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Quick Medical Aid Helped Ward Off Epidemics That Could Have Arisen in Indian Ocean Tsunami Disaster

by T C Lai

n the wake of last year’s December 26th Indian Ocean tsunami, nations affected by it were left to count the costs of the disaster. Many lives were I lost, livelihoods interrupted and property and infrastructure destroyed. Even as this story was being written the costs were still being measured: How many have died; what will happen to the fishing industry along the coasts; how are the wrecked towns and villagers going to be rebuilt; how are the lives of the survivors, so fractured by loss of kin and property, going to be pieced together ever again? At the time of press, 226,000 people have perished. As the situation stabilizes, a more accurate picture of the number of lives lost will emerge putting to rest accusations of double-reporting and hysterical accounting. And it appears that things are finally settling down, with fears of aftershocks diminishing, and the many affected receiving the aid they need. Relief operations are moving from providing immediate aid to giving assistance in rebuilding. And so, many foreign military helpers, such as those from the US and Singapore, who were quick to respond when the disaster struck, are preparing to leave. Said Admiral Thomas Fargo, commander-in-chief of the US Pacific Command: “No deadlines or datelines have been established. My observation here is that we are pretty much past the immediate relief phase and are rapidly moving towards rehabilitation and reconstruction.” The initial fears of a disease epidemic due to the high number of corpses in the open and of drinking contaminated water appear to be unwarranted. However, this is probably not due to improved circumstances but rather the efficient arrest of a potential problem through the quick supply of medical aid and equipment. This is best illustrated by the quick action of the Singapore Armed Forces who were the first to arrive in Meulaboh, one of the worst tsunami-hit areas in the Aceh province. The SAF brought with them not only disaster-relief food supplies, but construction materials and much needed field medical equipment to treat wounds and fight disease. It was on December 30th — just four days after the tsunami struck — that the SAF sent its first heavy-lift Chinook helicopters to Meulaboh with a cargo full of food.

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The next day, the RSS Endurance, a 141-meter long, 6000-ton landing ship tank was dispatched, carrying 470 people, including a 33-strong medical team, Singapore Civil Defence Force members, combat engineers, divers and guardsmen. The ship also carried 51 vehicles and heavy equipment like bulldozers, forklifts, excavators, dump trucks, mechanical shovels and generators. There were also 350 pallets and crates of relief supplies. It arrived at Meulaboh on January 2nd. But before the ship could land and its supplies off-loaded, landing sites had to be identified and prepared amidst all the debris and devastation along the Meulaboh shoreline. This, the SAF divers did with the help of their fellow combat engineers. In no time, 700 sandbags were filled and padded down for the safe landing of those craft ferrying bulldozers that were so desperately needed to clear and lift debris in the devastated region. The SAF also set up a field hospital in an identified displaced persons camp location. The rest of the troops helped prepare landing sites for more helicopters to use. On January 6th, another ship, the RSS Persistence, further ferried another 196 men, including navy crew, combat engineers and guardsmen. Besides other work, they helped prepare a 5- to 7-kilometer stretch of road leading from the shore, which was damaged by the waves. Four container loads of supplies like 200 cement packets and 27 pallets of rice, water, milk and milo, were also brought to supplement the supplies before. The SAF also brought along very critically-useful water purification trucks that acted as portable water dispensers to the relief effort. Using a reverse osmosis process, these trucks churned out almost 3000 liters of clean drinking water everyday for the refugee camps there. How the lives of such displaced persons were protected from catching debilitating diseases through drinking contaminated water cannot be praised enough! Besides these trucks, the SAF also (in partnership with the Defence Science Organisation of Singapore) set up a field lab in the disaster zone to support the detection of any epidemic activity. Just returned home, volunteer Dr Low Cheng Ooi, head of orthopedic surgery at SingHealth recalled “SAF expert personnel working tirelessly to test water samples everywhere.” Dr Low was part of two surgical teams dispatched to help in Singapore’s Humanitarian relief operation. One team operated at the medical center in Meulaboh Hospital whilst another was sent to Banda Aceh.

