January 21, 2005 - By Dr. Tom Lee
A lot has happened. We've been continuing work with the temporary hospital, which is well-staffed, but still lacking in essential supplies. Despite all the donations, there are still needs that are not being met. There are many supplies that are not being used because the local doctors are not familiar with them, they are written in another language, or they are not appropriate for the situation (4th generation drugs that cost $$$ but missing cheap local drugs that the local doctors are accustomed to using). We met with the person in charge of the medical laboratory, who nearly 4 weeks after the tsunami, is still unable to work because of lack of supplies. He made me a list of specific items that he needs from a local supplier in Colombo. We also met with the local doctors, who made another list of essential drugs that they would like from the state pharmacy, so that they would be familiar with them. We purchased these from Colombo today, and hopefully this will fill the gap until the supply lines are better organized.

We visited camps of displaced persons, many who used to inhabit fishing villages destroyed by the tsunami. One of the most critical losses was their boats, which leaves them unable to rebuild their lives. In some areas, we see pieces of the same boat lying hundreds of meters apart. The fishing village next to Grace Care orphanage was also destroyed. Although their boats survived relatively intact, their motors were severely damaged. We will help provide support to repair the motors so they can return to self-sustenance.

Although the damage has been enormous, the international response has been equally enormous. We am confident that within a few months, the people, with the support of the government and international organizations, will recover substantially. Locally-based organizations like the Grace Care orphanage, supported by VeAhavta, have provided indispensable support that will continue long after others have left. The only irreplaceable loss will be the lives, the mother who lost four children, and the woman who lost her husband and daughter (in Dang's photos). After recovery, we hope people will continue to be aware of ongoing international tragedies, many of which carry the same burden of disease and death as the tsunami but not nearly the same attention. Far more children have died in the countries affected by the tsunami since December 26th 2004, from preventable causes of death (diarrhea, malnutrition, and malaria) than were killed by the tsunami itself.

January 17, 2005 - By Dr. Tom Lee
Stopped in Bangkok en route to pick up specific medical supplies from our reliable wholesaler that Team 1 said were in short supply in Sri Lanka. Spent a short night in Columbo and have arrived in Trinco. Yesterday, we ran a clinic for a nearby camp of displaced persons. Today, Howard, myself, and Dr. Sameem, the local District Medical Officer, went with a mobile clinic to a rural area with poor access to any healthcare resources. We saw about 100 patients, and I also took the opportunity to learn from Dr. Sameem about the current healthcare situation, health practices, and future needs in the district. We then returned to the temporary Kinniya hospital set up by Rushdi, Larry, Loren, and local Sri Lankan doctors. In the afternoon there, we worked alongside the local Sri Lankan doctors to see another 200 patients, mostly with minor illnesses. My brother Howard commented that he had seen over 100 patients today. In the evening we attended an interagency meeting to coordinate care with other organizations working here. Finally, we returned to Grace Care orphanage, to another dinner from their wonderfully hospitable staff. ÐTom

January 8, 2005 - By Dr. Rauch
We visited the central public hospital in Trincomalee and visited the patient we had transferred intubated. She was awake and smiling; Peter shook her hand. We also transferred many cases of expensive, powerful antibiotics for their inpatient service. Next door to where we are staying, the houses were all destroyed. In front of the orphanage and church, the reverend had planted a grove of pine trees that absorbed the brunt of the tsunami there. Next door, they were not so fortunate. We visited the survivors that were returning from the refugee camps to occupy their lands. Because the records are so spotty, the people need to occupy their lands -- otherwise squatters or even the government will use the land. However, they had nothing. We gave them clothes and toys and money that we had brought from the States to donate. At least for this small community we helped them to recover and rebuild. South of us in Batticola we heard about a town of 15,000 that was destroyed down to the foundations. Only a little over 300 of these people have been accounted for, 240 of these were treated at the hospital. Now we are leaving the devastation. We found out that the driver back to Colombo lost his wife and all of his children. We have all fell in love with this country and its people. In the face of so much destruction they are so resilient and they have been so grateful for all of our assistance. We too are so grateful for all of the people at our home that have made our work here possible: our brave spouses and children that are missing our help and presence, and accepted the risk that we put ourselves in; our colleagues that are filling in for us at work; all of the Sri Lankas here who have come together to recover and rebuild their country; and everyone that has donated time, supplies, money and assistance. We are but the fortunate tip of a large iceberg of people, resources and work. Everyone should be proud of what we have achieved here. This is the worst natural disaster of our generation; we seem to be meeting it with the best international response of our generation.

