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Relief Organizations Face Hurdles Giving Medical Assistance to Tsunami Survivors

January 5, 2005 at 12:00 AM EDT


RAY SUAREZ: Basic infrastructure is in ruins. Millions are homeless. Relief workers are fighting huge obstacles in caring for survivors. Priority one: Distributing clean drinking water to avoid the spread of diseases like cholera.

Makeshift hospitals have sprung up in the immediate aftermath of the tsunamis; this one in a public hall in the Maldives Islands in the Indian Ocean. As international medical teams made their way to outlying regions, field hospitals are finally treating rural survivors and their many wounds. This one, just off the airstrip in Banda Aceh, treats ailments ranging from pneumonia to tetanus.

In India, doctors are vaccinating children against tetanus and other infections. The threat of water-borne illness is ever-present there and around the region as pools of stagnant, dirty water breed mosquitoes that can carry diseases like dengue fever.

At the Kesdan Hospital in Banda Aceh on the Indonesian island of Sumatra, recent conditions were dire and supplies running short. Surgeries are performed without anesthesia or much needed medicines and instruments.

FIRST DOCTOR: We’re really low on hydrogen peroxide. We’re really low on scalpels right now. There could be other things as well– heavy painkillers. The painkillers we’re using right now are basically aspirin.

RAY SUAREZ: An endless flow of wounded continues to overwhelm the hospitals still in operation. Broken limbs are a common sight; wounds infested with maggots another.

SECOND DOCTOR: Sometimes we find larva in the wounds, —


SECOND DOCTOR: — little worms in the wounds.

RAY SUAREZ: Feeding the sick is another problem. Rice is the staple food, but some people haven’t eaten for days. The Australian army recently arrived and set up a field hospital in a deserted wing of the hospital.

AUSTRALIAN ARMY OFFICER: If any of you are sick, we’ll see you inside shortly. We’ll just set up. Okay? We won’t be long. We’re here to help.

RAY SUAREZ: Aid continues to trickle into Aceh Province. Helicopter crews from the USS Abraham Lincoln ferried supplies to the decimated region. And today, an Indonesian ship delivered much-needed food and medicine to Calang, a town 99 percent destroyed when the tsunamis hit.

RAY SUAREZ: For more on the effort to deliver medical assistance, we’re joined by Catrin Schulte-Hillen of Doctors Without Borders.

That group has dispatched teams to each of the affected countries, and is now focusing efforts on Sri Lanka and Indonesia. What’s the latest you’re hearing from Doctors Without Borders teams on the ground?

CATRIN SCHULTE-HILLEN: Well, we have some feedback from the teams especially in Aceh, with finally the possibilities to go outside of Banda Aceh, the teams have organized two helicopters and have been able to go both down the west coast in direction of Malabar and to the eastern areas of Sigli.

So we have feedback on regions that haven’t really received any aid until now, and are seeing hospitals or medical structures if they’re still standing overflowed with patients. We’ve been able to establish teams in the different sites, in Sigli we’re managing the hospital now and have been doing operations, though, seven operations of patients today and ten are scheduled for tomorrow.

So the actions are really, or the operations are really going on and what is most needed at this time is to deal with, or to offer medical care to the patients that have been without care for days because nobody has been able to reach them. And also of course drinking water and food is a major issue in these areas.

RAY SUAREZ: Is it your sense that the scale of this disaster isn’t even fully understood because you’re first getting to places like these coastal regions that you described?

CATRIN SCHULTE-HILLEN: Well, the scale of what we see in a certain way, it’s absolutely dramatic because as was previously said, as we saw in the images, the areas that are most affected by the tsunami, especially in Aceh, up to three quarters of the population or 80 percent of the population has actually died in the initial impact of the wave and of the floods.

So we’re now dealing with a population that has severe wounds but that most of all is severely traumatized. People are afraid, they don’t want to go back to where their houses used to be, and we need to reach out to them and find them in the different displacement camps.

In the area of Sigli there’s about 60 different displaced camps with small settlements with people. We need to reach out to them to provide food, to make sure the water supply is adequate and to offer medical assistance in all of those areas.

RAY SUAREZ: Well, what does a population with trauma present in the way of a challenge? Is it harder to provide medical services to people who are in this state, are they less able to help themselves and help you?

