special journal report permanente and the tsunami relief … · 2011-04-12 · special journal...

72 The Permanente Journal/ Fall 2005/ Volume 9 No. 4

Special Journal Report

Permanente and the Tsunami Relief Efforts—One Year Later—The Volunteers’ Stories: A JournalBy Sarah Beekley, MD, Editor

To get a complete picture of the Permanente physician, it isimportant to highlight life outside the normal work environment.Possibly nothing demonstrates the compassionate heart ofPermanente better than the amazing response to the December2004 tsunami disaster.

Approximately three weeks after the tsunami struck the north-ern Sumatra province of Indonesia, I joined a medical-surgicalteam of volunteers from Baltimore. Although I have been on nu-merous short-term missions to developing countries, I was notprepared for the devastation. I was not alone; many other KaiserPermanente (KP) volunteers joined the relief effort. You will seefrom their stories that they also had life-changing experiences.

To give the Journal reader a glimpse of what these physiciansand other clinicians experienced during their volunteer work inSri Lanka and Indonesia, we have prepared this edited compila-tion of writings from some of these relief workers. Writing theirstories is important not only for sharing experiences with othersbut also for these physicians to gain perspective and insight intotheir own personal experience. Writing deepens empathy. Thetestimonies and pictures are only the tip of the iceberg–—manyothers in KP contributed.

—Lee Jacobs, MD, Section Editor

IntroductionPhysicians take many paths to finding meaning in

medicine. For the doctors of the TPMG InternationalTsunami Disaster Relief Team, humanitarian medicalwork in South Asia provided meaning and much more.

In the following collection of essays, you will read ofthese experiences and of the lessons learned. Teamsconfronted rare diseases and complicated medicalcases with minimal resources. They developed large-scale public health programs as part of a collabora-tive international team. As medical volunteers in ar-eas ravaged by both civil war and tsunami, teams werechallenged to be resilient and flexible, to maintain anopen mind, and to improvise. We were reminded ofthe tremendous wealth of our communities, the valueof our own skills, and the personal rewards of servingwhere the need is so great. Both our international col-leagues and our patients inspired us to maintain ourhope and idealism in the face of immense tragedy andsorrow. Above all, we shared with our colleagues, ourstaff, and even with our patients, a tremendous senseof pride and gratitude as we watched KP set the stan-dard for corporate compassion and responsibility.

However, the most important stories are about thepeople we served. Bearing witness to their experiencesand learning first hand of their lives was not alwayseasy. As Brian Hertz, MD, our Team Lead, recently ex-plained upon accepting the American Red Cross, BayArea Region, International Humanitarian Hero Award,“Humanitarian work requires that one struggle to bepresent and stand in close proximity to those who aresuffering.” Supporting this work, he says, “… allowsus, as relief workers, the opportunity to continue toexpand the boundaries of human consciousness. Thisis a consciousness that says that humanity in its high-est form does not willingly leave its wounded to sufferalone on the road. It is through these actions that wetruly make our lives richer.”

kp in the community

Sarah Beekley, MD, is a pediatrician at KP Redwood City in NorthernCalifornia. She is the incoming Regional Chair of the Physician Satisfactionand Wellness Leaders. E-mail: [email protected].

Banda Aceh, Indonesia

73The Permanente Journal/ Fall 2005/ Volume 9 No. 4

kp in the community

December 26, 2004Banda Aceh, Indonesia

Banda Aceh was a city of approximately 450,000 people located atthe northern tip of Indonesia. The epicenter of the 9.0 earthquake(one of the largest on record) was approximately 150 miles off thecoast of Sumatra at the boundary of the India and Burma tectonicplates in the Andaman-Sumatran subduction zone. It has been re-ported that one of these plates suddenly dropped 100 feet creating aplunger-like effect resulting in the tsunami. Satellite photography sug-gests that the waves traveled up to 200 mph until they approachedIndonesia. The first waves struck northern Indonesian shores within15 minutes, at approximately 9:00 am on December 26th. Giganticwaves continued to strike the shores throughout the Indian Oceanover the next 4-5 hours. The countries most severely affected wereIndonesia and Sri Lanka.

