Report of the Tsunami Relief Operation Andamans (15th to 25th January 2005)

The RESQ International team reported to the Director of Health Services (DHS) A&N and offered the availability of the services of the team for medical relief to the people of the most affected areas in the Union Territory (UT).

The DHS told the team about the gravity of destruction which occurred in the various islands of the UT and the non availability of transportation and accommodation in islands like Katchal, Teressa, Kamorta and Trinket. The team agreed to go to these islands despite the challenges and since these were tribal islands that required special permission, the DHS asked the team to wait till the afternoon to get permission. In the afternoon when the team met the DHS again, it was informed that there was no need of doctors in these islands and the team was asked to visit and assist in the medical relief of inmates of different camps in Port Blair who were originally evacuated from different islands.

Though the change in opinion of the DHS created some misunderstanding and confusion the team complied with the request by the DHS and visited five camps in and around Port Blair on 16th January 2005, which were set up for Tsunami victims from different islands. These camps were

1. ITF exhibition ground which contained Tsunami victims from Nicobar
2. Government Senior Secondary School Camp at School Line
3. Nirmala School Camp
4. Government Senior Secondary School Haddo (Tamil Medium) Camp

The Disaster scenes

In the ITF camp there was a medical team consisting of four doctors and necessary paramedical staff equipped with all needed medicines. The surroundings were kept clean and there were special sanitary latrines built for the use of the camp inmates. The other camps were not kept as clean as the ITF camp and the inmates didn’t have necessary sanitary latrines. There were no resident doctors and the fly menace was high. It was found that the remnants of food were dispersed openly where the fly breeding was abundant. The team provided health education to the inmates and volunteers of these three camps with the help of local social worker Mr. Zubair Ahmed. There were sufficient supplies of food and medicines in all the camps. There was at least one paramedical staff in all the camps. The volunteers were also very active and receptive to advice. At the camp at Haddo the team met a team of doctors from NIMHANS who have been working at that camp for the past two weeks giving valuable counselling and psychiatric help. Our team wished that such help be made available to all the camps.

In the evening the team met the Honourable Lieutenant Governor of Andaman and Nicobar Islands and conveyed to him the willingness of the team to offer medical relief at the remotest of islands despite difficulties in access and accommodation. The Honourable Lieutenant Governor appreciated the team’s spirit and entrusted Mr. Anshu Prakash, Secretary Health to avail the team’s service according to the need. He requested the service of the team at Hut Bay in Little Andaman, which is 124 kilometres south of Port Blair.

On 17 Jan 2005, two members of the team stayed back in the capital to get the necessary paper work done and to arrange for transportation to Hut Bay. The rest of the team visited Camps for Tsunami victims in the rural areas of South Andaman. They were

1. Relief Camp - Sippi Ghat
2. Government Senior Secondary School Camp - Garacharma

In the first camp the team examined 42 inmates who had illnesses like fever, loose stools, respiratory tract infections and provided medicines. Almost all the inmates complained about watering of eyes and itching of skin due to contact with saline water as all the water sources were salinated by the tsunami waves. Fly menace was very high due to unhygienic practices and non-availability of sanitary latrines. The team gave health education to the inmates regarding environmental sanitation to decrease the health hazards due to insect vectors with the help of local social worker.

At Garacharma, the team examined and treated 23 inmates. The main complaints were abdominal discomfort and fever. All of them were given tablets for deworming and symptomatic treatment. Here also the sanitary latrines were absent and the inmates were practicing open-air defecation. The fly menace was high and the team warned them about the threat of outbreaks of water borne diseases and enlightened them about the necessity of personal hygiene, food hygiene and environmental hygiene.

All the necessary paper works were done and the tickets to Hut Bay arranged by the two team members who stayed back by evening.

Due to the delay in sailing of the ship to Hut Bay the team had to change plans and visited the remote rural areas of South Andaman namely Wandoor, Bathu Basti and Hasmatabad on 18 Jan 2005. The team visited two camps at Wandoor and one camp each at Bathu Basti and Hasmatabad. They were

1. Relief Camp at Forest Guest House
2. Wandoor Camp II
3. Hasmatabad Relief Camp
   
4. Government Senior Secondary School Camp Bathu Basti

At the Forest Guest House Camp there were 27 families. There was doctor staying at the camp and there were sufficient supplies of food and medicines. Despite all these facilities there was absence of sanitary latrines and facilities for safe disposal of waste. The fly menace was on the increase. The team inspected the surroundings for the source of vectors identified it as the heaps of waste materials strewn over the landscape and advised the inmates about the necessity of safe disposal of waste materials and also impressed upon the inmates about the necessity of boiling the drinking water.

