1. BOOM -- 2 x 27

1. BOOM -- 2 x 27

New tsunami concern: A baby boom in refugee camps

Chris Brummitt Associated Press/Banda Aceh

With the birth of her first child just one month away, Wadiana Wahab worries about the world her baby will enter.

She mainly eats rice and instant noodles and has no money for a crib, diapers or baby clothes. And while she expects to deliver at a hospital, she will likely return to the sweltering tent she calls home, where the stench of human waste hangs in the air.

"I never imagined it would be like this," said Wahab, 23, at a makeshift camp for about 5,000 refugees in Banda Aceh, the capital of Indonesia's tsunami-hit Aceh province. "It's already eight months and we have bought nothing for the baby."

With the threat of epidemics abating and most injured survivors treated, one of the most pressing medical needs now emerging across tsunami-hit countries is also one of the most basic: ensuring pregnant women stay healthy -- and deliver safely.

Indonesia, the country most devastated by the Dec. 26 earthquake and killer waves, is girding for a flood of newborns in Aceh's squalid refugee camps and ruined villages. Some experts say that birth rates among tsunami survivors may rise next year, as bereaved parents who lost children in the disaster try to rebuild their families.

Pregnant women comprise about 25,000, or 6 percent, of some 400,000 refugees in Aceh's camps, the United Nations says. Every month, some 800 babies are expected to be born in the province, on the northern tip of Sumatra island.

The figures are similar in Sri Lanka, an island nation off the coast of India, where as many as 5,000 will be delivered in the next few months, the United Nations says.

"What can we say to them? They want someone to continue the family line," said Sri Setiyati, a midwife in Banda Aceh. "It is their right to have children. We can only advise them to wait."

Despite a massive international relief effort, Aceh's devastated public health system is ill-equipped to handle the births. Though a few hospitals have reopened, smaller clinics remain shuttered. Once abdundant, midwives are now scarce, many of them having died when the sea surged.

"The (pregnant) women here are in a bad shape," said Henia Dakkak, a Palestinian public health specialist with the U.N. Population Fund in Banda Aceh. "If we don't start to do something in a few weeks, then we are endangering people's lives."

Health workers say most pregnant women in Aceh are not eating enough protein, meaning they may have underweight babies or may become anemic and bleed to death during labor.

Indonesian and U.N. authorities say a shortage of contraceptives means that many women in the camps will have unwanted pregnancies.

Still, things have improved since the disaster's immediate aftermath when many women gave birth without any medical supervision, often in unsanitary conditions in refugee camps.

Midwives flown into Aceh from Jakarta now routinely call on Wadiana and the 40 other pregnant women in her camp. A car is on call to take them to a health clinic, if needed. And a freshly painted maternity unit has just reopened in the city's public hospital, parts of which remain covered in thick mud washed in by waves.

In Sri Lanka, most refugee camps have access to a doctor. U.N. officials have provided hospitals with 300 emergency reproductive health kits, which include equipment to perform cesarean sections and blood transfusions and treat miscarriages.

For Wadiana, it's not just about health care, though. She said it pains her to think about being unable to prepare for the new member of her family.

"Before the tsunami, we were getting excited and readying the house for the birth," she said. "Now all I can do is sit here." Indonesia's family planning agency has been swamped by requests for condoms and other forms of birth control, agency official Tri Tjahjadi said. The office has about 16,000 contraceptives -- but needs 80,000, he said earlier this week.

2. TRAUMA -- 1 x 46

Sri Lanka has edge to deal with tsunami trauma

Joe Ariyaratnam Reuters/Jaffna, Sri Lanka

A long ethnic conflict has given Sri Lanka an edge over other Asian countries hit by last year's tsunami in dealing with the disaster's psychological impact on people, a top specialist in psychiatry said.

Professor Daya Somasundaram of the University of Jaffna said in an interview that there were similarities between the psychological impact of man-made disasters such as a war and natural disasters that take people by surprise.

"Due to the war we have had the experience of dealing with psychologically affected people, which many of the countries don't have."

A team of 90 counsellors and 900 "be-frienders" were available to the affected people in Sri Lanka's war-ravaged north and east, where the coastal areas were battered by the tsunami on Dec. 26.

About 40,000 people were killed by the giant tidal waves that washed away entire villages along Sri Lanka's shores and snatched children from their parents' arms.

Most of those who died in the tsunami were women and children -- unlike the two-decade war between government forces and the Liberation Tigers of Tamil Eelam (LTTE) that killed 64,000 people until a ceasefire was brokered by Norway in 2002.

"The difference is that during the war more men were killed and we had lots of widows. Now we find males left with children. They are unable to come to terms with the situation," said Somasundaram, who has written a book on the psychological impact of the long war in Sri Lanka.

He said many men had taken to alcohol and some had attempted suicide.

The big problem on Sri Lanka's coast was that most of the fishermen did not want to go back to the sea.

"The sea was so very immediate to them. They had a very intimate relationship, but suddenly some kind of an organic bond has been broken," Somasundaram said.

Simply rebuilding houses and giving them boats or a net is not going to get them back to the sea, he said, adding there was a need for group activities for children and others for quick healing.

"You have to deal with their trauma -- their fears and grief." There was also an urgent need to reunite families separated by the disaster so that adults and children can be together.

Somasundaram said most of the survivors were very strong and resilient and would eventually come out of the trauma.

"Time is the best healer. We should be compassionate and supportive," he said, but added that all support and international aid would last for a short time.

"Then these people will be left alone. The crunch will come."

REUTERS

GetRTR 3.00 -- FEB 4, 2005 15:35:45