The people of Banda Aceh did not have a chance. The destructionwas not just the coastal villages, but also included the city’s flat, highlypopulated area that extended up to two miles inland from the shore.As of January 26th, the dead and lost in northern Indonesia ap-proached 230,000 with 2000 bodies found that first day.

The devastation in and around Banda Aceh was indescribable.Miles and miles of cement slabs were all that was left. The scenefrom an atom bomb could hardly be any different. I was remindedthat large numbers of people had lived here when I passed by themany mass graves.

— Lee Jacobs, MD

Permanente and the Tsunami Relief Efforts—One Year Later—The Volunteers’ Stories: A Journal

First True Chance

By Sarah Beekley, MD – Sri LankaRegional Chair, Physician Satisfactionand Wellness LeadersRedwood City, CA

A team of three doctors, wewere part of the initial humani-tarian response sent by our col-leagues at KP to a remote refu-gee camp for the villagers fromMankerny, where aid had onlyjust begun to trickle in. We setup our mobile medical clinic witha few scavenged chairs andtables, and the lines of patientsbegan to form.

Toward midday, the line was in-terrupted by a small child’s re-quest for the doctors to visit her18-year-old sister who, the nightbefore, had delivered a seeminglyhealthy baby at 36 weeks. Thefamily had heard that an Ameri-can pediatrician was in the campand they hoped that we wouldcome to check the newborn. Theyoung girl led us down a dustyfootpath, until we crossed theboundary between the makeshifttent camp and the neighboringvillage. The village’s palm frondfences marked the borders be-tween thatched huts, and wecould see what life must havelooked like in better times. Fi-nally, we reached a small, tidycompound of huts. By this time,a shy and inquisitive crowd, madeup of three generations of theyoung girl’s family, had joined us.

Among the crowd was the mid-wife who had delivered the baby.Reportedly 80 years old, she waslithe and nimble and moved withthe grace of a ballerina. She in-vited us into the compound andexplained, with obvious pride,


kp in the community

that this new baby was the fourthgeneration of this family that shehad delivered.

“How many children have youdelivered?” We asked. “I don’tknow,” she replied “the wavetook my journal, as well as all ofmy equipment, including my onlypair of scissors.” She stated, withobvious pride and authority, “Wecut the cord with a well-boiledkitchen knife.” With that explana-tion, she brought us to the door ofthe smallest of the shelters in thecompound. Inside, legs out-stretched, on a palm mat that washer only protection from the mud,sat the smiling young mother.Cradled in her lap, swaddled inworn, but freshly washed clothes,lay the small but perfectly formedchild. With her new mother’spride tempered by maternal pro-tectiveness, she gingerly un-dressed the infant for us to ex-amine. Between two delicatepieces of cloth lay the umbilicalcord, still thick and gelatinous, asclear evidence of the newness ofthis life. Tiny but perfect, coveredin the dark hair of its pretermbirth, the infant captivated all of

could be at her next birth, to sharein the experience, and to learnfrom her skill.

That night our team quietlyshared the wonders of the day.In the last few weeks, we had wit-nessed tremendous tragedy, suf-fering, struggles, dignity, pride,and now, joy. Sharing these life-altering events with the peopleof Sri Lanka was a precious gift.However much we accomplishedduring our medical mission, we feltas though we were the ones whohad benefited the most. To quote acolleague, Randy Bergen, MD, “See-ing their strength has made me stron-ger. And being able, in a smallway, to share their pain allows meto feel the good and bad of thisworld more intensely.”

I have heard many colleaguessay that doing humanitarian reliefwork always gave them backmuch more than they felt they hadgiven to their patients. It is nowmy turn to say the same. ❖


Drs Beekley and Meghani, Mankerny Camp. Photo by Regina Pietersen, RN.

Young girls at Vattuwan Displaced Person’sCamp, Sri Lanka. Photo by Sarah Beekley, MD.

us. The first grandchild, the firstbaby born since the tsunami over-whelmed their family, the firstchance for true hope—the firstsource of true joy. Despite hav-ing attended hundreds of births, Ihad never felt such awe at theblessings of a healthy child, orsuch gratitude for having been in-vited to witness the wonder of it.

