Need remains great post-tsunami, medical student reports

I pondered medical causes such as diabetes or a urinary tract infection but in this instance the cause was likely to be non-medical. Five weeks earlier she had avoided drowning in the tsunami by clinging desperately to a palm tree. She was discovered two days later still holding the tree.

The limited tests I conducted were normal. Sadly, it was impossible to order others. Her symptoms were likely of psychiatric origin, but as we did our best to offer her support I noticed another problem. A 1-inch diameter wound on her left leg appeared grossly infected, dangerously deep and at risk of infecting the bone. We carefully instructed her and her grandmother on how to dress the wound and look for signs that the infection had progressed. They left with sterile dressings, tape, topical antibiotics and a course of oral antibiotics.

Even as thousands of Sri Lankans try to resume the rhythm of normal life—going to school like this girl, opening shops and taking fishing boats to sea—a variety of wounds from the tsunami still remain to be treated.

I left medical school at the end of January to spend roughly 12 days doing relief work in Sri Lanka, the country that my family is from and where as many as 38,000 people have been reported to have been killed.

The nonprofit aid group International Medical Health Organization/Center for Health Care accepted me in January as a volunteer, and several weeks later, unsure of what to expect, I arrived in Sri Lanka. I traveled with my mother, who could work as a translator in Tamil, Sinhalese and English, and Elizabeth Erin Rogers, a pediatrics resident at UCSF and close friend from medical school. The IMHO dispatched us to Batticaloa, a city of about 315,000 on the hard-hit eastern coast.

We arrived there very uncertain of the extent of the medical need. But on the first morning of seeing patients, it became obvious that the need was vast. In 15 minutes our group—with the help of several volunteer nurses from England and Norway—set up clinic in an open-air elementary school classroom in a small town on the outskirts of Batticaloa. Within one hour, it was packed, with an overflow of people waiting outside. There was no patient privacy, and a constant throng of people crowded around as I examined people on our makeshift exam table—two school desks pushed together and wiped off with a disinfecting towelette. I managed to do heart and lung exams but was forced to steer back onlookers to gain space for the occasional hip or abdominal exam.

Seven hours after arriving, we stopped for the day. I had seen 70 patients, and Liz, the pediatrics resident, had seen more than 50. Over the next few days, as we set up mobile clinics in other regions, we continued to attract crowds.

On the first day alone, we saw perhaps 20 adults who had lost their blood pressure or diabetic medicines when the waters hit and now needed re-evaluation and new medicines. One gentleman arrived with his blood pressure 250/131—I rechecked it twice and was so shocked that I checked my own pressure twice to ensure the cuff was working.

Throughout the visit we also saw a number of acutely asthmatic patients, who were started on inhalers that we brought and steroids. We treated many other adults and children with PTSD (post-traumatic stress disorder), dehydration, lower back pain, sciatica, neurological symptoms, upper and lower respiratory infections, diarrhea and infected leg wounds from standing with cuts in still water.

I watched one day as Liz treated a boy, 6 or 7 years old, his foot peppered with penny-sized abscesses. With no scalpel to lance them, she used sterile needles. On other occasions, we used the wooden edge of a sterile Qtip to open the abscess. My mother, overwhelmed at one point by the plethora of infected foot wounds, threatened to stop mid-translation to go to town to buy a hundred pairs of shoes. She settled on giving the coordinator U.S. dollars to buy rubber Bata slippers at 40 cents a pair.

Throughout the visit, I struggled with the language difficulties that emerged —even with a translator. On one occasion, I asked the patient via the translator: "Is there blood in your stool? When was your last bowel movement?" Twenty minutes later, I received the answer: "She says that a coconut fell on her head, and since then the fourth toe on left foot has been hurting."

At the end of each visit we felt some satisfaction in addressing in part the problem at hand, hugely grateful for the experience, and glad to offer some much-needed supplies. I was—and still am—filled with gratitude to Lars Osterberg, MD, clinical assistant professor of medicine and medical director of the Stanford-run Arbor Free Clinic in Menlo Park, for providing me with such antibiotics as augmentin and levofloxacillin and the heads up "these will be very useful!"

That week we gave away not only much of those medicines but also toothbrushes, thermometers, wound dressings, feminine hygiene products, multi-vitamins and iron and rehydration tablets from Stanford, UCSF and other donors.

While the acute need is perhaps at bay, there remains a need for chronic medical care and accessible clinics and facilities outside of the main city. And the benefits of aid can be quickly apparent.

A few hours after the girl with the infected wound left with the bundle I gave her, she returned as we were packing up our supplies. She proudly showed me how well she had dressed the wound by herself, following our instructions perfectly. Despite the language barrier between us, we were both beaming.

Niroshana Anandasabapathy suggests that individuals wishing to help victims of the tsunami in Sri Lanka consider donating to VeAhavta (http://www.you-shall-love.org) or the International Medical Health Organization, P.O. Box 901, Bel Air, MD 21014-0901. For additional information about the group, please visit its Web site http://www.imhousa.org.

Posted 3/7/05