractures of his femur and tibia/fibula. He couldn't stay in this hospital though. As it turns out, his mother died in the earthquake, his father is 200 km away and his aunt, who is with him, needs to go back to her home, to be with her five children. He has nobody else.

Many people talk about why the earthquake has happened. Why did it happen to them? Why did it destroy so much? Why are they having so much suffering? A said today, ‘It is obvious. We deserved it. We have sinned and not followed our faith as we should have.'

November 25, 2005

2005-11-25T08:05:00.000-08:00

Imagine this. Your house was shaken down in 45 seconds. Most of your family is now dead. Your injuries are life-threatening so you are transferred to an unknown hospital. You are hearing foreign languages that you don't understand. You are transferred from one hospital to another to get better care. Now, you must put all your trust and faith in total strangers. Decisions about your health, your care and your future. Their eyes gaze at you with that full trust and faith, hoping and praying that things will all be ok.

After a disaster, life still must go on. Although many stores were destroyed, there are still stores that have opened in unstable and half fallen buildings. A man tries to sell his goods in a store that is surrounded by dangling wires, precarious pieces of hanging roof and doors that are only half standing. In Balakot, a man looks through the debris to find his barber chair. He pulls it out, dusts it off, and in the middle of a pile of rubble, offers barber services again.

November 23, 2005

2005-11-23T08:07:00.000-08:00

I heard some stories today.

A team reached a very remote area and found a young woman with a very badly crushed foot. It was almost falling off. The team explained that she would need to come to the hospital and that, unfortunately, she needed to have an amputation. Her family refused because an amputation would mean that she would never be “beautiful” again. The alternative was that she would die of septicemia. It took a lot of discussion and the family reluctantly agreed to send her to the hospital. These situations are always very difficult, and they always begs the question, “Who was right?”

We also have heard stories about people trying to steal children, across the borders. Heart-breaking. Glad to hear that the rules are clamping down to decrease the chance of children being mistreated.

It seems that after the tsunami in Aceh, the majority of patients in the hospital were men. Here in Pakistan, it is mostly women and children. To see a child smile when they receive a little toy (donated by a Canadian) is heartwarming.

A snow coyote attacked a child yesterday. Rare and unusual things happen after an earthquake.

Last night, there was an earthquake in the middle of the night. Very traumatic for those who survived the last one. All the patients in the middle of the night ran outside the hospital. Parents frantically ran outside leaving their children inside. Is it survival of the fittest or just sheer terror? The latter, I think.

The disaster is now in the subacute and early rehabilitation phase. It appears that the biggest need now here is for rehabilitation specialists, physiotherapists and prosthetic specialists.

November 21, 2005

2005-11-21T09:01:00.000-08:00

There are many activities that occur during these disaster situations and many aid workers who work very hard, never having the opportunity to tell their stories.

We know that when the media leaves, so does the world's attention. We have seen this so many times, in many different situations. By keeping the stories alive, the public interest, hopefully, will also stay alive; and they public will not forget about the suffering that is still occurring.

Today we will do an assessment for the need of a field hospital in an outlying area. A new road just opened up and therewere people who arrived yesterday with untreated wounds from 6 weeks ago.

Sometimes it can be frustrating working in these situations. Sometimes it feels like one step forward, two steps back. But we still keep trudging forward.

November 20, 2005

2005-11-20T09:03:00.000-08:00

The prayers are starting. It must be 5 am. At 7:30, all the helicopters leave the area to deliver the much-needed supplies and food.

Today was interesting. The hospital in-patients were in need of some more detailed review and care.

We went to a tent village where we were met by the many smiling faces of women and children. They anticipated our arrival and had set up 4 chairs and a small table at the top of a big hill.

We soon had many patients to see. Some fractures from the earthquake, but many beautiful, yet dirty, faces, and some diseased. We saw few very sick and malnourished children. Some will be admitted to the hospital. A young man with cerebral palsy lay in his tent where he spends most of his time. His younger brother limps around after becoming a victim of polio, a disease preventable with a vaccine. Their 3 sisters have all died of different infectious reasons. We will come back again, we promised.

November 18, 2005

2005-11-18T09:05:00.000-08:00

UN cluster meeting this morning. Everyone is working hard to deliver aid and care to the different communities.