As the day ended, wesaid our goodbyes andwere escorted by themidwife and her youngcompanion down thedusty paths to our mo-bile clinic. There, withgratitude once more ex-pressed from all sides,we said our goodbyes.The senior member ofour team rustled throughthe trunks of suppliesthat KP had sent with usand presented the mid-wife with a suture kit asa replacement for herlost scissors. Watchingthe midwife walk away,holding the preciousand unexpected giftclose, we all wished we


kp in the community

I write about my experiences in SriLanka on the tenth anniversary of theOklahoma City bombing. That dayten years ago, when I searched thesmoldering rubble of the childcarearea of the Murrah Federal Buildingfrantically looking for a living survi-vor but finding only body parts, is asvivid for me today.

Although these experiences aretraumatizing, disaster relief work hasbecome the most profoundly posi-tive and deeply moving work I haveever done.


“We have now completed our efforts to assist thevictims of the tsunami in Sri Lanka and prevent anepidemic of malaria in Indonesia. The success of theseprograms exceeded my greatest expectations. In SriLanka, our physicians cared for thousands of indi-viduals, both those with acute problems from thedisaster itself and those with secondary problems fromcontaminated water, infectious diseases, and psycho-logical trauma. In Indonesia, our three teams com-pleted a three-month partnership with the MENTORInitiative. They made significant inroads in malariacontrol and abatement, potentially saving tens of thou-sands of lives.”

“As the premier medical group in this country, weare fortunate to have the ability to support a uniquerelief effort such as this one. Our organizational cultureof compassion and commitment allowed us to respondswiftly and effectively to this natural disaster. Hundredsof our physicians volunteered their services, but unfor-tunately, we were not able to utilize all of their exper-tise. Our hope was to send more physician teams to SriLanka, but given the circumstances, no additional teams

will be going overseas. I appreciate your willingness tovolunteer your services.”

“Our history as a program includes many fine ex-amples of when Kaiser Permanente was willing to stepforward, and as a result, serve as an example and rolemodel to the rest of medicine and the nation. I amgrateful to those who went to South Asia and to theircolleagues who remained here and provided outstand-ing medical care to the patients of these physicians.”

“As an organization, we try to do the right thing, andin this case, we did just that. I know that we will beready to help should something of this magnitude oc-cur again. I am confident that should our assistance beneeded that you and your colleagues will once againvolunteer to serve. On behalf of our entire medicalgroup, I thank you.”

— Editor’s note: On September 12th, working in col-laboration with the US Department of Health and Hu-man Services, Kaiser Permanente fielded the first of mul-tiple teams to the Gulf Region to assist the victims ofHurricane Katrina.

When the tsunami struck, the en-tire world had front-row seats, thanksto the technology of cell phones,videocams, and Web blogs. The $2billion pledged so far and the thou-sands of disaster relief workers thathave poured into the affected areasare clear indication of the global em-pathy for the victims of this disaster.I’m very proud to belong to an orga-nization that sent 300 volunteers torelief efforts. I’m privileged to havebeen one of the first to go.

As with other disaster relief experi-

ences, Sri Lanka has filled me withsome degree of internal conflict. Howdo I come to terms with such positivefeelings and sense of personal growthwhen such devastation and sufferinghas occurred in the lives of so many?Sri Lanka has also given me a greatersense of appreciation for the simplethings in my life. I am more gratefulfor my life, my family, my patients,and my friends. It is easier and alsoimperative to be a compassionate be-ing. To relieve suffering in any way Ican is an ever-present mission. ❖

Compassion—An Ever-Present Mission

By Hernando Garzon, MD – Sri LankaEmergency PhysicianSacramento, CA

Excerpts from Robert Pearl, MD’s address to TPMG Board of Directors,at the April 2005 Directors Meeting


kp in the community

A Coughand a Child

By Cathy Baker, MD – Sri LankaOb/GynRoseville, CA

I keep thinking about this guy.He initially asked for treatment forhis cough, a common complaintassociated with the stresses thatall the tsunami refugees suffered.I thought of it as their culturallyappropriate way of expressingposttraumatic stress syndrome.Nonetheless, I listened to hislungs, checked his blood pressureand asked him about his othersymptoms. Everything appearednormal for a middle-aged man.