At Wandoor Camp II, 63 families were accommodated and there were about 15 volunteers to look after the needs of the inmates. But there was no medical attention given to the inmates so far. Hence the team conducted a medical camp and examined 87 inmates who had various illnesses. Majority was respiratory tract infections and fever with chills. For those who had fever with chills presumptive treatment for malaria was given. Sanitary latrines were absent here also and the team instructed the volunteers on how to build temporary sanitary pit latrines and gave them diagrams on the measurements for the construction of the same. Environmental hygiene was also poor and all the patients who attended the medical camp were given tablets for deworming. There were a few patients with abdominal pain, caecal gurgling and loose stools mixed with mucus. They were treated with anti amoebic drugs and warned about the chance of outbreak of such diseases.

In the Hasmatabad Camp there were 48 families (184 individuals) and enough number of volunteers to look after them. Food supply was sufficient and a few sanitary latrines were present which was not sufficient to prevent problems due to insanitation. A Japanese social worker and health volunteer was present in the camp and she was giving health education to the inmates using LCD projector with the help of local volunteers. The team conducted a medical camp and examined 43 inmates with various illnesses. Majority of them had respiratory infections due to stay in open space with just roof and no walls.

At Bathu Basti there were 118 inmates. The environmental hygiene was satisfactory and there were temporary sanitary latrines. The team conducted medical camp and examined 16 inmates with minor illnesses. But the team felt a need for psychiatric counselling for 37 inmates who showed clear evidence of psychosomatic disorders arising from the fear of facing the tsunami waves.

On 18 Jan 2005, at 10 pm the team boarded MV Mus which is a ferryboat leaving for Hut Bay. The ferry was packed with about 900 people though the capacity was just 300. On board we met two other rescue teams from West Bengal. There were no cabins or seats available and the team had to sleep on the rear deck. The distance of 124 kilometres was covered in 10 hours and we reached Hut Bay at 8 am on 19 Jan 2005.

Child sleeping safely on her mother's chest in a ferry to the islands.

The sight at Hut Bay was one of total devastation and destruction. The harbour was cut off from the land.


Destroyed harbour

The whole township was destroyed.The breakwater built to protect the harbour and to transport people and goods was destroyed and only pieces of concrete piles were visible. The jetty for ferries was broken into two and half of it was not seen at all. The sight on landing ashore was not different.


Destroyed warehouse at hutbay

The buildings were reduced to rubble and trees and vehicles were found thrown across the remnants of building for two kilometres from the shore. A few buildings, which withstood the ravaging waves, were found deserted. Roads were disrupted and water and power supply interrupted. Household utensils and fridges and televisions were found everywhere. The erstwhile community health centre was found in a state of complete destruction and the X ray machine was found strewn in the road along with other equipments. We came to know that two patients who were admitted in the hospital were killed by the deadly waves.

The local social worker Mr. Zubair Ahmed was accompanying the team to Hut Bay. He arranged for accommodation in an abandoned house, which withstood the rage of tsunami waves. The team cleaned up the first floor of the building and settled down arranging a kitchen, bathroom and sleeping area. The team was fully prepared with sufficient supplies of food, kitchenware, candles etc. and we cooked our first meal in the disaster zone.

After breakfast, the team met the Relief Commissioner in charge of Little Andaman and gave him the letter issued by the Director of Health Services. We were informed that the island was virtually split into two due to disruption of road from 4 km to 8 km. There was only a jungle path now connecting the villages from 8 km to 28 km to the head quarters at Hut Bay. The doctor at Hut Bay did not have any information about the condition beyond the camp at 4 km due to lack of transportation. The only information available was that there was a primary health centre at 16 km, which had a doctor, and he is manning all the health work beyond the point of disruption of the road at 4 km. In and around Hut Bay there were 7 camps. The team visited 3 camps. They were

1. Ongi camp for tribals
2. Tamil camp near the new head quarters at the forest guest house
3. Relief camp at 4 km.

The team visited the camps and found that the inmates had medical attention regularly. But the sanitary facilities were absent and the fly menace was much more than what was seen in Port Blair. The team could find animal carcasses strewn around even 23 days after the disaster. According to the doctors at the new head quarters the real need of the team was at relief camps situated at 8 km, 11 km, 16 km, 19 km and 26 km. They were ready to supply us sufficient medicines and chlorine tablets.

