Outreach programs aid battered health care systems in tsunami-affected areas

After a tsunami devastated coastal areas of South Asia, the mission of many NGOs is to rehabilitate health services through long-term support.

The tsunami that devastated South Asia in December 2004 precipitated an international outpouring of support that helped alleviate the immediate need for food, clothing and first aid. However, the rehabilitation of affected areas will require long-term devotion and the concerted effort of many groups to help survivors reclaim their lives.

“There’s a lot of work to be done, and the real work starts now,” Sunita Agarwal, MS, FSVH, FRSH, DO, of Dr. Agarwal’s Eye Hospital in Chennai, India, told Ocular Surgery News. She said that the coast of Chennai was affected by the tsunami, which killed more than 25,000 local people and left more than 100,000 homeless.

The Dec. 26 tsunami, which was triggered by an earthquake 90 miles off the coast of Indonesia, killed more than 220,000 people in more than a dozen countries surrounding the Indian Ocean.

“A number of hospitals in Chennai were demolished by the tsunami,” Dr. Agarwal said. “The clinics and everyone in them just went away with the water.”

In the Banda Aceh and North Sumatra provinces of Indonesia, where the World Health Organization (WHO) estimates that 150,000 people died, more than 50% of the health care workers were killed or reported missing.

“In the aftermath, health care was nonexistent,” said Sjakon G. Tahija, MD, a vitreoretinal surgeon at the Klinik Mata Nusantara in Jakarta, Indonesia, and a founding member of The Tahija Foundation, a social organization that has provided outreach services to tsunami-affected areas.

He said that many health care workers died in Banda Aceh, the hardest hit area in Indonesia. Of his colleagues, he said “an ophthalmologist was killed, but his family survived. Another ophthalmologist survived, but her husband, children and hospital staff perished in the tidal wave.”

Long-term rehabilitation

Early on, government officials and international nongovernmental organizations (NGOs) knew that providing survivors with immediate necessities was key, but beyond that need, the rehabilitation of damaged health care systems was vital.

“We must look beyond immediate relief to rebuild lives, livelihoods and systems,” said David Nabarro, MD, executive director of the WHO’s sustainable development and healthy environments division, in a statement. The focus of many NGOs such as the WHO has since hinged on planning for long-term restoration of health care systems.

“A key challenge is the re-establishment of the health system at all levels,” said Colin J. Davies, project coordinator of The Tahija Foundation’s Aceh Project, an “Assist a Village” program that was established after the tsunami to help rebuild two Banda Aceh districts.

In an update on the Aceh Project, Dr. Davies reported that “reconstruction of the health sector is reflected through [the] re-establishment of activities as before the tsunami; for example, nutrition, malaria, curative health services, maternal and child health.”

Emergency care

In Chennai, Dr. Agarwal and volunteers from the Agarwal clinic began administering aid to displaced refugees on the coast within days of the tsunami; they have since set up several long-term eye camps in those areas, she said.

“We privately organized our own collection, and within a few days we were able to gather 7,000 kilos of dry food, like rice, flour, sugar and powdered milk. We distributed these staples to about 1,000 families,” Dr. Agarwal said. She and her colleagues also collected blankets, medical supplies, antibiotics and ointments, an d clean drinking water to distribute to families whose homes had been destroyed by the tsunami.

“We put all the supplies on a lorry and took them throughout the coastal plain,” Dr. Agarwal said. With the help of the Indian ministry, Dr. Agarwal has returned weekly to distribute food and provide medical care to people living in the refugee camps, or “kuppams.”

“There are thousands of people living in kuppams. They are completely homeless,” Dr. Agarwal said. “People are living beneath enormous plastic tarps in an effort to keep out the elements. They have little to no food, firewood or utensils to cook with.”

She said that the Indian government is planning to build shelters for displaced families to live in, but the process may take months or years.

Ocular aid

During her first visits to the kuppams, Dr. Agarwal said that the incidence of ocular trauma was more extensive than she had expected.

“There were a lot of eye injuries, like corneal opacity, because many people were hit by the rocks and rubble that came out of the sea. People who ran for higher ground had a lot of foreign bodies in their eyes, like sticks,” she noted. Dr. Agarwal estimated that 5% of injuries were eye-related.

“This is a significant percentage when you consider that the eye accounts for less than 1% of the whole body,” she said. Other ocular injuries included lacerations, eyelid trauma, corneal abrasions, perforations and traumatic cataract.

In addition, the debris that settled on the coastline in the aftermath of the tsunami triggered allergic reactions in many people, Dr. Agarwal said. “Asthma, allergy and dry eye was rampant,” she said. “We distributed eye drops and ointments to people with eye allergy or infection.”

She said that some people tried to fight infection with alternative treatments, such as creating an antibiotic ointment with turmeric paste and herbal leaves.

After providing free food and medical care to the victims, Dr. Agarwal said that the need for permanent medical stations on the premises of the coastal kuppams was evident. Within days, first aid camps were set up.

“In the camps, we cover everything from fever and chest wounds to bruises and infection,” Dr. Agarwal said. Patients who require ocular surgery are transported inland to Dr. Agarwal’s Eye Hospital.

Restoring hospitals

The Tahija Foundation’s “Assist a Village” program is currently focused on restoring health care facilities on the coast of Indonesia that were damaged by the tsunami.

“We are rehabilitating two clinics in Banda Aceh that were demolished by the waters,” Dr. Tahija said. One clinic, the Puskesmas BLKM in Baiturrahman, was a large general health practice that served as a training center for young physicians.

“It was severely damaged and filled with mud after the tsunami,” Dr. Tahija said. When aid workers entered the clinic to begin draining the mud, he said, 15 bodies were discovered.

Providing specialist care

Once public health officials and NGOs rehabilitate primary health facilities in tsunami-affected areas, efforts can be aimed at providing specialist care, Dr. Agarwal said.

In Chennai, Dr. Agarwal’s Eye Hospital has begun this process.

“After the tsunami, eye surgery was reserved for patients with pathology that originated from the disaster, but now we are treating all patients with cataract, opacities and ocular illness. Many of these patients never would have received these services in their own villages,” Dr. Agarwal said.

“We are continually holding eye camps in affected areas; we plan to go every week. This has become a routine venture for us,” Dr. Agarwal said. “We have adopted these areas.”

For Your Information:

• Sunita Agarwal, MS, FSVH, FRSH, DO, can be reached at Dr. Agarwal’s Eye Hospital, 15 Eagle St., Bangalore 560025, India; +91-80-2222-3100; e-mail: dr_agarwal@vsnl.com.
• Sjakon G. Tahija, MD, can be reached at P.O. Box 6032 MT, Jakarta 10310, Indonesia; +62-21-5261415; fax: +62-21-5261416; e-mail: sgtahija@austindo.co.id.
• David Nabarro, MD, can be reached at the World Health Organization, Sustainable Development and Healthy Environments, Avenue Appia 20,1211 Geneva 27, Switzerland; +41-22-791-21-11; fax: +41-22-791-3111.
• Colin J. Davies can be reached at P.O. Box 6032 MT, Jakarta 10310, Indonesia; +62-21-5261415; fax: +62-21-5261416.

• Nicole Nader is an OSN Staff Writer who covers all aspects of ophthalmology, specializing in pediatrics/strabismus and neuro-ophthalmology.