Then we asked him about hisfamily. He and his wife had triedfor many years to have children.Five years ago, they had finallyhad a daughter, a delightful childand a joy to be with, she was hisreason to laugh. He delighted inbeing her father. Now he had losteveryone—his beloved child, hiswife, and all of her family.

He sobbed. The interpreter, alsocrying, could barely talk. I wascrying. The only thing I could dowas to give him a prescription forvitamins. Maybe it would helphis immune system. ❖


A Wave andTwo Children

By Christine Fernando, MD – Sri LankaRheumatologistSacramento, CA

From Colombo, the capital of SriLanka, it’s an eight-hour drive toBatticaloa, one of the areas mostaffected.

At the earliest opportunity, we vis-ited the campsites of the tsunamivictims. All related heart-wrenchingstories of loss. One woman de-scribed how the waves pulled hermonth-old infant and three-year-oldson out of her hands.

In addition to giving medical as-sistance, I became a counselor, of-ten returning to our vehicle to cry.A few asked, “Why am I still liv-ing?” Having no answers was thehardest thing for me.

At the end of long days, we hadeach other for support. I am sograteful to my teammates, SarahBeekley and Hernando Garzon, fortheir support and their friendship.We all became true friends as wetraveled in Sri Lanka.

This will not be the end of myinvolvement in disaster relief. And Ilook forward to the ways that I cancontribute more in the future. ❖

StrangeAlliances

By D Scott Smith, MD – IndonesiaInternist and Infectious DiseaseSpecialistRedwood City, CA

The tsunami stopped the warand brought many people togetherfrom incredibly diverse back-grounds—from around the worldand from the local area. It was ex-hilarating to work shoulder toshoulder for long hours, in an ef-fort to make things a little better.

If some of the strange alliancesthat developed after the disasterwould only persist, this worldwould be a much better place: TheTerminix Company worked to-gether with the Indonesian mili-tary to spray for insects; the mili-tary took on completely differentroles: delivering food to the hun-gry and setting up diagnostic test-ing centers.

Like others, I was amazed by thedevastation, but I felt uplifted bythe opportunity to be part of theunified effort. ❖

A child’s toy in the mud in Indonesia. Photo by Randy Bergen, MD.


kp in the community

The Pictures Children Drew

By Heena Majmudar, MD – IndonesiaHospitalistWalnut Creek, CA

I always wanted to help people in need and make a difference in theirlives. When the tsunami hit, we all know that there was tremendous dev-astation and that several thousand families lost loved ones. The aftermathcreated the possibility of another catastrophe. An epidemic of malariacould worsen the problems of analready suffering people. When KPoffered me this opportunity to goto Banda Aceh and help the peopleaffected by the tsunami, it perfectlymatched my vision of helpingpeople in need.

I delivered backpacks to one ofthe elementary schools. It felt sogood to see smiles on the children’sfaces. The children drew pictures ofhow they were saved from the tsu-nami to show their gratitude and ap-preciation.

Being a part of the Aceh commu-nity and getting to know theAcehnese people, I was able to seetheir strength and to share theirpains in a small way. I was im-pressed by the resilience and cour-age of these people, and that mademe stronger. This experiencehelped me realize the importanceof life. It was a journey on an in-credible mission. ❖

Dr V, BatticaloaAttending

By Joshua Weil, MD – Sri LankaChief of Emergency MedicineSanta Rosa, CA

Today was a nice day. I’m begin-ning to feel comfortable beingdriven around. Getting behind thewheel here would be bumper-carmadness. I like the sights that arenow becoming familiar—funky traf-fic, school children in waves on bi-cycles, street vendors, workingcattle, strolling cattle, goats, dogs,shops, colorful clothing, and thedaily bustle that is Batticaloa.

