25 November, 2005

Tsunami - after the wave. Session 161 2005-6: Meeting II

The Society met in the Ebenezer Duncan Centre at The Victoria Infirmary on Thursday 24th November 2005 at 7pm. The President, Dr Philip Wilson, was in the chair.

Sederunt 35
I Apologies
Apologies were received from Dr David Kidd.

II Minutes
The minutes of the meeting of 13th October were accepted. Dr Wilson reminded members that minutes are published on the Society's website in addition to the written minute in the Society's minute book.

III Christie Cup
Dr Wilson presented the Christie Cup to Dr Ewing Forrester for winning the Bogey Competition at the Society's golf outing on 6th September.

IV Next meeting
Dr Wilson announced that the next meeting of the Society will be a joint meeting with the Royal Medico-Chirurgical Society on Thursday 12th January 2006 at the Royal College of Physicians and Surgeons of Glasgow at 7.00 for 7.30pm. The lecture will be given by Prof Alan Silman, ARC Professor of Rheumatic Disease Epidemiology and Director of the ARC Epidemiology Unit at the University of Manchester. His talk will be entitled 'Clinical trials – do they always give the right answer?'

V Dr Willox's lecture
The President then invited Dr David Willox to give his lecture to the Society recounting his experiences as medical officer for the charity Glasgow the Caring City in the aftermath of the Asian tsunami. A précis of the paper follows this minute.

At the close of Dr Willox's talk, and following interesting discussion, the President called upon Dr Duncan Macintyre to move a vote of thanks to Dr Willox. This was most heartily responded to by members of the Society.

This was all the business and Dr Wilson closed the meeting.

Tsunami – after the wave
Dr Willox described Sri Lanka as a beautiful land populated by beautiful people. The warm currents of the Indian Ocean lap on sandy beaches. Along the coast, fishermen and their families live in small villages beside the shore. You might be forgiven for thinking that this is paradise. This is the picture you might have imagined on 25th December, 2004. Within 24 hours, all this changed. The Asian tsunami on Boxing Day killed a quarter of a million people, of whom 40,000 died in Sri Lanka.

As soon as reports of the tsunami reached the UK, local charity Glasgow the Caring City mobilised support and began collecting donations. Through the involvement of his wife Morag, Dr Willox volunteered to drive a van round Glasgow to uplift bags of clothes and other gifts. He soon found himself acting as medical officer to help sift through donations of medical items. It was a natural next step to join the small team of volunteers and fly out to Sri Lanka to begin the long process of supporting relief and regeneration.

Dr Willox described the destructive power of the waves. He showed photographs of shattered buildings, dead animals and birds, and the massive human toll. He showed how the scale of the debris was overwhelming. On closer inspection, what appeared to be small mounds of wood and masonry were, in fact, the bodies of men, women and children. In temperatures of 42°C and oppressive humidity, the smell was unbearable.

In March 2005, three months after the tsunami struck the coast of Sri Lanka, a team of volunteers from Glasgow the Caring City flew out to the Hikkaduwa region. Dr Willox and the rest of the team spent two weeks assessing needs and setting up projects. The only forensic pathologist in the area, Dr Clifford Perera, had been faced with the task of managing 6500 bodies. To put that in perspective, relief workers from Leicester indicated that 200 bodies over two weeks would be enough to strain local services in the UK. In spite of this, Dr Perera remained remarkably positive and the relief team were able to help him with donations of computer equipment and fund travel to a conference in Thailand on disaster victim identification and management.

After the terrorist attack on the twin towers in New York on September 11th 2001, people posted photographs of their missing relatives on a wall. In contrast, Dr Perera was only able to create a 'wall of the dead' – photographs of the dead bodies yet to be identified. In the scramble to recover and identify bodies, villagers claimed that a team of scientists from Interpol investigating the deaths of foreign nationals had shown callous disrespect in their handling of the bodies of local people.

Dr Willox went on to show photographs of the Galle to Colombo train which was partially derailed at Peralyia by the first tsunami wave. As the water withdrew, people sought refuge in the railway carriages, only to be caught by the second wave. There were stories of people lying injured and dying three days later when the press and news media arrived. Government rescue teams are said to have taken a further seven days to reach the scene. The official death toll was given as 1500, though the true figure is certainly much greater. In spite of this, Dr Willox was reluctant to criticise the Sri Lankan government given the scale of the disaster. A permanent memorial of three railway carriages has been created on the site.

It is easy to underestimate the difficulty of conducting worthwhile work in the aftermath of such a large disaster. The Disasters Emergency Committee had received donations amounting to £300 million, but the Sri Lankan government had been slow to identify priorties. In Peralyia there was an urgent need to provide shelter before the arrival of the monsoon season. Charities had built terraces of wooden huts. Unfortunately the local practice of using open fires for cooking had led to some shelters catching fire and being destroyed. Dr Willox alluded to conflicts of interest between fishermen who lived beside the sea for access to their boats, and corporate plans to build luxury hotels on the beaches. The 100 metre rule instituted after the tsunami prevented villagers from rebuilding their dwellings within 100m of the high tide mark. A model village had been built 10 kilometres inland, an impractical proposition for the fishermen. Other examples of poor relief work included the rebuilding of an obstetric ward in a hospital run by Dr Weerasinghe in Arachikanda at a time when delivery rates were falling as more women were going to a local consultant unit. Dr Weerasinghe dealt with up to 150 patients a day with very limited resources, and it was felt that the money might have been better spent.

On a smaller scale, there were some valuable charitable projects. With the rainy season about to start, the medical officers were concerned about the spread of infectious disease, particularly Dengue Fever and Japanese B Encephalitis. The tsunami had destroyed refrigerators in local hospitals resulting in the inability to store vaccines. This meant that children were no longer being immunized against infectious diseases. Glasgow the Caring City was able to help by donating fridges.

The library at Peralyia had survived the flood and had been transformed into a makeshift medical centre. Instrumental in this was a remarkable American nurse, Alison Thompson. Also here were Dr Shouren Datta and Dr Carolyn Datta who had been working in Chennai. On receiving news of the tsunami, they had moved to Sri Lanka to help with the relief work. Both were well known to members of the Society as Dr Shouren Datta had worked in gastroenterology at the Victoria Infirmary.

A principal aim of the charity was to engage in projects that were sustainable. An 82 year old rice farmer had had his paddy fields inundated by salt water. The charity was able to supply him with rice seed for replanting once the monsoon had washed the salt from the soil. This will enable him to feed himself and five other families. The Raka Institutional Complex provided respite care for the victims of abuse. With help to improve the rooms and by training more teachers it would be able to cater for an influx of 800 orphans.

Dr Willox accepted that much of the work amounted to applying a sticking plaster on a gaping wound, but through small acts, Glasgow the Caring City was able to make a material difference to the lives of ordinary people. He spoke briefly of some future plans to arrange surgery for two deaf twin boys. Dr Willox encouraged members of the Society to support the work of Glasgow the Caring City as it continues to provide help in Sri Lanka and other areas of the World.

Listen again:
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Further reading:
Glasgow the Caring City
Sri Lanka Report
After the Tsunami: Legal Implications of Mass Burials of Unidentified Victims in Sri Lanka
Revisiting the Tsunami: Health Consequences of Flooding
Alison Thompson's diary
The Waste Land
TS Eliot
Maslow's hierarchy of needs