Human approach on disaster victims is the most difficult

Among the thousands of relief workers in the tsunami ravaged areas are those from the Paris-based medical aid charity Doctors without Borders (Medecins sans Frontieres, MSF), recipient of the 1999 Nobel Prize for humanitarian aid. MSF opened a mission in Indonesia in 1995 after an earthquake in Kerinci in Jambi, Sumatra. The Indonesia mission is part of MSF Belgium, one of five divisions of the Paris-based organization. The following are excerpts of an interview with Sabine Rens, head of the Indonesia mission, who talked to The Jakarta Post's Sabam Siagian and Ati Nurbaiti.

Question: What's the composition of your team in Aceh? Answer: It is still increasing, we have doctors, nurses and psychologists, of many nationalities such as Sudan, Belgium, France, Hong Kong. (By Tuesday, MSF had 40 personnel in four teams in Aceh, including Indonesians.) Did you head the first team to Aceh?

Yes, on Tuesday (two days after the Dec. 26 disaster) we had a team of eight there, including a translator, and 3.5 tons of material including medication. We went to the capital (Banda Aceh) and it was not a pretty sight ... Now it's a bit better. Some buildings are still standing but everything between the shore and the main road is almost inundated. What did the team do?

We first met with various authorities, and set up everything to launch medical consultations with mobile teams. We worked with the only hospital that was functioning at that time, the Harapan Bunda.

On Thursday we did medical consultations in an area where many homeless people were gathering. On the first day we did almost 120 consultations -- patients arrived at the tents, they see a nurse and then go to a doctor, and then back to the nurse for dressings for those with open wounds and to receive medication.

The main thing we found during the first day were trauma wounds, and open wounds that would normally require stitches and more treatment, but in many cases it would be too late. We would expect amputations.

The second main pathology is stress, anxiety. Surely that would be difficult to treat in one consultation?

Yes, you can really feel that people come in with several symptoms, but it's basically anxiety and stress. The third main thing is respiratory infections.

On Friday we opened mobile clinics again, but with psychologists. We had one patient holding a doctor for two or three hours in a row because she was so scared.

Some even fainted each time there was an aftershock because they thought that with every aftershock the water would come again. What they went through is tremendous, not to speak of the loss, the feeling of helplessness of not being able to save loved ones. So in the medium term is there need for a kind of a psychological therapy center?

I don't know if centers are the right approach. It depends on the communities. In Ambon (in the Maluku province, following communal riots in which thousands were killed since 1997) the way we found best was to work with the people. We would identify resource persons, build up skills, so these persons could then develop skills of others.

Doing it through medical consultations is also a very positive approach. People won't seek psychological care, saying "I've got a mental problem". You go to a doctor because you can't sleep, you're very tired, and the doctor might say that it may be good for you to go the next room, where there's a psychologist.

In Banda Aceh many actors (relief workers) are arriving but in many other parts there might not be so many. MSF has often got the means to reach out to the population. With a helicopter we went to the west coast. We could land twice, once in Lhok Teunom.

There was a group of people on a mount there, and only a mosque standing. Banda Aceh is a big pile of rubble but everything along the west coast is flat, washed out. The people were so happy to see other people. They need everything; they also need human contact.

So we want to drop teams (in different areas on the west and eastern coast) with helicopters and boats, each one to stay three days for medical consultations and seek local solutions for water; we hope to open a base in Meulaboh.

On Saturday when I was at the airport (in Banda Aceh) a woman told me how she tried to get her 14-month baby, and then she had a memory block. This often happens (with traumatic experiences). I think everybody needs this human approach. It's very hard. But MSF must have had much experience in these relief operations.

Yes, I was also in Chechnya in the first war (mid 1990s) but I never thought I would see anything like this. What will be complicated will be working with what's left; in one village only about 2 percent of the population was left. What problems have you had in starting up the operation, and how can it be sustainable?

From the beginning there was the issue of fuel. But we're independent and funded by the public; this allows us to set in gear our operation.

Many will continue to arrive but it needs to be systematic; for instance you need to follow up of a person's symptoms; if there is diarrhea then is there a water problem, and then (it needs to be assessed) what is the potential for epidemic there. Does there seem to be an absence of framework in the whole relief work; do you feel there is clear authority?

Well the authorities are hit too, the office of the ministry of health there is wiped out. But (regarding relief workers) exchange of information is vital to prevent overlapping of work. We are always in collaboration with the ministry of health. We were immediately cleared by the Coordinating Minister for People's Welfare (Alwi Shihab) on Monday. What would you like to see better in terms of coordination, given that aid has been slow to reach many survivors?

If you mean that concerning among government bodies I don't know. We have been managing ourselves, on a day to day basis like fuel for instance, but this is normal in such situations. The Acehnese are a proud people, and now they're broken. How do you see that?

We have seen amazing solidarity; you see relatively few people in refugee camps because most survivors have been taken in by others, including their families who still have their homes. A house we saw had maybe tripled the number of inhabitants. We haven't seen beggars. People are just too shocked.