We are still organizing the newphase of mobile clinics for thecamps, so we are unable to go backuntil Saturday—I hope. Today Irounded on the cardiac care ward,ICU, poison ward, and medicineward—about 70 patients. It is fas-cinating. Dr Vivekanandarajah isthe attending for all of thesewards. In the US, often a differ-ent physician would attend eachward, for larger wards like medi-cine. Dr V has attended at this hos-pital since the 1970s. He says thatin the 60s it was a pretty goodplace to practice, with plenty ofstaffing and a new facility. How-ever, since the civil war, neglectresulted in physicians leaving. Fora time, he was the only physicianfor the entire hospital! Now hefeels it’s about 40 years behind thetimes. Though better than a fewyears ago, it would be easier forhim to practice in the capital (Co-lombo) or even in the UK. How-ever, he is dedicated to the peopleof this area. To me, he embodiesthe important qualities of a physi-cian and a person. ❖

Indonesia—What WeHeard: EyewitnessAccounts FromSurvivors

Because emotional support wasa major focus of our clinics, wediscussed the tsunami with every-one we cared for and so heardfirsthand from those who wit-nessed the disaster.

We heard amazing stories—some of survival but almost alltragic. It was repeated several timesthat in these villages, unlike in thecity where almost no one survivednear the water, you only lived if youcould run fast and climb a tree. Fa-thers away from home returnedonly to learn that their wives andchildren were killed. Everyone wesaw in our clinic had heartbreak-ing stories to relate.

—Lee Jacobs, MD


Schoolchildren’s drawing, Indonesia


kp in the communityPermanente and the Tsunami Relief Efforts—One Year Later—The Volunteers’ Stories: A Journal

Two Little Girlsand My Daughter

By Linda V Packia Raj, MD – Sri LankaPhysician Medicine and RehabilitationIntegrative MedicineSanta Clara, CA

For me, the most cherished mo-ment is the same as the toughestday. It was hot when the grenadewent off at the political office ablock from the hospital Sarah(McCarthy) and Cathy (Baker) weredriving by. We were sharing ahouse with eight people. Half ofthe team wanted it cool, halfwanted it hot. Half of the team feltit was dangerous in the house; theother half thought it was safe be-cause the incident was like a drive-by shooting in LA. We were ex-pressing internally the externalturmoil we were in. We were con-cerned that if we were injured, itwould jeopardize the future of “Kai-ser International,” as we thought ofourselves. We went to the orphan-age to see a displaced five-year-old.She did a little dance; she acted socute. Just behind her stood a girl ina pink, ruffled dress, crying. She hadjust come to the orphanage the daybefore because her parents had losteverything and had to give her upfor her survival. Watching them …my daughter is three, I love her somuch; I can’t imagine how terribleit would be to have to give up yourchild, the sacrifices people made outof love. ❖

The Small Things

By Karen J Kruger, MD – Sri LankaPediatricianRichmond, CA

Our first visit to the beach in Batti was one of the most memorable momentsof my life. Tropical beaches are my favorite of nature’s gifts. Tremendous effortshad been made to partially remove debris, but uprooted trees and demolishedhomes were still everywhere. The small items grabbed my heart … a child’sshoe up in a tree; a broken pot; one lone fishing boat at sea; families afraid ofthe water, angry at the water; young men hanging out at the shore, talking andlaughing like you would see on any beachfront, except they were carrying rifles.I saw the generosity and resilience of human nature: terror, joy, peace, faith, love,destruction, and reconstruction. That day, I heard stories at the camps of heroessaving neighbors’ and strangers’ lives; stories of unimaginable loss and unimagin-able strength. It was profound to stand in one place where all these parts of lifetook place. I am tremendously grateful to KP for supporting this project. I amenormously proud to be working for such a terrific organization. ❖

When we arrived, the geopoliti-cal situation in Sri Lanka was rap-idly changing, and the acute disas-ter relief was evolving into along-term rehabilitation mode. Ourtask was to identify projects thatwould make a significant improve-ment in their health care system,thereby making “Kaiser Interna-tional,” as we were known, an un-forgettable entity in Batticaloa.