Refugees traveling back to their native islands on search of their belongings.

On 20 Jan 2005 the team set off to the camps after collecting the medicines from the head quarters. The Relief Commissioner arranged an official jeep for our transportation. The driver left us in the jungle path near 4 km and directed us to walk for the rest of the way.


RESQ team walking through the thick forest to reach the otherwise inaccesible camps at hutbay.

The team proceeded carrying the medicine boxes and food and water for one day. We proceeded at a good pace and covered about 8 km through the dense forest taking a time of one and half hours. There we met a group of people coming opposite to us in a tractor. They revealed to us that this route would take us a full day to reach the 8 km camp as it traversed the whole jungle and was 28 km long. They informed us that there was another path which was used by the villagers and that was the one that we should have taken. As we had to retrace the whole path to reach the above said short cut path we decided to move on through the long route. After walking for another half an hour we met a group of relief workers in a jeep who were going in the same direction. As the jeep was full they couldn’t accommodate us also. But they sent a tractor, which was ahead back to us so that we could travel the rest of the distance in it. The tractor took about one and half hours to reach the 8 km point where we met the doctor of the primary health centre at 16 km.


Tractors are sometimes the only means of transport through these evergreen forests.

He informed us that all the camps beyond 8 km were merged into one camp at 19 km. We then met the BDO who accompanied us to the camp at 19 km. He explained to us about the need of doctors in the camp. We reached the camp at 2 pm and had lunch with the inmates.

There were 980 inmates in the camp. There was a separate tent, which functioned as the dispensary manned by two JPHN. The doctor at the primary health centre at 16 km visited the camp and examined patients for one hour a day. The team examined the available medicines and was surprised to find that antihelminthics were absent. We examined 316 patients and gave them medicines. There were 17 cases of fever with chills at regular intervals and the team considers it an emergence of malaria. These patients were given presumptive antimalarial treatment and advised to go to primary health centre for examination of blood, as there was no facility to take blood smear. There were many cases of joint pain especially of the knee joint which resulted out of the strain of fleeing from the tsunami waves. Most of them were elderly. There were no sanitary latrines and the waste disposal was unhygienic. The water was supplied by local authority after chlorination. Kitchen was open and near the place where the utensils were being washed and waste dumped. The team taught the volunteers the construction of temporary sanitary pit latrines and they enthusiastically promised to construct them according to the layout given by the team. At 5 pm the BDO took us to the edge of the jungle in a jeep. From there we trekked through a field for 1.5 km and through a small path through thick jungle for 4.5 km and reached the main road near 5 km point. From there we walked to the base camp, which was 3 km away.

Medical camp at 21 kilometer Hutbay

On 21 Jan 2005 the team reported the experience to the relief commissioner and doctor at the headquarters at Hut Bay. As there was no further need of the team at Little Andaman the team decided to take the next ferry to Port Blair. The next ferry available was MV Mus, which left the harbour at 9 pm, and after a turbulent journey we reached Port Blair at 7 am on 22 Jan 2005.

Waiting for the ship. Being in islands means that you have to be very very patient. On occasions, one might have to wait like this for days to board a ship.


On the ship

The team had a break from the tiresome mission for a day when we celebrated Bakrid with the family of one of the team member’s sister. We met the authorities once again and requested them to grant permission to go to the Nancory group of islands. But the request was rejected mercilessly. As the work in Andaman was almost over and access to remote islands of Nicobar denied by the authorities the team decided to go back to mainland. The tickets were available only for 25 Jan 2005 and hence we had to stay for two more day.