CATRIN SCHULTE-HILLEN: Yes. I think what you say of less able to help themselves is probably one of the key issues. A population that is, or people that are traumatized, people that walk around in shock, children, it’s very likely that they’re very disoriented, they might even if there’s water and food available, not realize that this is really needed.

So you get them in the health structure, you see them in the consultation, they’re dehydrated, they’ve hurt themselves, so not wounds that necessarily come from the tsunami, but from wandering around, you know, stepping into a nail or something, and are just so disoriented that once they come to the medical structure you can actually reach out to them.

They might be in a state that’s relatively precarious from a health point of view, even though they haven’t had a direct impact from the tsunami itself.

RAY SUAREZ: A few moments ago we heard a doctor talking about the shortage of anesthesia, of surgical tools, of sterile materials. Yet at the same time, we hear about the world trying to pour aid into this region. How do you coordinate it and make sure that the things you need get to the places you need them?

CATRIN SCHULTE-HILLEN: Well, the way Doctors Without Borders works, we work in teams that both have the medical capacity and logistic capacity and we have our own supplies.

So obviously in the field and where we’re coming now, medical structures are overstretched, they have a lot of patients and they have huge needs; we have at the moment been able to get much material into both Sri Lanka and Aceh and are able to provide.

The transport is an issue, the fact that we now have two helicopters that we’re operating under MSF has helped to create a bridge where teams go into areas with medical material and with food items, do the medical consultation and then do a quick assessment around the area, go back the next day with more of the needed material and set up a team inside if it’s necessary.

But the logistics continue to be a challenge, there’s many places that when there’s rain the helicopters cannot go down and road communication is very handicapped in Aceh.

RAY SUAREZ: So the rain, even with a helicopter has made it impossible for you to go some places where you know there are people in need?

CATRIN SCHULTE-HILLEN: Yes. For example, a couple of days back the helicopter couldn’t land in Malabar, you have to imagine what the ground looks like, so if, if you don’t have a solid spot where the helicopter can go down, you know, it would sink into the mud, so it can’t land.

RAY SUAREZ: Well, Doctors Without Borders attracted a lot of attention in the last couple of days by talking about its needs for responding to the tsunami already being satisfied and asking people to send their aid elsewhere. You got a lot of attention. What did you mean by that, why did you put out that call?

CATRIN SCHULTE-HILLEN: Maybe I could quickly go back in time and say, when the tsunami disaster hit, we had medical teams working in just about every country that was hit by the tsunami MSF has medical projects in over 70 countries in this world and they were in most of the places where the tsunami hit.

So at a very early stage we were able to dispatch personnel, medical and logistical personnel, from the countries to go to the specific areas that have been affected. And we have had important feedback from the teams on local capacity, on local agencies intervening into the disaster, and into the needs that were still existing.

So we are now at a time or, you know, at the end of last week we felt that we were at a moment where we had a pretty good idea of in this first, in this initial phase of the emergency, what would be the key operations that MSF would undertake, which will very much concentrate on Aceh and Sri Lanka and some other countries but with minor operations.

At the same time, we have received an incredible generous outpouring of aid in very few days, and we have seen also the general commitment of the international community to support the efforts.

So what we intended by this message was to inform the donors that support MSF, you know, support us to even be able to go out in such an emergency and act right away, to inform them that we considered that for the actions that we could foresee now, we had already received sufficient funds and that we did not, you know, we wanted to inform them that over, donations over and above that we would not be sure that we could actually use them in operations of tsunami.

So if somebody was really, really – really, really wanted to contribute to the tsunami, then we cannot over and above the donations that we’ve gotten assure that they will be used in tsunami.

So we said either you can support us in the general emergency fund that will be used in tsunami if we have additional needs, or in other areas with much needs such as Darfur or the Democratic Republic of Congo, or many other countries, or if somebody really wants to support tsunami, then turn to organizations that have a different mandate, will stay longer term.

MSF is a medical emergency relief organization, our interventions are in this initial phase of the emergency, there will be many medium and long-term needs that have to be addressed for the population, for the people that have been hit by this crisis, and other organizations have had other tasks, and will still need a lot of support.

RAY SUAREZ: Catrin Schulte-Hillen, thanks for being with us.