A young nurse came to the hospital today looking for a job. His hospital was severely destroyed by the earthquake. He had tears in his eyes when he told me that many of his fellow nurses had died. He also told me that in his tent village there were many women who could not access care because all their male relatives died. The hospital is too far for them to be allowed to walk. Maybe we will need to do some outreach.

Kofi Annan was here today, roads were closed for part of the day.

A hot shower? We went to the Canadian DART (Disaster Assistance Response Team) who supplied us with a 3-minute hot shower. It was great to have a shower after 7 days of filth!

We had a tour of the marketplace downtown which was hit hard by the earthquake. Many buildings were completely toppled down. We walked through a gravesite, many new graves, unfortunately.

November 13, 2005

2005-11-13T09:05:00.000-08:00

First few working days

The roosters are calling in the distance. A dog is barking. The still, cool of the mountain air seems to invite a deep crispness to the morning. As I step out of my tent, and look to the mountains, I notice that they are becoming more snow capped each day. What does this mean for the people still displaced very far north without shelter? Time is of the essence.

Today I will visit a new hospital. One that is being set up in a hotel, part of which was destroyed by the earthquake. The international relief agencies will only be here for a short while, but the health infrastructure needs to be rebuilt. Many doctors and nurses died in the main hospital on that fateful Saturday morning. There is now a shortage of health professionals, especially nurses. At their request, we will help to train some more local nurses in an effort to make the hospital a more sustainable one.

I head a story last night from a new friend. On the day of the earthquake, most schools were open and in session. Many young children lost their lives as the earth shook the schools to rubble. My friend looked up and said, “but my sister's school was closed that day. She was at home, and thank god she is still with us.”

We saw many injuries in the hospital yesterday. Many children and women with fractured femurs and tibias. Many fractures were open and severely infected. My colleague transferred a high-risk pregnant woman to the helicopter pad where she was flown to a high-risk hospital. Care for many people in this area has been intermittent, often substandard, antibiotics are not always available or not taken correctly. I wonder what we will see today.

November 12, 2005

2005-11-12T09:06:00.000-08:00

Arrival in Islamabad

We have arrived in Islamabad. The flight attendants and crew were very hospitable and very attentive when they found out that we were a Canadian relief team coming to volunteer our time. I felt a real sense of genuine thankfulness; sometimes this occasionally lacks in our day-to-day interactions at home.

The past 2 days have been spent in a fog of jetlag and a spree of buying supplies for the field. We need to ensure that we do indeed have our winter tents and supplies for our primitive cooking and living conditions. The suggestion of a shower every few days is questionable at best, so we must ensure, at least, that we keep our hands clean.

The concern I am hearing is that many people have been suffering terrible physical pain from their injuries and that the use of pain medications is not the same as it is in Canada. Aid workers try to alleviate their pain the best way that they can.

We had a tour of Islamabad and took photos where a large luxury building fell and killed at least 200 people.

Arrival to the final destination

We have just had a very winding 5-hour drive up to our final destination. What a long day. I feel shaky, so much so that I thought what I was sensing was an earthquake, but it was just hypoglycemia, I think.

Driving into the city reminded me of the areas of Banda Aceh that were affected by the earthquake. Buildings down in rubble. Tent compounds scattered all over the city and countryside. Different non-governmental and international organizations everywhere.

We had a quick tour of the public hospital. It was very dusty. It was under construction when the earthquake hit. My first impression was that it was dirty, had virtually no supplies and even less nurses and doctors to staff it except the dedicated humanitarian workers there who were trying their best to work under these conditions.

Then we arrived at our compound. The helicopters soar in and out close by delivering aid and transferring patients to referral hospitals. It was very dusty, I imagine like some described the situation of Bagh after the earthquake there. We set up our 5 tents, then set up our portable potty. As the weather quickly cools down, I realize that it will be a very cold night in the tents. We heard about a large bus accident from last night. Few survivors, many dead. Perhaps more people could have been saved if it wasn't in such a resource-poor area.

Now we need to debrief around the campfire and find out where we will be tomorrow…..

November 10, 2005

2005-11-10T09:06:00.000-08:00

Pre-Departure Reflections - Pakistan Earthquake Relief

The wind is blowing strong. The cold weather is starting to arrive in the mountains. And many people in the mountains have no shelter, no food, no fresh water, no medical care and maybe no hope. But there is always hope. I recall learning in Greek Mythology the story of Pandora’s box. No matter what the situation was and how bad it was, there was and always will be hope left in the box.

