Staring disaster in the face

Medical Tribune October 2008 P11
David Brill SFXV

Dr. Arif Tyebally is a veteran of disaster relief missions in South East Asia. He spoke to Medical Tribune’s David Brill about dealing with tsunamis, earthquakes and cyclones.

December 26 2004 was a day that
changed the lives of countless people.
As a 9.3-Richter earthquake
shook the ocean floor off the coast of Sumatra,
the tsunami that resulted at the surface
killed more than 200,000 and left some half a
million homeless.
Dr. Arif Tyebally witnessed the devastation
first hand. Arriving in Aceh, Indonesia,
as part of the emergency relief effort, he saw
homes destroyed, families separated and
people living through hardships he had never
imagined possible.
“To this day I can’t think of anything that
could be worse than the tsunami,” he says.
“It was unbelievable. Thousands of homes
just flattened. Nothing can recreate it, and
nobody can describe how bad it really was.
I don’t think anyone could be prepared for
what we saw.”
On a regular day, Tyebally, 33, is a pediatrician
at KK Women’s and Children’s Hospital
in Singapore. He decided to volunteer
for the mission to Aceh when he saw the extent
of the destruction on television. While
millions donated their money, he felt that offering
his medical expertise was a better way
to help.
On arrival in Aceh, the Singapore team
lived in a camp for internally displaced
people, where they set up and ran a general
clinic. Being part of the second wave of relief
teams, there were few acute injuries from the
tsunami itself, and they treated mainly postdisaster
complications such as gastroenteritis
and respiratory and skin infections. With
local pediatric facilities severely stretched –
one local hospital with facilities having been
completely destroyed and another badly
flooded – Tyebally helped to run a makeshift
pediatric department in a nearby military
hospital.
In spite of the devastation all around
them, the residents of the camp showed a resilience
which inspired Tyebally.
“People would go back to where their
homes used to be to search amongst the
rubble, and if they could find something like
a sewing machine they’d take that back and
start to work from the camp. And the children
still went to school, even if they’d lost
their parents. I’m sure they must have been
going through really hard times, but it was
good to see that despite the situation that
they were in they were all trying to get back
to their daily lives,” he says.
Tyebally spent 10 operational days in
Aceh, treating some 70 patients each day. For
many, however, the tsunami had left wounds
that he was powerless to heal. He recalls the
thousands of photos of missing children that
lined the walls, and the haunting memory of
one lady who spent weeks going from hospital
to hospital looking for her child, long
after the waters had subsided.
“You can’t really help someone like that,”
he says. “You just have to talk to them. They
probably know that there isn’t much hope,
but for a mother any hope is still hope. It’s
very sad to see things like that happening.”
With some of these memories still troubling
him to this day, you could have forgiven
Tyebally for shying away the next time a
natural disaster struck in Asia. Yet in October
2005 he found himself among the first official
medical teams to arrive in Muzaffarabad,
Pakistan, following a 7.6-Richter earthquake
which left some 80,000 people dead.
The Singapore team set up a hospital –
again within a tented camp – comprising an
emergency room, wards and an operating
theater. Unlike in Aceh, however, the team
was treating mostly acute cases such as fractures
and open wounds. Some patients, he
says, had walked for 5 days with fractured
hips in order to receive treatment.
The conditions encountered in Pakistan
were also a challenge for the relief teams.
Aftershocks from the earthquake were common,
while sleeping in tents in an inaccessible
mountainous region with winter approaching
ensured that living conditions
were far from luxury.
For Tyebally, who speaks Bahasa Indonesia,
the language barrier in Pakistan was another
new problem which he had not faced
in Aceh. He soon realized the need to work
closely alongside local volunteers, many of
whom had given up paid jobs to come and
help out at the disaster zone. He was touched
by how helpful the people were – both in assisting
with the logistics of the team’s medical
operations and acting as interpreters for
the patients and local medical staff.
With two disaster relief missions under
his belt, Tyebally was elevated to Singapore’s
team leader when Cyclone Nargis struck
Myanmar at the beginning of May this year.
With much of the world denied access to the
country, Tyebally and his team found themselves
operating for the first time without the
coordination and resources of the UN.
Undeterred, the 23-man team managed
to treat nearly 5,000 patients in just 2 weeks,
operating from their base in Twan Te – a
town around an hour’s drive southwest of
Yangon. They worked out of a local hospital
but also set up mobile clinics and travelled
by boat to deliver aid to the region’s more
remote corners.
Two weeks had passed between the advent
of the cyclone and the arrival of international
aid, and the team mostly encountered
a similar post-disaster caseload to that seen
in Aceh. There were also many patients with
untreated chronic diseases such as hypertension
and diabetes who took the opportunity
to seek medical attention from the doctors.
Myanmar also presented Tyebally with
one case that he will never forget – a young
girl with ascariasis, a parasitic infection in
which worms mature in the intestine and
migrate up the respiratory tract.
“The family didn’t seem very upset
or perturbed by it. In fact she came in for
something else and oh, by the way, there are
worms coming out of her mouth,” he says.
Everywhere Tyebally has been he has
been struck by the gratitude that the people
have shown him. Sometimes he wishes he
could do more, he says, but adds that even
when nothing can be done the patients are
often glad of the sense of closure that comes
from knowing their fate.
He shrugs off the notion that his work is
heroic, describing it simply as a form of charity
work like any other.
“It takes so little for us to give to make a
big difference to the lives of the people. Not
many people want to go on such missions
because there are dangers, but I think that
the benefits – the sense of satisfaction and
the fact that you can help people – outweigh
these.”
His experiences, he adds, have helped
him not just in a professional context but also
to grow and develop as a person.
“You gain as much from the patients as
they gain from you. You see how resilient
they are in the face of suffering, and how
they can turn their lives around and get back
to their normal routines despite all that has
happened. It really makes you appreciate
what you have.”
Tyebally, it seems, is just one of those
whose lives were forever changed by that
fateful day in 2004. And next time disaster
strikes, he says, he’ll be ready to go where
the people need him.