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Reflecting on the dire situation there, surgeon Francis Seow-Choen said: “What we did was against our basic training. There was no sterility ... we were using the same instruments on different patients; we were operating on patients who were screaming in pain. But all of us (doctors) knew we had to do it or the patients would die.” In the three days there, he was said to have performed 50 operations! Dr Low concurred, saying that his period of volunteer work was marked by “chopping and sewing, typical of everyday surgical work.” He felt that even with the best equipment they had, the number of cases was just overwhelming. At another treatment center in Aceh, it was reported that doctors were seeing at least 600 patients a day. A disaster of such large-scale destruction and loss of lives demanded the quickest response. Equipment and people had to be assembled in double- quick time. Dawn Neo, executive, Services, Singapore Red Cross said her organization’s reaction to the crisis was probably a record of sorts. A typical relief operation normally takes ten days, she said. For this tsunami disaster, they took three. “We had only three days to prepare and send teams to Tricomalee in Sri Lanka (one of the worst-hit there),” said Neo. “First response medical relief supplies are typically quite straightforward and simple the usual bandages, IV drips, water purification tablets, etc. There isn’t much high- biotechnology. I guess the priority is to give people immediate relief. Later, there might be a need to exercise disease control to prevent an epidemic from starting. Perhaps then, anti-serum drugs, for typhoid, tetanus, hepatitis A, may be needed. If so, some cold-chain supply equipment, e.g. a fridge, may be brought in. For example, at the moment, there has been a request for medication against measles in Aceh. “The current problem with many infectious diseases is that they are spotted when people contract them, not easily foretold by some advanced diagnostic kit,” she added. Perhaps things are a-changing. Said Dr Low: “I seem to recall Medicin Sans Frontieres (MSF, a volunteer medical relief group from France) having this quick diagnostic kit for detecting the malaria parasite. It was much faster than doing diagnosis peering through a microscope.” Are there other areas of field medicine to improve on? Dr Low said: “I guess one other area of improvement could be in the testing of blood for electrolytes in the field. Blood analysis action was not going too well and we had to depend on the

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Indonesians (who had the equipment) to supplement that.” Of course, in any disaster relief operation, communications is just as important as any medical kit. At Meulaboh, SAF specialists were roped in to help an Indonesian firm restore mobile phone services there. Communications specialists were also part of the relief teams sent by the Red Cross. Neo added: “Without effective communications, relief work coordination is difficult. Our specialists bring with them GSM- based mobile phone network equipment and try to connect it to the outside world as soon as possible. They also have with them means of satellite-based communications.” One could see how important this can be. Even as Neo was being interviewed, her handphone rang a few times as Red Cross comrades called in from the frontline requesting additional relief supplies. Dealing with the living is just one aspect of a relief operation; there’s also the dead to worry about. Dr Seow-Choen’s comment was typical: “There were hundreds of bodies by the road, thousands clogging the river, packed close like dead fish or logs. There were cars with rigid bodies hanging in the air.” Identifying so many bodies is going to be a major challenge. Said Eileen Lew, executive, Control of Operations, Ministry of Health Singapore, who helped assemble teams of forensic technicians and doctors for the Singapore humanitarian relief effort: “Yes, it is difficult. DNA matching is one way. But to do that, we need also to take identity samples from the victim’s next- of-kin to match as well. In our teams, we also include a dentistry forensic expert.” In this tsunami disaster, many of the dead were children. (In Sri Lanka, it was heartbreaking to learn that what used to be a busy village school by the sea was left with but few children.) Even to such dental forensic experts, identifying them is doubly

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difficult as many do not have dental records. With so many dead and the state infrastructure gone, as in Meulaboh and Banda Aceh, finding next-of-kin and dental records are going to be tough. It such a situation, it is proving that foreign victims stand a better chance of being identified. Compounding the problem is that many of the corpses are very badly decomposed. It is proving to be one very challenging forensic task ahead. Perhaps it is time that we all carry a microchip in us just in case we get caught unawares in another disaster! Lew worries about the dead as she does the living. Said her: “We have also dispatched Emergency Behavior Officers or EBOs out as well. These officers are skilled in the counseling of victims involved in disaster and other emergency situations. Well, not just the victims, but the relief workers as well. They do need as much mental healthcare as the surviving victims at times.” The speedy response of the Singapore military to the disaster at Meulaboh and Aceh drew much praise from not just the Indonesian president and others, like the United Nations Relief Agency, but at home too. One Member of Parliament of Singapore even expressed surprise at the speed with which the government acted “without any second thoughts” to aid a neighbor in need. Prime Minister Lee Hsien Loong, who visited the devastated sites in Aceh before flying on to Jakarta for an international conference to coordinate aid relief, said: “This operation costs us S$20 million dollars (US$12.2 million), but it is not about the money. It can never be. It is about helping a neighbor in need, about being a responsible and caring international citizen.” Well said, an apt description of the many who selflessly risked their lives to save those who were drowning when the tsunami struck, and now, the many who are giving up their personal time and rewards to be stationed in Indonesia, India, Sri Lanka, Burma, wherever help and equipment are needed, to lend a hand or just a listening ear.

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