The extra 2days thus got was utilized for conducting a medical camp at Wimberly Gunj at Crescent Public School on 23rd and 24th Jan 2005. The team examined 328 patients and administered medicines and advice

Observations

1. Food and medicines were sufficiently available in most of the camps
2. Medical attention was unevenly distributed as most of the camps lacked medical attention while some had sufficient medical attention.
3. Sanitary facilities were present only in two camps visited by the team and mosquito and fly breeding was found abundantly in all camps except the camp at ITF ground.
4. There was no initiative to educate the public regarding the steps to prevent outbreaks of communicable diseases (both water borne and vector borne) that are common in such disasters.
5. There was significant number of cases of fever with chills where malaria can be suspected. The team could not confirm the cases of malaria due to lack of facility for examining blood smears.
6. Inter and intra island communication and transportation was not satisfactorily reinstated even after 25 days.
7. A time bound approach towards post disaster health management was markedly lacking from the part of the administration.
8. Access to remote islands of Nicobar is being restricted by the administration which might hinder the amount of medical relief reaching the people stranded there. It might also prevent well meaning medical professionals to have an on ground assessment of the health problems present there and give timely warning against probable outbreaks of epidemics.
9. The administration failed in coordinating the different voluntary organizations offering relief work and this resulted in failure of uniform and just distribution of relief between different islands and also between different parts of the same island.

Suggestions

1. There should be a long-term strategy for management of such disasters in a time bound and step wise manner.
2. The administration should be trained to coordinate the aid offered by different voluntary organisations.
3. The administration should not be lulled into a slumber of false security at the present health scenario, as it is only good fortune that there are no outbreaks of diseases. Sanitary facilities should be provided to all the camps on wartime basis by constructing temporary sanitary pit latrines to prevent outbreaks of water borne and vector borne diseases.
4. Fortunately there are no reports of any outbreaks of any communicable diseases. But surveillance for communicable diseases should be continued at least till the end of monsoons as the inmates of the camps are going to stay there for a much longer period and monsoons are just round the corner.
5. Active surveillance for malaria should be carried out in all camps and vector surveillance should be strengthened.

Members of the team

1. Dr. Sajith Kumar S., Asst. Professor, Department of Community Medicine, Medical College Thiruvananthapuram.
2. Dr. Sajeesh G., Senior Lecturer, Department of Anaesthesiology, Medical College Thiruvananthapuram.
3. Dr. Habeeb Mohamed, Lecturer, Department of Surgery, Medical College Kozhikode.
4. Dr. Santhosh Kumar S.S.
5. Dr. Krishnan B.
6. Dr. Dinesh R.S.
7. Mr. Ratheesh Kumar K.P. (Social Worker)

RESQ team having food together


Cooking our own food. Our team stayed in the first floor of a two storied building that escaped Tsunami waves.

RESQ International is publishing this report in an effort to bring awareness about the situation in Tsunami affected regions of Andaman and Nicobar. We regret that this report might not be complete as it is formed out of observations based on experience working at the very little areas where we were granted access.

Update from Port Blair

We provided Medical care for the inmates of relief camps in the remote parts of Port Blair for three days.Further our team travelled by ship to badly affected island of Hutbay and served there to attend to the inmates of the camps over there.The people of this region has still not recovered from the shock. The infamous discriminations of Island authorities have caused undue delay in retaining normalcy to the land. We lived with the people who are struggling for their survival. We attended to their badly needed medical requirements.

The detailed reports are being posted.

Our visit to the worst affected Nancori group of islands are being scheduled and will be finalised as per the Government's proposed evacuation programme.We have formally reported to the island authority and have registered our willingness to extend our service to Nancori group of islands.We are closely monitoring the situation.

Dr. Santhosh Kumar S. S.

Kerala docs stranded in Port Blair - Newindpress.com

KOCHI: A six-member team of doctors, which arrived in Andaman and Nicobar Islands under an initiative of Non-Resident Keralites for taking part in the relief and rescue operations, has been denied permission to visit the worst-hit islands in the archipelago.

Despite repeated requests from the medical team comprising doctors from Thiruvananthapuram and Kozhikode Medical Colleges, the island administration has not given them permission to travel to the battered islands of Kachchal, Kamota and Nancowri. Following this, the doctors remained stranded in Port Blair.

"The situation in these islands are very bad. Two doctors are already in the area. They recently urged the administration to rush more doctors as the situation there is very grim. But we don't know why we're being denied permission,'' team co-ordinator Ratheesh told this website's newspaper over phone from Port Blair. The team is being sponsored by Overseas Friends, an alumni association of Anjuman Engineering College and Rescue International. All the three organisations have been launched by Malayalis working in UAE.