Each of us, in our own specialty,focused our energy on the BatticaloaGeneral Hospital, even though wewere fortunate enough to visit therelief camps assigned to us by thelocal health care professionals. Know-ing Tamil, the local language, helpedme communicate with the peopleso enormously affected by the tsu-nami and by the 20-year civil war.People had lost everything twice intheir lifetimes. We were helpless lis-tening to their stories, because wecould offer no immediate solution ex-

cept just to listen and to cry with them.Many people had chronic medical

conditions, such as hypertension anddiabetes—out of control due to thedisaster. We could do very little tohelp. Many sought our medical ex-pertise from the neighboring townsand villages after traveling long dis-tances to see us. We could often treatacute ailments such as fever, variousinfections, aches and pains, sprainsand fractures, insomnia, and pregnan-cies. Most people were anemic, andall we could offer were a few ironpills and vitamins!

What strikes me most is that ouradministration stepped outside thebox and took a major risk by com-mitting the personnel and funds tohelp those in need from a distant di-saster. During this project emergedthe best in all of us and our familiesand made us proud to be a part ofKP—or “Kaiser International” as thelocals call it. ❖

People Lost Everything Twice

By Malti Charlu, MD – Sri LankaMedical Director of the Anticoagulation ClinicSanta Teresa, CA


kp in the community

The prevailing atmosphere ofgoodwill and helpfulness of therefugees and all the health care pro-viders I met struck me the most. Ihad the privilege of interacting witha number of volunteer organiza-tions in Batticaloa, including theItalian Red Cross, Oxfam, Unicef,and Doctors of the World Greece.

At one point, when my partner,Lali Thambi, and I found ourselveshomeless, a volunteer group fromEngland moved mattresses tomake room for us. We later re-turned the favor and took in twonurses who were having troublefinding housing. We met physi-cian staff from the local hospi-tal, Batticaloa General and, dur-ing our three-week stay, were

School HouseHorror

By Randy Bergen, MD – IndonesiaChief of Pediatrics; PediatricInfectious Disease ConsultantWalnut Creek, CA

My hardest moment was at a vil-lage called Lamno, on Sumatra’swest coast. While delivering sup-plies during malaria training, wedrove by a school. The sight ofthis school brought me to tears—I missed my own two girls. On theground floor of a very solid, three-story building, only a skeleton ofthe support columns remained—all the walls were gone. On thesecond floor, the exterior wallswere gone; and on the third floor,above the level of the wave it wascompletely intact. No child on theground floor survived. Most on thesecond floor died as well, but allof the children on the third floorlived. What horror those childrenmust have experienced.

Unlike the clinical work of theSri Lankan teams, our work wasalmost exclusively public health:teaching, and advising. In thatrole, it is harder to be certain ofyour impact. When we left for theairport, our Indonesian cowork-ers and friends filled the vehicles,and we formed our own motor-cade, rivaling the VIPs. The peoplethere know that even wealthy Cali-fornians care about them andwant to help them recover fromthis disaster. ❖

I think that I can speak for all the doctors involved in the tsunami reliefproject when I say that we all hope that KP will continue international medi-cal humanitarian work. As a formally sponsored project within KP, this re-lief project has set a standard of corporate compassion and responsibility forlarge and successful US-based nonprofit corporations. Seeing KP formallyinvolved in humanitarian work has given so many of our staff, physicians,and members new reasons to be proud of our organization and has renewedphysicians’ satisfaction with their work. For this work to continue, the chal-lenges are safety and choosing projects that are cost-effective and time-lim-ited to minimize the sacrifices made by our members. Based on my ownexperience, I am confident we can achieve these goals, and I hope that wewill find the organizational will to continue this work.