January 8, 2005 - By Dr. Stock
Awoke at 0300 to prep for departure from Trinco and initiate heading home. Left behind Cliff Bars, Ultrathon Mosquito Cream, and Camera for Rushdi and Tom. Rushdi has my second Leatherman knife; on his departure will give to Hirum as a gift from me. Hugs goodbye and sad to leave these wonderful little girls at the grace care center orphanage. I know though we did everything and more we could have done in our time and restored and enhanced an essential public service to the people of Kinnyai. We have begun the skills transfer piece of the program with our first training yesterday with US, Italian and Sri Lankan docs on airway management. The Sri Lanka docs want more lectures as often as possible.

Sustainability is an essential part of our mission. We will ensure success by turning over the reins of our work to a larger NGO. The program is set up for the long haul. Huge victory for all. I have a sense of calm exhaustion that I have felt before after over seas work in Albania and Liberia. It seems to me that if we can help build a hospital/emergency room capacity in a town in 6 days, we should all be able to solve the majority of big picture problems that confront the world today. We really don't have time to waste, nor the money and other resources. Our team consisted of Muslims, Jews, Christians, Hindus, Buddhists, and Atheists and the Sri Lankans we served were Hindus, Muslims, and Buddhists. A sense of mission, and a tireless tenacity to see our vision translate to results, characterized our team. Awesome guys each who decided to drop what they were doing, leave their families, and travel half way around the world to help people they had never met (except Rushdi). To answer the NPR reporter who asked what do you 2 guys expect to do with those 2 little bags I say again: ÒJust because you can't do everything doesn't mean you shouldn't do somethingÓ.

Larry
OUT

January 7, 2005 - By Dr. Stock
We said goodbye to 2 members of our team who were heading back to Colombo. After hugs we headed to Kinniyai. We met with the Spanish MDM team who has set up operating room capabilities and labor and delivery capabilities in their tent facility. They have an emergency room doc coming who will work with us, and a pediatrician at their place. Between our 2 groups (who are in close proximity) we have an emergency room, operating room, labor and delivery and, some in-patient capacity. They are only planning to stay 3 months but this will buy some time until the larger Kinnyai Transitional Hospital is ready to occupy. Today we did our first training with the Sri Lankan docs. Rushdi spoke on emergency allergies and the Italian lead doc and myself spoke on airway management. Well received and more training to come. Poco a poco...

This is my last day in Trinco. Tonight I will celebrate my birthday with my team and the orphan girls (who will get ice cream!). They have become our little friends. They are wonderful and beautiful kids. We head to Colombo in the morning, leaving Rushdi to work with Hirum and carry the ball until Tom and Dan arrive. Hirum is an amazing young man who has kept this whole program together before, during, and after the tidal. He is a 25 year old Sri Lankan who has been indispensable. I will miss him quite a bit. All for now. Time to go home.

Larry
OUT * Update Great Birthday in Sri Lanka: Sung happy birthday by 50 wonderful Sri Lankan orphan girls age 6-16. They all shook my hand and said, "Happy Birthday Uncle."

January 6, 2005 - By Dr. Stock
Today things seemed to gel. We completed the organization of the ER storage shelves including meds, supplies, defibrillator, and crash cart meds. The number system is working with patients no longer swarming the doctors. They are actually sitting on the benches in the waiting area instead of standing because they trust and understand they will be taken in order. Big victory for all. The lab area is now ready to be moved into as the newly cemented floor is dry. The Italian firemen who helped us fix the ER building departed today. What awesome and happy guys. I went up on the roof of the unfinished hospital building that we had built our temporary field hospital within and finally rested for a moment, reflecting on what we had done this week and staring out over the river steam that separated the bridge from the part of town hit by the tidal wave.