I do have hope. I hope that I can try to make a difference to a few whose lives have been so shattered by recent worldly disasters. As I get ready to depart on yet another mission, I always ask myself what makes me do this type of work? What makes me want to give up my privileged life in Canada, my family and friends and go around the world to an often dirty, smelly, unclean, unhealthy, unknown and sometimes politically unstable environment? Well, I guess it is because I was a ‘lucky’ one. It was random luck that I was the one who was born in the safe, secure country of Canada and not in a refugee camp in Northern Kenya. It was random luck that I am the one who has had two wonderful, supportive, healthy parents who would do anything for their children (and still do) and not an AIDS orphan from Africa. It was also luck and situation that I was born into a middle class family with lots of opportunity to continue in post-secondary education to study medicine and not one of the girls in Afghanistan who never was allowed to go to school. So why do I do the work that I do? I challenge myself and say, ‘what is your excuse not to do this kind of work?’

This time I am off to the earthquake zone in the north and disputed part of Pakistan, Kashmir. I leave very soon, and fly to Islamabad. We then will drive north to Muzaffarabad and maybe north again into the mountains. I have been shopping and packing and try to decide what needs to go into my dufflebag. I expect to have winter camping conditions and expect to be living in a tent, on the ground. I am not sure about internet and telephone access. The latrines are overflowing and we must now bring our own latrine. Only once a day to the latrine? That will be very interesting. If we are really fortunate, we might get a shower about every 4th day. Sounds like a hardship after leaving the comforts of my Canadian home. Not when you look at the big picture. The truth is that I will still have much more than many of the earthquake survivors. Many survivors would give anything to have a tent over their heads, a winter sleeping bag and a chance at a shower. ‘So why am I having such a difficult time deciding the contents of my bag?’ I ask myself.

The earthquake has been cruel. We know that there are many injuries from the earthquake. Some injured people have arrived to medical clinics and field hospitals in the area. Other people have not been so fortunate, still trapped in the mountains with no road access to get in or out. I imagine that some of the medical problems will be similar to what I experienced in Banda Aceh, Indonesia after the Tsunami this year. I expect to see fractures infected wounds that will be very difficult to heal, complicated lacerations, head injuries, crush injuries and more. I don’t expect to see the near drowning (aspiration) pneumonias that I saw post Tsunami. I do expect, however, to see people suffering to stay alive from the intense cold, the very opposite of the intense heat in Banda Aceh. I also know that there have been many broken families because of the earthquake. Children who have been plucked from their village, taken to a hospital hundreds of miles away, all by themselves, who have not uttered even one word since the disaster weeks ago. What will happen with them?

In addition to the disaster related to the earthquake, I know that I will also be dealing with another disaster. It is a disaster that affects far too many people globally. I have seen it over and over again in many countries like Indonesia, Rwanda, Kenya, Honduras, Bangledesh and many more. It never gets any easier to see. That disaster is poverty. Poverty breeds poor health. Even this year, after the Tsunami, I saw many examples of illness directly related to poverty. I saw children who never were able to have their congenital cataracts repaired, so they became blind. I saw young women who had recto-vaginal fistulas who had not been able to marry because of never having the opportunity to have their congenital problem repaired as a child. I saw people who came to see us as their very last hope. They had never seen a doctor before because they could never afford to. They had tumours that were so advanced that all we could offer was pain control and their faith. I also saw preventable diseases that should have never occurred in the first place. If there had been an accessible, effective immunization programme, I would never have seen the 8 year old girl with tetanus suffering in the intensive care unit, or the many others who died of tetanus from their infected Tsunami wounds. It all seems simply unjust and unnecessary.

So as I finish packing my bag and medicines, I think about all those people and those orphaned children. My second piece of luggage will contain a box of toys, with papers, puzzles, books, crayons and stickers. I hope that it will make a suffering child smile, if even for a minute. I hope that they can draw some of their experiences, maybe to start a healing process.

So ahead of me for the next while will be a challenge. Each mission is never the same. One thing is always the same, uncertainty about what to expect. With every mission, I learn more, I reflect some more and I grow some more. Humanitarian work is definitely not for everyone. There are many reasons that I feel driven to do this type of work. There is something that calls me to do it. Yes, it is very difficult to leave my kids, pack my bags and get on that plane. But not nearly as difficult as what others are doing right now.

Now I take a big breath, here it goes……