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| Flying into hell |
25-Jan-2005 |
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Australian doctors were quick to volunteer to help survivors of the tsunami tragedy. Three GPs share their experiences with Cathy Saunders.
GPs were among the first Australians to put their hands up to help in tsunami-affected countries. Some had only minutes to pack and join government deployments, while others paid there own way to fly overseas on commercial airlines.
The goodwill and desire to help is overwhelming. At the time of going to press more than 4000 doctors have registered with the Federal Government as volunteers and this number is climbing daily.
Some of the first to leave Australia, hand-picked for their skills and experience in disaster situations, are now returning home with stories that inspire tears and shock, admiration and hope.
GPs who have spent time in the Maldives have tales of stunned islanders, displaced people who are bereft of their families, homes and livelihoods, but who insist that the doctors and their teams have enough to eat and drink before they tend to themselves. They are flocking to the hastily set-up GP clinics where the doctors stay late into the night, listening to their distressing stories.
In Sri Lanka, a GP from Victoria who returned to help in his homeland is learning to come to grips with the plight of young children affected by the disaster.
Here are those GPs’ stories.
IMMENSE DEVASTATION
WHEN Dr Vince Duffy, a rural GP from Elermore Vale in NSW, first arrived on the Maldives, everybody was still shell-shocked.
Although the acute trauma patients had been cared for and the bodies of the dead had been buried, there was no clean-up underway.
“Nothing was really happening and I could understand that, because if you stood there and looked you thought, ‘Where on earth would I start?’,” he says.
The devastation was immense. One island had lost 90% of its homes and all the inhabitants from several others had fled to nearby atolls.
“What they were trying to do was get people to come back on a daily basis to clean up and go off again, but it really wasn’t happening,” he says.
Like Dr Adamski, Dr Duffy was part of the Federal Government’s Team Charlie, which split into smaller groups to be able to cover more of the many islands.
He is a reservist with the Royal Australian Air Force and has experience in tropical medicine. Also, he has previously been deployed to East Timor, Bougainville and parts of Africa.
His group of four included an emergency department doctor and nurse, and an anaesthetist, and although it turned out the specialist skills were not needed, they all mucked in and helped with general practice clinics and other work.
One of their first tasks was to complete a public health assessment of the islands, looking at the sanitation, water supply and communications, and making recommendations to the disaster control team in the capital of Male.
“It was pretty dismal,” Dr Duffy says. “The communications didn’t exist, the generators had all been damaged, the cables were all ripped up from the ground and the water wells they had used were all contaminated by saltwater so the water wasn’t drinkable.
“There was enough rainwater for 10-15 days, but it is the dry season.”
Another major problem was the seawater that flooded the islands was killing the plants, including the breadfruit trees that provide much of the islanders’ diet.
Working 16-hour days and sleeping on a small Maldives Government boat, his group was also asked to assess disease risk and prevalence. They found an increase in viral-related illnesses, such as non-specific fevers, but the biggest problem was psychological trauma.
“People are not sleeping; people are anxious and not wanting to return to their normal fishing jobs; but the biggest fear that came across time and time again was that everybody is terrified it is going to happen again,” Dr Duffy says.
The tsunami-related physical complaints were cuts, bruises and saltwater inhalation from near-drowning, but because doctors are few and far between on the islands, many people arrived at clinics with problems they have had for 10-15 years.
“We got to see a fair few unusual conditions that we didn’t have the power or ability to treat,” Dr Duffy says. These included spinal tuberculosis, malignancies, chronic leg ulcers, chronic musculoskeletal problems and joint deformities.
“But our brief was specifically to assist with tsunami-related problems, not to solve the medical problems of the island,” he says. “We certainly didn’t turn anybody away who turned up and a couple of the clinics certainly ran late into the night with little light and lots of mosquitoes, but what we attempted to do was direct them back into the local health system.”
Although he is now back in Australia, he would not hesitate to go again if called on.
QUICK EXIT
“GONE to the Maldives. Back in a week.”
This was the note Dr Mark Adamski’s wife and three children found when they returned home from the cinema one afternoon, three days after the Boxing Day tsunami.
The rural GP had only 15 minutes to pack before he made the three-hour trip to Sydney, from his home in Nelson Bay in NSW, to join the first Australian government-sponsored medical contingent to the Maldives, known as Team Charlie.
Once there, one of the things that struck him most was the number of small children who came up to him and said: “I’m scared.”
“Most of the Maldives is about 1m above sea level and on most of the islands we visited you could stand in the centre of the island and see the ocean on every side,” Dr Adamski says.
“The children and adults are still very frightened of another tsunami and I think we were all checking out where the nearest palm tree was.”
Dr Adamski had phoned a disaster response line on 29 December to offer his services because of his skills as a rural GP and his recent completion of a disaster medicine course in the Hunter region of NSW. Ten minutes later he was asked to pack up and join the 16-person deployment of rural GPs and physicians in public health, infectious diseases and emergency medicine specialists, plus nurses.