January 5, 2005 - By Dr. Rauch
We are working hard in Trincomale. The hospital in the district of Kinniya here was destroyed, along with the ministry of Health Office next to it. They lost many of the patients and staff. Our primary job has been to reconstitute that hospital and the mobile health vans that serviced the remote areas before the tsumnami. Now these ÒmobilesÓ are also servicing the refugee camps.

The whole country is mobilizing though to rebuild. A trucking company from the capitol Columbo donated trucks to us to transport supplies and people. Donations from all over the world are coming in.

Yesterday we had our hospital emergency department fully operational and Dr. Peter Brown had to intubate a patient in respiratory failure from a heart attack. It was the first patient intubated in the Kinniya District and had to be hand ventilated for about 3 hours while she was transferred to the district hospital in Trincomalee. Dr. Uday DeSilva, a Sri Lankan anesthesiologist with us from Lancaster California, ventilated him with the bag-valve-mask and none of the other usual equipment. I find it amazing how resilient everyone is here. Everyone, including the people working with us and volunteering at the new temporary hospital, has had many family members and friends killed in the tsunami. They are just pulling themselves up and working to service and rebuild. No doubt the grief and loss is profound but I am amazed at how they keep working and living. If I ask anyone about the tsunami, everyone has lost family. If I did not know to ask, I probably could not have predicted that. The bodies had all been buried by the time we arrived. The buildings that were not too badly damaged are now being rebuilt and teams are collecting the enormous amounts of debris that have been left everywhere. Often the only clue of what has happened to a building is the signs of fresh repair work and a dirty water mark 6 feet up on the side of the building.

Many people are volunteering at the hospital with us. A local English teacher and dentist are among the volunteer translators. They lost their school and office respectively.

We are now helping the local doctors run the now operational ÒKinnaya Temporary District Hospital.Ó out of the Tsunami-hit unfinished library building.

The DeSilvaÕs may go Friday to the South of Sri Lanka, the area around Galle, where many people were killed and hotels destroyed. They want to see what needs the people there have. That is the area their families are from. The rest of us will stay as long as we can to try to ensure that the hospital continues to work and that the crisis care transitions successfully into the continued care.

January 5, 2005 - By Dr. Stock
Another full day. Yesterday the Italian team of docs, paramedics, and firemen asked to work with us. We happily said of course and what a good decision that was. They are awesome guys: working in the ER, fixing the electrical and deficiencies in the Transitional Field Hospital. They also brought great supplies/equipment. We saw loads of sick and injured patients with the Sri Lanka docs today. Just as I completed organizing the key supplies and meds for critical patients we needed to utilize them for a women in respiratory failure. Despite maximal medical therapy, she needed intubation but this had never been done in the old Kinniyai Hospital. All helped out and Peter Brown intubated the patient. She stabilized and the Sri Lanka ambulance and our paramedic Peter Taft took her to the ICU at Trinco Hospital. I don't think they had ever received an intubated patient from outside the hospital in the past and were a bit surprised. It was a teachable moment in our ER and we had turned a corner. The Italians came to dinner at our base, Grace Care Center where celebrated our joint efforts and exhaustion.

Larry
OUT

January 4, 2005 - By Dr. Stock
Key words only, no time for detail. Kinniyai Health Coordination Meeting attended by all medical NGOs and the local SL medical leaders. We ran the meeting and collected contact info and work in progress of each group: The Spanish, Italians and our team were represented. We established our ER, a wood wall unit with organized supplies and medications and our presence side by side with the Sri Lanka docs. IMC has shown interest in merging with our program which would bring expertise, infrastructure, and $ to our start up project. The ER is taking shape and we saw many sick patients who otherwise would have had to travel to Trinco hospital. Good energy within our team, working in synch, exhasted but happy. Larry OUT

January 3, 2005 - By Dr. Stock
Another packed day. We spend the first half of the day on a myriad of details. We sent out the supply request list for the "ER" in the Kinnyai transitional field hospital and had a quick phone briefing by Brenda from USAID on the security scene: all is well. Rushdi and I then split up: He want to the Kinnyai hospital and I went to the Siraj Nagar IDP camp. Rushdi met with the District head of Ministry of Health who loved his idea of emergency medicine skills upgrade. The carpenter is half way done with our ER supply wall unit. The beds with new mattresses and IV polls were moved into the ER area. I had a good day at the camp. Only 150 families remain; most are now retiring to their properties to rebuild. We will go there tomorrow, for possibly the last day, as the school could be free of all IDPs very soon.

