TamilWeek

by Mala Kadar, RN, MPH

In the aftermath of the devastating tsunami that slammed African and Asian countries
last December, the International Medical Health Organization (imhousa.org) flew
teams of physicians and nurses to northeastern Sri Lanka to set up medical clinics in
refugee camps in the districts of Batticaloa and Mullaitivu. The teams included Tamil-
speaking physicians and nurses, along with health care professionals of other
nationalities like myself. The areas that were populated by the Tamil-speaking minority
had experienced the brunt of the tsunami’s fury, causing the displacement of a large
percentage of the population who lived by the sea.

We flew to Colombo, the capital of Sri Lanka, and then traveled on land to Batticaloa.
It was an eight-hour journey because of the poor condition of the roads and the
numerous army checkpoints. Sri Lanka had been embroiled in a brutal ethnic war
between the government of Sri Lanka (the Sinhalese Buddhist majority) and the Tamil
minority from the northeast for the past 20 years. The logistical support for our
medical clinics was provided by the Center for Healthcare (centerforhealthcare.org), a
nongovernmental organization (NGO) that serves in the northeastern regions. More
than 66% of the damage had been in the northeast, with an estimated 30,000 deaths,
according to World Health Organization figures.

The village schools had been converted into refugee camps and there were
approximately 1,500 people in each camp. At Batticaloa, there were an estimated 75
camps. At least five to six families at a time occupied one classroom, each family
consisting of an average of three children and grandparents. They all slept on shared
mats on damp floors and had limited toilet facilities. International organizations, such
as UNICEF, Oxfam, and the International Red Cross, provided chlorinated drinking
water and dry rations, along with basic medical services. A committee of local village
elders supervised the camps.

We set up the clinic in a classroom and organized it into three stations – physicians,
nurse practitioner, and pharmacy counter – and instituted a triage system. The
majority of the cases were children with respiratory illnesses; the rainy season had
begun and the cold, damp floors and crowded living conditions were contributing
factors. Most of the women presented with symptoms of reactive depression, anxiety,
and apathy.

There was an urgent need for public health education for those in the camp to
prevent the outbreak of communicable diseases such as diarrhea or hepatitis A. Using
visual aids, I explained the etiology, signs, and symptoms of respiratory,
gastrointestinal, skin infectious diseases, and mental illness. We also discussed the
importance of hand-washing after toilet use and before meal preparation.

After exploring the areas surrounding the school with the committee of elders, we
decided that all waste had to be buried and containers with stagnant water needed to
be removed to prevent malarial and Dengue-producing mosquitoes. To make even
small changes needed gentle persuasion, but the committee agreed that it was best to
prevent an outbreak of communicable disease. I participated in the first cleanup
campaigns, collecting glass and debris that would cause injury, removing cattle
droppings, and disposing of unused containers that could become a breeding ground
for mosquitoes. The debris was also harboring snakes that had been displaced, and
some children had already become victims of snakebites.

I helped implement a health education training program for the health care workers in
the camps that included creating a public health training manual. The workers’ public
health knowledge was limited because of the decimation of the health system in these
districts due to war. I spent five days presenting the information to students who had
been selected by the various NGOs. More than 100 students received certificates for
training.

Upon returning to Colombo, I submitted a report that discussed the need for
continuing education programs. Nurses with public health knowledge could contribute
immensely. However, their was a shortage of nursing staff in Sri Lanka as well. The
Tamil nurses with whom I spoke were frustrated with the central government’s
discriminatory policy toward those who worked in areas of conflict, denying them the
pay increases that nurses on the rest of the island received. Moreover, they, too,
were being lured away by offers of foreign employment.

My accommodations were always in a village with the most basic amenities. I bathed in
well water, slept on mats, and watched out for snakes. I experienced the kind of
poverty in which an average family lived on an income of just $20 per month.
However, the people showed such appreciation for and kindness to a stranger who
had come to teach their children. I listened to their stories of sorrow, loss, and a life of
“darkness” that never seemed to lift — more than 20 years of civil war and, now,
nature in its fury — yet their resilience remained unfazed. [Courtesy: Nursing Spectrum]

Mala Kadar, RN, MPH
is a volunteer with the International Medical Health Organization.