FRED DE SAM LAZARO: Relief camps now dot the area where the tsunami hit India hardest, the impoverished villages near Nagapattinam, on India's southeastern coast.
About 2,000 children perished, a third of all victims in this region. What's especially painful is that many of the parents who survived them had already been sterilized. Sterilization is one of India's most common forms of birth control
Fishing communities like this would typically be prime targets for India's family planning program. Women are urged to become sterilized after the birth of their second child or third child, and they usually agree if at least one those children is a boy.
Beyond basic food and shelter, the challenge was how to deal with post-tsunami depression. Parents were racked with guilt, says district collector J. Radhakrishnan. He's the top government official here.
J. RADHAKRISHNAN, District Collector: They have guilt that they couldn't save their children. This gets compounded by the fact that now, because of this sterilization, they cannot even aspire to have a kid.
FRED DE SAM LAZARO: Radhakrishnan convinced the government to make an unusual and generous offer: free surgery to bereaved parents to restore their fertility. Reversing serializations might seem a strange decision in a nation of one billion people, a third of whom live on less than a dollar a day.
But many tsunami-hit nations expect a small baby boom, as couples deal with their grief. In Nagapattinam, children are a measure of one's self-worth.
NIRMALA PALANISAMY, Public Health Nurse (through translator): Fishermen don't consider things like boats and houses important. They don't have any aspiration for these things. To them, children are their real property.
RANJINI RAMADOSS, Public Health Nurse (through translator): In these fishing communities, boy children are important. They go out to sea and assist the family at earning a living.
FRED DE SAM LAZARO: So, public health nurses Ranjini Ramadoss and Nirmala Palanisamy, who had long coaxed women to become sterilized, began doing just the opposite.
The surgery reconnects a woman's fallopian tubes, which have been severed to block the passage of her eggs to the uterus. The procedure, called recanalization, is major, intricate surgery, with a success rate of 50 percent, at best.
Despite the risks and pain, dozens of bereaved mothers signed up. Geetha and husband Bhaskar lost their only two children in the tsunami.
GEETHA, Lost Children in Tsunami (through translator): It is difficult. It's very painful to look at other children running around the camp, because it makes you think of the ones you have lost
FRED DE SAM LAZARO: Geetha underwent her sterilization reversal surgery last April. Her case in particular was watched closely by nurse Ranjini, since Geetha had chosen sterilization, even though she had no sons.
RANJINI RAMADOSS (through translator): What's different about Geetha and Bhaskar is that most people would never undergo the family planning operation with just two children, especially if they are two girls. But Geetha and Bhaskar, they said, no, two girls are just fine with us
FRED DE SAM LAZARO: Today, Geetha and Bhaskar's one-room shack is the first stop on nurse Ranjini's rounds at the refugee camp. There's nothing like starting the day on an up note. As of January, Geetha was five months along in a healthy pregnancy.
RANJINI RAMADOSS (through translator): The child is fine. Your weight could be more. You need to eat well, be calm and happy, eat vegetables, eggs, and fish.
FRED DE SAM LAZARO: Uplifting as her first stop was, there's no escaping the lingering grief around this camp, particularly among those near or past reproductive age.
Ranjini urged people to move on.
RANJINI RAMADOSS (through translator): Balakrishnan, your wife died in the tsunami. You haven't married again?
BALAKRISHNAN, Lost Wife in Tsunami (through translator): No, I haven't.
FRED DE SAM LAZARO: She often tries to forge new families from those torn apart.
RANJINI RAMADOSS (through translator): Many people in the camp have found people who were widowed and got married. Why have you not married?
BALAKRISHNAN (through translator): Because I love my wife, I could not marry again.
RANJINI RAMADOSS (through translator): But what about the children? Are they in school? Who feeds them?
BALAKRISHNAN (through translator): I look after them.
FRED DE SAM LAZARO: The most challenging visits are to women like 30-year-old Shanti. She and husband Mahendran lost all three of their children in the tsunami. Nine months after recanalization, she has yet to conceive. Nurse Ranjini took Shanti to the crowded, busy camp clinic.
"Don't worry," the doctor said. "Many people conceive much later."
Of course, there's a 50 percent chance she will never become pregnant, but that wasn't mentioned. District collector Radhakrishnan says, that's OK.
J. RADHAKRISHNAN: Immediately after a tragedy, depression is what we have to tackle. This offers them hope. And, from a psychosocial angle, that's a very important hope for them, to continue to return to normalcy.
FRED DE SAM LAZARO: As for those couples who, despite surgery, can't have children, he says, it will take time for them to realize this. And that time itself could heal their pain, and perhaps they will consider adopting some of the 128 tsunami orphans.
Adoption is not common here, though. There's strong cultural preference to have one's own.
SHANTI, Lost Children in Tsunami (through translator): With older children, 1 or 2 years old, they will always wonder about their real parents. They will ask, "Where's my mamma and my papa?"
FRED DE SAM LAZARO: Still, Shanti says, it's impossible to contemplate her future without children, and she is determined to follow the advice to stay positive.
SHANTI (through translator): I know others who had the operation the same time as I did have become pregnant. I'm happy for them, but I feel that, if they did it, we can do it, too, in the future.
FRED DE SAM LAZARO: Looking ahead, the future does seem brighter for babies being born here, and, to some extent, for their parents, thanks to government and private aid that has come in.
A new auction hall and better refrigeration and drying equipment for fish should bring better prices for fishermen. Some women have trained in small-scale businesses, and more children are in school.
Despite the hopes for a better life ahead, it all seems muted, even among those who feel lucky, like Geetha and Bhaskar
GEETHA (through translator): I was very happy when I learned that I had conceived, but I am still grieving for the children that I lost.
BHASKAR, Lost Children in Tsunami (through translator): One's name was Jodya. The other's name was Sociya. These photos were in my sister's house. It was a group photo, which we had redone with our girls. They help keep their memory alive. They will be in our memory until we die.
FRED DE SAM LAZARO: They never had a preference, never minded having girls. But, having lost them, Geetha and Bhaskar, say they really hope the new baby is a girl, a child who, either way, they insist, will get an education.