Even Good Health System Is Overwhelmed by Tsunami

KALMUNAI, Sri Lanka, Jan. 6 - Carmen Ramírez de la Pistina, a physician from Spain who works for the aid group Doctors Without Borders, was speaking to exhausted health officials here in southeastern Sri Lanka and suggesting they could do even more to forestall an epidemic in local refugee camps.

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Now, more than a week after the tsunami, she said, disease and even more death "can explode in front of us."

The camps have been free of epidemics, despite crowding and latrines. Sri Lanka has a strong health care system, reflected in low infant mortality and long life expectancy, and health specialists say the country's doctors and health officials have averted a medical disaster by setting up the camps quickly and running them well, particularly in providing clean drinking water immediately.

But now the local medical staff is tired and overwhelmed after working in emergency conditions since the tsunami. Some staff members were killed, clinics were wiped out and vehicles were destroyed. Tempers seemed short at times at the meeting. A doctor pleaded for help in providing care at the 16 camps in his area, 6 of which could be reached only by boat.

Now Dr. Ramírez de la Pistina was noting a weakness in the system. Here and there, cases of diarrhea have occurred, but camp records did not provide enough detail to tell if a deadly disease like cholera or typhoid might be at work. It is essential to detect such problems early for doctors to stop an infectious disease from sweeping through a camp. The Sri Lankan doctors agreed: they needed better record keeping, with strict criteria for making diagnoses and identifying cases. In crisis mode, perhaps, they had let slide an essential rule of public health.

More than 500,000 people have been displaced, Sri Lanka's Ministry of Health said. Many thousands have left the camps to live with relatives or go home, but many more have nowhere to go. For them, life in the camps will drag on for weeks and months. Keeping them healthy will be an enormous challenge to the health care system. The camps, in tent cities, and in schools, Buddhist temples and churches, house 100 to 1,000 needy people.

Infectious disease is a constant threat, and officials have their hands full trying to keep it at bay. Now, with the prospect of people living in camps for extended periods, doctors have to worry about pregnant women, infants and children who need vaccinations. At a camp in Kalmunai, a doctor made a special effort to encourage pregnant women to be examined.

Preventing outbreaks takes vigilance and sticking to specific routines like disinfecting drinking wells with chlorine and nagging people to wash their hands. Survivors are generally in good health but many are grieving, having lost one or more relatives. Some doctors say the bereaved need counseling or therapy, but others say people will cope with sadness in their own way. The threat of sickness looms because of the lack of toilets and because flooding has contaminated many wells. Clean drinking water has to be trucked in. At camps in Ampara, about an hour inland, heavy rains filled latrines. The earth is saturated, so no more pits can be dug.   Continued...