Once there, the team was spilt into three and between them they visited about 20 of the more far-flung islands of the Maldives, which has a total population of about 300,000 living on about 200 of the country’s 1200 islands.
“We were flown by a 1949 Indian Airforce cargo plane to a distant atoll, hopped onto the coastguard boat and then got onto a hospital launch which was our main transport from island to island,” Dr Adamski says. At night the team’s quarters were a tuna processing plant on a small island.
Most of the casualties had been cared for by local doctors by the time they arrived, a couple of days after leaving Australia, but they played other important roles.
“Our Australian flexibility came to the fore because we had anaesthetists doing general practice-type clinics and GPs doing public health assessments,” Dr Adamski says. “We just did whatever task was asked of us.”
On one island with a population of 2500, a health care worker and a nurse had been trying to care for patients with no medications.
“We set up a clinic and saw 100 people in a very short time, about 2-3 hours,” Dr Adamski says. “It was a lot of relatively simple respiratory infections, fevers and lacerations from the tsunami.”
But one of the most important roles the doctors played was to listen to the people’s stories and fears and to tell them that countries such as Australia cared about them.
Dr Adamski was often moved to tears. One of the saddest stories was from three teenage girls who had lacerations and respiratory infections after almost drowning. They were distraught because their grandfather had drowned saving them.
Another woman had lost her 11-month-old daughter. “An ED guy, and they are not necessarily noted for their touchy-feely stuff, spent an hour with her,” Dr Adamski recalls.
Since he returned to Australia on 8 January, Dr Adamski has been in regular contact with people from the Maldives to reassure them he has not forgotten their plight.
His actions bear out his words. He is preparing a proposal for the government to make free medical school places available to students from the Maldives because there are no universities there (see story, Tsunami aid: GP calls for free med school places, Australian Doctor, 21 January) and already has had discussions with members of his local Rotary Club about adopting an island and physically helping to rebuild it.
His latest plan is to ask Rotarians with communications expertise if they would provide advice on a radio communications system for the Maldives, because the country’s system fell into disrepair after the advent of a mobile phone network, which was damaged in the tsunami.
“I am daydreaming in between patients as to what I can do to help,” Dr Adamski says.
And what did his wife, young son and two teenage daughters think when they read the note? “They were very anxious, but also proud I guess, and a bit tearful.”
FLOOD OF FEAR
IN Sri Lanka at a tsunami refugee camp by the sea, the young children will only drink their rations of water after they have walked up to higher ground.
“They associate water with the tsunami,” says Dr Duleep Mendis, a rural GP in Mirboo North in Gippsland, Victoria, who has been helping with the aid effort since 6 January.
Every day he travels 80-100km south from the capital, Colombo, to various camps set up to provide food, shelter and medical aid to 1500 tsunami victims.
He says there are cases of diarrhoea, URTIs and skin infections, but one of the biggest problems is that people with pre-existing chronic conditions such as hypertension, diabetes and asthma had all their medicines washed away by the floods.
“For the past two weeks we haven’t had any medications of that kind,” he says. “We were prepared for acute things but we never thought of that aspect.”
All they can do is give the people prescriptions and hope they can get them filled at the local general hospital.
“I saw a lady who hadn’t had insulin for 10 days and I was surprised to see her in an okay state of health, but I had to refer her to the major hospital ASAP,” he says.
Dr Mendis finds the scenes of devastation in the country most distressing. “Some of the towns are a mass of rubble now and nothing is standing,” he says.
“Even now the people who were affected go to their areas to see them and although some of them have only partially broken houses, they still won’t sleep in them because they are scared of the sea.”
Dr Mendis admits the fear might be slightly infectious. “When you are driving down along the coast, you find you are turning your head and looking over your shoulder,” he says.
The fact that Sri Lanka is his birthplace makes coping with the tragic stories all the more difficult. “We hear of friends and other people close to us who have been killed,” he says. “And yesterday I counselled a woman whose only two children, eight years and eight months, were both washed away.”
Dr Mendis says he and GP colleagues are working up to 10 hours a day seeing up to 100 patients and acting as GP, counsellor and, in many cases, pharmacist. “My car is a travelling pharmacy now,” he says.
As soon as he heard of the tsunami disaster, he planned a hurried self-funded flight with two other GP friends.
“We informed the local hospitals and they were very kind to donate some antibiotics and all the things that we wanted,” he says. “And a travel agent managed to get us cheaper tickets and extra luggage allowances to take everything.”
The Mendis contribution to Sri Lanka has been a family one. His sister Dr Priya Mendis, also a GP, was one of the first to reach Sri Lanka after the disaster (Australian Doctor, 14 January) and has now returned to Melbourne, and his mother, Dr Olga Mendis, set up a Sri Lanka Disaster Fund that has attracted more than $60,000 in donations. Donations can be posted to Sinhala Cultural Foundation, 20 Hillard Street, Malvern East, Victoria 3145.
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