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| Sunday, 16 January 2005 |
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Features |  |
| News Business Features Editorial
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Beware of post tsunami diseases by Carol Aloysius Sri Lanka's health system has stood up remarkably well to the beating it received from the recent tsunami disaster. That is, compared to most other tsunami affected countries.
The WHO Director General was also quoted as saying that clean water and antibiotics were the need of the hour. He also noted that there were no major epidemics thanks, to the efforts of the health officials who were working hard to keep diseases like diarrhoea and dysentery which were the result of impure water and poor sanitation, from spreading. An outbreak of influenza in Matara and Hambantota and a viral flu similar to the flu leading to pneumonia that led to the death of some patients just before the tsunami, have also been reported. Asked for his comments, Dr. Nihal Abeysinghe, Chief Epidemiologist admitted that there could be a spread of some of the vector borne and water borne diseases, unless adequate stocks of clean drinking water reached every single camp and proper environmental hygiene was maintained in these camps." The National Water Board is already providing clean water to the camps. But if any persons are not at the receiving end of such water, they should complain to the G,A who in turn will inform the AGA and government niladharis who have representatives in each camp", he said. He said that his unit had sent out teams of officers to monitor the health status of all refugee persons and obtain reports from the camps" so that we can act accordingly". As the number of displaced persons were so large, he said that it was not possible to have a 'blanket' covering. Whenever a case of diarrhoea or dysentery or hepatitis or some other contagious disease is reported, we have to study each individual case separately, and then take remedial steps to prevent these diseases from spreading". For example every case of viral flu doesn't mean that the victim will end up with pneumonia. We have to identify the cause, study the patient's condition and act accordingly". Regarding the distribution of cooked food, he said," We have categorically stated that no cooked food should be brought to the camps from outside. "Instead, we are encouraging people to cook their own meals inside the camp premises using clean water and fresh ingredients, to avoid getting bowel related diseases". He added that diarrhoea was the' biggest health threat', facing displaced persons in refugee camps, largely due to drinking impure water. To ensure that safe drinking water was available to these persons, the Epidemiology Unit was distributing chlorinated tablets and TCL chlorine in powder forms along with instructions on how to use them to clean well water. "If anyone does not know how to purify water using these tablets, they can seek the help of the PHI's and MOH's in the area", Dr Abeysinghe said. What about common diseases such as mumps, chicken pox, measles , hepatitis, malaria and dengue which usually occur following floods or heavy rains? "These are endemic diseases. A few cases have been reported from Kalmunai, Gampaha and other districts. Our main aim is to see that they don't spread". Dr. Abeysinghe stressed the importance of close collaboration between all those working in the medical field with the Health Ministry. "We have a government system that is already in place. It is our duty to see that we strengthen it by working with the Health Ministry and the government, instead of individually. It is only by closely collaborating with the official system that we can get a true and clear picture of the overall health situation in the country", he said. Fearing an outbreak of rabies and animal related diseases, informed sources told the Sunday Observer that veterinarians have decided to set up a Veterenarian Medical camp at Unawatuna to inoculate stray dogs. Disease control Living in close intimacy with strangers or even friends could lead to physical contact and sexual relationships that can result in sexually transmitted diseases. We asked officers at the National Program for Sexually Transmitted Diseases Control for their opinion on this subject. Dr. Kulasiri Buddhikorale, Consultant for the Program, said that this was an area that had to be addressed with a great deal of care. Unlike in certain other affected countries where the incidence HIV/AIDS was very high, he said that the prevalence rate in Sri Lanka was comparatively very low. "We will not be going into camps to identify high risk groups for these diseases since all those who are internally displaced are at risk. Instead, we are encouraging the distribution of condoms in these camps and any NGO is welcome to obtain them from us for distribution in these camps. If there is any health risk among the inmates, the doctors attending to them at these camps will direct them to the nearest clinic. " He added that the medical officers of health, Phi's and Public Health Nurses could play an effective role in this area, as they were directed to give talks on Reproductive Health and Family Planning at these camps. Unprecedented goodwill In a gesture of unprecedented goodwill, Sri Lanka has been at the receiving end of a seemingly unending flow of foreign aid. Manpower, equipment as well drugs and medicines as well as very generous cash donations from countries around the world have arrived to expedite the process of rehabilitation for the tsunami victims. Australia has sent a team of five government doctors while several