—Brian Hertz, MD, Program Director, Family MedicineSan Rafael, CA


The Importance of Working Together

By Mary Meyer, MD – Sri LankaEmergency PhysicianWalnut Creek, CA

invited to dinner at several homes.In each case, the people we en-

countered were eager and excitedto share resources, information,and emotional support. It was atrue pleasure to work in such anenvironment, and something that Ibrought home with me. I work ina busy ER, and sometimes in myday-to-day life at KP, it’s difficultto remember the importance offunctioning as a team, of lendinga helpful hand or ear to my col-leagues. When I am tempted toput blinders on, I remember theuniversal generosity of those I en-countered in Sri Lanka, and it in-spires me to do better. It is one ofthe best things that came from myexperience. ❖


kp in the community

Mama Donut

By Nancy Torres, MD – IndonesiaPediatricianRoseville, CA

I will always remember “MamaDonut.” She was a woman on asmall island at the most northerntip of Aceh Province. She told mehow she had lost several relativesin the tsunami, including heryoung son. He had run down tothe ocean excitedly when thewater receded to see many fishjumping. He was grabbing at fishas she stood watching on the hill-side when the wave took him.She did not cry telling me herstory, but her face showed herunbearable grief. I felt so help-less. All I could do was buy moredonuts from her than I could evereat and hope that by listening andacknowledging, I might offersome solace. ❖

A Casualty Come to Life

By Sarah McCarthy, MD – Sri LankaObstetrician; Assistant Physician in ChiefVallejo, CA

The physical evidence of the tsunami was overwhelming, incomprehensible.Our team quickly accepted the omnipresent military presence, the fre-

quent checkpoints, the bunkers and garrisons, and the warnings aboutlandmines. After all, life in town went on. It was only through the refu-gees’ telling of stories that I began to understand the larger impact ofthe decades-long civil war.

One family recounted their second stay in the refugee camp; the firstwas after fleeing from rebel fire, the second after losing their home totsunami. They voiced no self-pity, borrowing cups for limeade from aneighbor tent to extend their hospitality to our team. A six-year-oldgirl’s new home was an orphanage after her father died in a bombexplosion at a full moon festival on the beach. At first, she was consid-ered a casualty until someone witnessed her slight movement in themorgue. People told many stories of lives, families, and homes dis-rupted from poverty and the civil war, which had caused twice asmany deaths as the tsunami.

As the international effort transitioned from tsunami relief to develop-ment efforts, I was struck by the fundamental discrepancy in the way theworld responds to a natural disaster as opposed to a man-made disaster.What could we, as citizens of the world, accomplish if each individualannually contributed the amount s/he donated to tsunami relief? How muchsuffering from starvation or AIDS could we prevent? Choose an interna-tional relief effort and let us find out. ❖


KP Made a Difference

By Regina Pietersen, RN – Sri LankaPediatric NurseThe Netherlands

Most of KP teams had one person able to speakthe local language. It makes things easier, re-moving a barrier and putting you closer to thepeople, and the people closer to you. Althoughsome doctors might think they achieved little,they showed a different way, a change of per-spective. If you were a doctor who listened,you made a difference.

Working with KP gave me the opportunityto work outside my normal work as a pediat-ric nurse/neonatal nurse trainer. I shared myknowledge about the country, the city, theculture. Many people from around the worldworked together. ❖Sri Lanka


kp in the community

I was born in San Francisco andraised in Hawaii. Water, a symbolof new beginnings, birth, and for-giveness, has also representedrageful storms, life’s endings, anddeaths. I grew up loving the oceanwaters. I rode waves, dove fromhigh rocks and floated in her im-mense embrace of calmness. Mostly,I have seen the ocean as a friend,full of energy and energizing. My par-ents were stern about teaching us torespect the ocean: we were not toturn our backs to her; we needed toknow the strength of the waves; pre-dict when it would crash on theshores and learn to deftly dive intoher waves, gliding through liquidglass to avoid collision. Tsunamiswere no strangers. One of my teach-ers drowned in a huge wave, andone of my surfer friends was para-lyzed by the force of smaller waves.

I considered myself “blessed.” Myamakuas or “angels” had great manaor “powerful grace” and kept mesafe. The “healing” sea turtles weremy amakuas, and they have savedmy life more than once. Once whileboogie boarding, a friend and I werecaught in a riptide that took us atleast a mile offshore. I felt my heartbeating fast, anticipating the worst.My friend was a pianist visiting be-fore a concert at Carnegie Hall. Ifanything happened to her, I was notgoing to hear the end of it. Thenthey appeared. Suddenly, two seaturtles flanked us on each side andled us at the right moment to a hugewave that carried us right onto thebeach. It was the best boogie boardride of my life and the fastest ever.We both lifted ourselves up on thesand somewhat dazed at the unex-

pected gift, and we spoke very little.We understood our amakuas had ledus to safety. Who would believe us?