"We also heard from personnel involved in rescue operations that even the dead bodies have not been removed from these islands home to many aboriginals. No one from the administration has visited these areas,'' Ratheesh said.

"We expressed our desire to work on these islands. But for some strange reason, permission is being denied,'' Ratheesh, a Dubai-based businessman who reached the isles for voluntary work, said.

"The Health Secretary after showing initial interest in our request suddenly changed his stand. We spoke to Union Minister E.Ahamed. But even his intervention has not made a change,'' he said.

Doctors in the team have already met the Lt. Governor and other senior bureaucrats in Andaman. "But nothing positive is emerging. They have not given us a proper reply. This sparks off doubts whether they are trying to hide something,'' Ratheesh said.

The team is led by Dr Sajith Kumar, assistant professor, Thiruvananthapuram Medical College. Dr Santhosh Kumar, Sajeesh and Dinesh of Thiruvananthapuram Medical College, B Krishnan and Habeed Mohammed of Kozhikode Medical College are its members.

Meanwhile, sources told this website's newspaper that the team would be given permission to visit Kamota on Monday. It will take eight hours to reach the island. "We need medical presence in Kamota than in other islands. The team would be given permission to visit Kachchal and Nancowri also,'' the sources said."

Monday January 17 2005 00:00 IST

Mission Andaman and Nicobar

RESQ International has sent a team of doctors to the Andaman and Nicobar group of islands which has been ravaged by the recent tsunami. The team which is headed by Dr. Sajith (Preventive Medicine) includes Dr. Santhosh Kumar S. S. (Orthopaedics), Dr. Sajeesh (Anaesthestist), Dr. Dinesh (Physician), Dr. Habeeb & Dr. Krishnan (Surgeon) and Mr. Ratheesh (from Dubai). The team boarded a flight to Port Blair from Chennai International airport today (15th of January) morning at 6 AM. As per current plans, the rescue mission will be two weeks long.

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Operation Tamil Nadu

The Tsunami's path of destruction

On the 5th of January, RESQ International embarked upon a journey to Tamil Nadu; the worst affected state in India. The nine member team of doctors and volunteers was led by Dr. Santhosh Kumar S. S. visited Kulaichal, Nagappattinam, Nagore and Velankanni.


A house devastated by the Tsunami

Five medical camps were held in locations in Nagappattinam and Nagore and about 700 patients were attended to over a period of 3 days.


Dr. Jayashankar examining a few patients at a camp at Nagappattinam.


An abscess on the left leg of a victim being drained by Dr. Bennet.


The make-shift pharmacy in the Toyota Qualis

Apart from camps, the RESQ International team travelled to the villages affected and spent time listening to the painful stories of persons affected by the Tsunami which unleashed itself on the 26th of December 2004.


One of the many saddening stories... from a man who lost his entire family.

Some of them had lost entire families while a few others were more fortunate. Many of the victims were so scared that they refuse to return back to their villages in the coastline.

Hundreds of persons are still missing. A fortnight has elapsed since the tragedy but the hunt for the bodies is still on in many areas. Those bodies which are being found are photographed and buried immediately.

One of the heartening aspects about this otherwise tragic disaster is the fact that a lot of voluntary organisations, both from the affected areas and elsewhere, had been actively helping the victims by providing water, food, shelter and medications. The administrative machinery has also been put into good use and the sanitation levels in most places were good.


After a medical camp at Nagore, the RESQ International team spent some time with the kids in the relief camp.

The funds were mobilised from the U. A. E. by Mr. Riaz who accompanied the team in its journey. The other team members were Dr. Santhosh Kumar S. S., Dr. Thirumalai Pandian, Dr. Jayashankar, Dr. Sreesobh, Dr. Bennet Chacko, Dr. Dinesh, Dr. Krishna Kumar V. and Mr. Jameer.


The RESQ International team (from L to R) KK, Bennet, Jayashankar, Thirumalai, Jameer, Sreesobh, Riaz, Dinesh and Santhosh.

Our next mission is a trip to Andaman. Trips to Indonesia and Sri Lanka are also under consideration.

Some of the photos taken during the trip will be published shortly.