volunteers have also shown up on their own. The five doctors who were sent on a government request visited all the tsunami affected areas including the north and east, a spokesman for the Australian High Commission said. They also brought with them 2-3 shipments of medical supplies which were handed over to the Health Ministry, a spokesman for the Australian High Commission said. Hungary sent a team of 15 doctors to look after the needs of the tsunami, survivors, sources from the Hungary embassy said. The estimated number of foreign medical teams that have come and gone or are still in Sri Lanka according to a spokesman for the Centre for National Operations are as follows: Britain has sent approximately 3-4 teams , the US around six teams, India two teams. The countries from where the largest number of medical volunteers have been reported are: Germany 23 in one team; Bangladesh 40 people in one team, Thailand 30 in one team, Russia 38 in one team.' According to the CNO spokesman, all these doctors have arrived bringing their own equipment i.e. sleeping tents, food, cooking utensils etc. "The condition is that they find their own food and accommodation or else pay for it if we put them up in hotels", the CNO spokesman said. He added that all the volunteers had been most co-operative and worked in close co-operation with the government medical officers in the affected areas including the North and East. "We do not send them to the hospitals because the real need is in the camps since people living there do not have transport facilities to reach the hospitals. This work is going on smoothly, except for the fact that we still need to fill some gaps in communication and transport". Ensuring the health of thousands of persons left stranded in makeshift refugee camps around the island is no easy task, as those involved in this daunting work will tell you. It involves such things as overseeing the immediate environment, supervising cooking of meals in a camp setting, ensuring good nutrition status especially among the young, old and mothers-to-be, comforting the traumatised and the grieving, protecting children and adolescents from sexual abuse, and helping them to start life new in a positive way. This surely is a daunting task for any country. To undertake this superhuman task , we need not only foreign assistance and expertise, but the wholehearted and voluntary support of the country as a whole, whether in our private capacity or as representatives of the government. Only then can we truly rise from the ashes of the tsunami. *** Psychological disorders Post traumatic stress disorders (PSTD) is currently being used to describe the psychological disorders affecting tsunami affected persons, especially those who have been displaced from their homes. Do these persons need counselling right now? If so how can this be done in their overcrowded surroundings? Contrary to belief that counselling is the need of the hour, Rajitha Fernando, a psychologist attached to Richmond Fellowship Lanka says he does not advocate counselling to these displaced persons right now. "My personal view is that the people in these camps are not ready for counselling at this moment. They are still adjusting to their present conditions and trying to get over the shock of being deprived of their homes and loved ones. What we need to do is to go to these camps and listen to what they have to say. We have to attend to their physical needs first, and show them that we care for them and empathise with them." when will counselling be useful? "Perhaps in a month or two", he says. "By then hopefully they would be out of the camps, in a more permanent and more conducive surrounding". What about little children? "We have to ensure that they get back to their normal activities like school and play. Those living in camps must see that children have some space of their own to play , draw and interact. Counselling can be done for them only when they are in normal surroundings." In the case of the elderly, he says, "They are now living in a dream world. We have to bring them back to reality and show that what has happened is over. The sooner we take them out of the camps the better, before they can develop negative thoughts and consider themselves as refugees, thus losing their self esteem in the process. Counselling can follow afterwards". Britto Motha, Vice Chairperson of Sumithrayo agrees. He says that 127 counsellors attached to Sumithrayo were recently trained on trauma counselling. Asked if these persons could turn suicidal, he says that from his personal observations and thanks to the attention and interaction they were getting at the camps most of the inmates were not suicidal. "It is only when they are isolated and feel lonely that their thoughts could turn to suicide", he says. "Fortunately, since all the people in these camps share similar experiences, they can empathise and share each other's experiences and thus get over their feelings of isolation", he said. He too believes that counselling was not appropriate right now to most of these survivors living in camps. "We should befriend them and show that we care and love them. Only when they have accepted the reality of what has happened to them will they want to be counselled". |
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No less than WHO's Director General Dr. Lee Jong Wook has gone on
record as reiterating this fact at a media conference after a brief
fact-finding visit here, when he paid a compliment to the health officials
and health volunteers from NGO's and visiting countries who he found
working round the clock to oversee the health needs of displaced persons
in refugee camps.