I followed up on our victim with asthma. She was transferred to the Trinco hospital from the smaller hospital where I had brought her. Hirum, our indespensible medical coordinator/Radar O'Reilly, took me to Trinco General Hospital. We found our patients vastly improved. Our team expanded by 6 members as our new MD arrivals were delivered. They were tired and sweaty, but we were all happy to see old friends and meet new ones. After a great dinner with the Grace Staff, we had our briefing and finally headed to our rooms. Big day tomorrow as we descend of the field hospital, treat patients alongside the Sri Lankan doctors and build our ER capability.

Larry

January 2, 2005 - By Dr. Stock
Amazing day. Too tired to write too much...key words only. Up at 0300, on the road by 0330 and arrived in Trinco at 0800. Grace Care Center will be our base... a miracle in multiple ways. Grace is an orphanage for Sri Lankan children.

Today we decided on our scope of work. After meeting with key contacts, we found our niche. The Kinniya Hospital was totaled by the wave. They have taken "temporary" residence in a vacated building were they have a makeshift treatment center seeing 500 people a day. Our primary goals will be to provide emergency medical care, upgrade the facility and its capabilities, and do some staff skills upgrades. We already have plans for a modest, but functional, redesign to be started immediately. Additionally we will run mobile clinics at 4 locations. Even pre disaster, these people had the worst access to health care in the area, and this has not changed. Lastly we will serve as the medical team for an IDP camp of 350 families (~ 1500 people) about 20 miles southwest of Trinco in a place called Siraj Nagar. I went there today while Rushdi attended a health coordination meeting. I arrived at 1700 and met with the medical team that has been rendering care for the last 7 days. They themselves are Tsunami victims. To my amazement, none of them were medical professionals. The lead man was a science teacher and the rest were teachers of a variety of subjects. They just did what had to be done after spending the first 2 post-disaster days with 2 Sri Lankan doctors who had to return to Colombo. I consulted on their sickest patients.

More tomorrow... our next group of docs arrive in the capital just after midnight and will be in Trinco by the afternoon.

January 1, 2005 - By Dr. Stock
After sleeping from 0400 to 0730 we drank tea, showered, and prepared to head out to Trinco. Vehicle delays led us to rethink our plan. We decided to spend one day in Colombo acquiring needed resources and making key contacts. Then we would leave for Trinco at 0200, allowing us to arrive at 0800 on 1/2.

What a day. By the end of it we had supplies headed out to our site to precede our arrival in Trinco. After ensuring arrangements for the arrival of our second wave of team members, we contacted the Trinco represenatative of USAID, whom Rushdi had worked with when he was here 4 months ago. She gave us a security assessment that was reassuring that things were safe in the areas we plan to work and stay in. We plan to see her in the morning and attend the daily UN Coordination meeting for NGOs in Trinco. We now understand that medical groups from different countries are working in the Trinco area. The meeting will help to ensure all the IDP (internally displaced persons) areas are under a groups area of responsibility (AOR). Time to sleep 2100. Will be moving in 5 hours.

Larry
OUT

December 31, 2004 - By Dr. Stock
We arrived at 21:30 Êhours on December 31st. ÊWe were greeted at the airport by the Sri LankaÊMinistry of Health. We have just spent 28 hours traveling. ÊWe utilized this time to plan, adapt and mold our ideas into a logistical plan that we could have operational immediately upon our arrival. Sri Lankan contacts drove us to our Colombo overnight station. We will sleep here before departing in the predawn hours bound for the hard hit coastal town of Trincomalee.

We will analyze the current situation and communicate with other GHAP members regarding current and future need. Please continue to check here for daily updates from the field.

Drs. Larry Stock, Loren Rauch, and Thomas Lee are working together with other NGOs and local health personnel to assist with post-tsunami relief efforts. Because of many people's interest in their work, GHAP is providing a centralized online place to read some of their field notes. These are informal communications and should not be considered for citation.