The Essentials of Aid
	An Australian doctor relates her experience
	By Ranjana Srivastava

Posted Monday, March 28, 2005; 20:00 HKT
I was visiting my parents in Bihar, India, when I heard about the tsunami. I wanted to go to the country's battered southern coast to help, but I couldn't get a clear response from the local authorities. So I headed instead to the Maldives, posted by Britain's Commonwealth Service Abroad Programme to Buruni, an island 24 hours by boat from the capital, Malé. Coral reefs had protected the Maldives from the full force of the tsunami, sparing all but 108 people. But this nation of low-lying islands suffered terribly from the subsequent flooding. Although no one on Buruni died from the tsunami, and the worst damage was waterlogged houses, conditions there were primitive, and its isolation meant that getting prompt assistance was impossible. I was to be the only doctor on the island, looking after some 1,500 people.

Most of those people came not from Buruni but from nearby Vilufushi, an island where 17 people had perished and where every house had been reduced to rubble. Buruni's residents welcomed these refugees, and the population tripled overnight. People were living 30 to 50 to a house; one that I visited had 71. Makeshift partitions separated the families. Old clothes, food aid, soiled mattresses and threadbare sheets spilled from every corner. Not one temporary shelter had been completed. Buruni lacked the basics—medicines and latrines—as well as dedicated transport from the capital, which stalled the rebuilding process.

Sanitation was a nightmare. Dozens of people shared one bathroom and, as generosity understandably ebbed among the hosts, tensions ran high: I saw one old woman beg to use a toilet at 10 houses. Turned down at every door, she squatted over the sand. The men simply went to the edge of the island every morning. Children tried to use the meager school facilities as much as possible, but they competed with scores of construction workers for use of the three toilets.

The situation at my health clinic was cruelly ironic. It employed 14 staff—all local except for me and an Indian nurse, and all constantly busy with never-ending paperwork. Registers were signed, lists shuffled, forms designed, faxes sent, drugs adjusted and readjusted on shelves. A patient was registered outside, then again a minute later on entering my clinic. My diagnosis and prescription were recorded, then the patient went outside and all the details were recorded again in yet another book. Despite this, I rescued many patients about to walk out with either the wrong drug or the wrong quantity.

The pharmacy was paved with so many cartons of humanitarian relief that I could no longer enter the room. It was a striking display of foreign generosity, yet the rationale for what had been dumped here was sometimes hard to decipher. Chest-drainage systems, blood-transfusion sets and oxygen tubing lay about, irrelevant in this basic environment. Drugs labeled in foreign languages were piled in an unused corner. But nothing created such a predicament as the gift of a blood-glucose monitor. One afternoon, a local medical team arrived on the island, tested 150 adults for diabetes, referred all abnormal results to me, and left me with the monitor. The first referred patient I saw was a 60-year-old man who tottered toward me, his niece carrying a sheet of paper with neatly inscribed blood-sugar readings. He was clearly diabetic, newly diagnosed but already blind, suggesting that the disease had been untreated for a decade. I looked at the meager supply of drugs available and gave him a small dose—enough to make both of us feel better for a short time.

In my first few days, I made a list of essential drugs of which we needed more—tetanus shots, antibiotics, antifungal creams, local anesthetic, and pain relievers—and faxed it to local medical authorities, who promised quick delivery. Weeks later, after many more requests, the supplies still had not arrived. Meanwhile, children limped in the streets with pus-filled wounds sustained during the tsunami and aggravated by a lack of medical attention; anemic women were too weak to have a conversation; and men, injured as they tried to build shelters, cried for relief from welding burns and nails embedded in their flesh. A pharmacy overflowing with aid, a population suffering from disease, yet it was a lucky day when the two met.

Now that I have completed my six-week stint on Buruni and am back home in Chicago, I keep wondering: What should have been done differently? In the small health clinic that was my world, I would have got rid of all but the most essential paperwork. I would have told donors that a boat to bring vital medicines and to ferry patients to the regional hospital would save more lives than a dozen unwrapped, sparkling instruments. I would have told aid agencies that their supplies do not determine patients' needs. It's not a lack of money that sinks hope, but a failure of organization.

I have found some consolation in the first lesson I learned when I was at medical school: the human body has a remarkable capacity to heal. I repeated this mantra to distressed parents, anxious teachers and suffering patients alike. But most of all, I repeated this to myself, after another long day of battle fought, and lost, on Buruni.

Ranjana Srivastava, 30, is an Australian doctor of Indian descent who is studying at the University of Chicago on a Fulbright scholarship

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