On December 26, 2004, I waskayaking with my niece andnephew off the west shore of Oahu.It was unusually rough, but I hadbeen in rougher waters and just keptheading out quickly to push beyondthe breakers. Usually fearless, myniece and nephew were tentative andunsure. I kept assuring them that wewould have smooth sailing beyondthe breakers. Suddenly, two turtlesflipped up into the air six feet highand our kayak seemed to jolt as well.The children started crying andbegged me to turn around. I thoughtthat they were overreacting but, none-theless, it was very unusual for twoturtles to flip into air. My nine-year-old nephew wept, paddling furiouslyand demanded that I hurry. My five-year-old niece just wept quietly, trem-bling and leaned in close to me.

When we arrived home andwatched the news, I understood whathad happened. Our amakuas were

keeping us safe, warning us to be care-ful, to watch out, to listen with ourhearts to those cries across thousandsof miles of ocean. My nephew andniece cried and so did I.

When I returned to San Francisco,an e-mail arrived inviting us to vol-unteer to do medical relief in SriLanka. Having just returned fromHawaii, I had no more vacation timebut I kept staring at the invitation onmy computer screen. I couldn’t hitthe delete button, so I took a deepbreath and typed, “I am interested”and gave my list of qualifications.When I heard that the first team hadbeen deployed I never thought that Iwould be asked to go on the seconddeployment. I had always wanted totravel to Sri Lanka because of my in-terest in Polonuwaru, where one ofmy mentors, Thomas Merton, hadexperienced “enlightenment.” Whenasked if I wanted to go to Indone-sia or Sri Lanka, I knew already thatI wanted to go to Sri Lanka. ❖

Dr Shirley Tamoria and patients. Photo by Josh Weil, MD.

Flying Turtles

By Shirley Tamoria, MD – Sri LankaFamily MedicineSan Francisco, CA



kp in the community

I Got More Than I Gave

By Steven P Chan, MD – IndonesiaInternal MedicineSan Francisco, CA

Even before the KP Northern California Regional Of-fice decided to support a tsunami relief effort, my wifeknew that I would go to Sumatra right after the newsof the tsunami hit the airwaves. She knows me betterthan I know myself.

I did not think I had the skills to help anymore. Thedays of Peace Corps Malaria Control Program were 25years past. My internal medicine practice in San Fran-cisco consists of caring for patients with HIV andlifestyle-related health risk reduction.

What in the world could I do in a disaster of unimag-inable proportion? I was lucky to be accepted as amember of the second KP team going to Sumatra tojoin the MENTOR Initiative to contain the threat of ma-laria in the Province of Aceh.

I got so much more from being there than the Indo-nesians got from me. Our contributions were minus-cule compared to their needs, but we all returned withhearts filled with the joys of meeting and working withincredibly strong and resilient people, the sorrow ofseeing so much loss, and, finally, the pride of being apart of an organization that cares. ❖

A PurelyHumanitarian Effort

By Mihir Meghani, MD – Sri LankaEmergency PhysicianFremont and Hayward, CA

KP’s tsunami relief effort was unique: All aid andrelief was purely humanitarian. There was no com-mercial, religious, or political agenda. I was hon-ored to serve with a dedicated team of people,backed by our organizational resources. Servingpeople in need, working through complex situa-tions, negotiating with several entities, communi-cating with local people who did not know English,and coordinating with our team in Oakland will allbe with me for the rest of my life. After returning, afriend I made there wrote, “We were blessed byyour team’s selfless efforts. If more people like youhelped in other parts of the world, conflict wouldsurely end.” ❖

AcknowledgmentThe authors would like to thank Kathryn Griffin for her efforts

in helping to pull these stories together.


Change the WorldNever doubt that a small group of thoughtful, committed citizens

can change the world; indeed, it’s the only thing that ever has.

— Margaret Mead, 1901-1978, American Anthropologist

special journal report permanente and the tsunami relief … · 2011-04-12 · special journal...

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