Since the emergency medical response in Batticaloa began to be coordinated on Tuesday 28th December 2004, over 176 mobile medical clinics have been held in and around the camps housing people displaced by the tsunami in the Batticaloa District. The number of treatment consultations as of 07 Jan 2005 was 19,307. The teams conducting these clinics have been coordinated by the Batticaloa District Health Response Team and have been comprised of doctors, nurses, public health midwives, public health inspectors, nursing students and volunteers from the DPDHS, Batticaloa General Hospital, districts of Colombo, Kandy, Mannar, Badulla, Negombo, Peradeniya, Matale & Polonnaruwa, Tamils Rehabilitation Organisation, Medicins du Monde (Greece), Handicap International, Terre des Hommes, Rupavahini Corporation, Rotary International, Malaysia, USA, Canada and elsewhere. Additional support has been provided by pharmacists and volunteers from Batticaloa General Hospital, Volunteer Services Overseas, Sri Lanka Red Cross and elsewhere.
Since last week, the population in the camps and shelters for displaced persons has dropped significantly. As of yesterday (07 Jan 2005) it was reported that there were approximately 17,500 families resident at 68 locations within the Batticaloa district. The Eastern University, Batticaloa estimated that around 9,500 persons were living with friends and relatives and that over 36,000 people had returned to their villages. Further information is available at
http://www.eusl.info/ and from the office of the Government Agent Batticaloa. Many camps are being closed and residents are being moved to other formal and informal shelters. These shifts within the population directly affected by the tsunami have clear ramifications for the work of BDHeaRT and the other medical service providers in the district.
To date, the work of BDHeaRT has been to provide emergency medical treatment, to support basic preventative measures and to conduct surveillance for communicable diseases that might pose a threat of an epidemic within the displaced population. The coordination of medical teams active in the district was intended to ensure the following: a) that there was consistent and equitable health coverage for the affected population; b) that medicines used are consistent with standard practice in Sri Lanka; and c) that there was systematic reporting of diseases that posed a threat of epidemic. Data gathered has been forwarded to the epidemiological unit at the Ministry of Health, Sri Lanka, which also provided advice to BDHeaRT on disease surveillance. Information related to water and sanitation needs of temporary camps was also forwarded to key relief agencies dealing with these issues within the district. Additional information (such as that pertaining to unaccompanied or separated children) was also shared with the appropriate agencies.
The support provided by local and visiting health personnel, NGO staff and volunteers was remarkable from the outset. Although the first week of operations were marked by a near-shortage of human and material resources, by the second week of work, the situation had changed to one of surplus. In terms of medical personnel and transport, the influx of external service providers actually necessitated the reduction of locally-sourced medical teams in order to avoid the over-supply of curative medical services to camps. The rapid turn-over amongst the majority of visiting teams (average duration of 1 to 3 days), lack of appropriate language skills within these teams and shortages of support staff (ie. dispensers and nurses) meant that a large proportion of BDHeaRT resources were dedicated to coordination of these external teams. A smaller number of these visiting teams have been prepared to remain in the Batticaloa district for between two and eight weeks, and it has been possible to easily integrate them into a longer-term plan for service provision to affected areas. There have also been teams operating within the district that have failed entirely to coordinate with BDHeaRT/DPDHS office, despite a directive requiring this by the Ministry of Health. Consequently, there is no available information on the activities of these teams, the incidence of disease/injury encountered by them or the treatment they have provided.
Over the past few days, there has been an attempt to start shifting the emphasis of medical service provision away from mobile clinics coordinated through BDHeaRT and back to the main structures for health service delivery in the Batticaloa District. This shift is imperative in order to ensure sustainable and sufficient services in an area where existing structures had already been weakened by two decades of armed conflict prior to the tsunami. The DPDHS Batticaloa has made an appraisal of the damage caused by the tsunami to the pre-existing health service institutions in the district and this information is available at his office. There is a need, at present, to make a formal appraisal of the capacity of the main health services to meet the needs for maintaining good public health through active disease surveillance, preventative interventions and treatment provision. At present, it seems that a lack of medical personnel, public health knowledge, transport facilities, and infrastructure for rapid information gathering, sharing and analysis may all present substantial impediments to ensuring the good health of the affected population. The shifting of displaced and affected persons out of camps into the ‘general population’ actually increases, in many ways, the public health challenges.
It is crucial that the invisibility of displaced persons within the general population does not lead to a perception that the health needs of such a population have necessarily reduced or disappeared.
