Singaporean medical team reports back from Burma

BMJ 21 June 2008
Link
David Brill

Although some humanitarian organisations are still encountering obstacles in providing aid to the survivors of the cyclone that hit Burma in May, a team of doctors and nurses from Singapore has been able to treat some 5000 patients.

The team of 23, now back home, was based for two weeks at a hospital in the township of Twan Te, roughly an hour’s drive south west of Rangoon. Dispatched under three separate banners—the Ministry of Health, the Singapore Red Cross, and a non-governmental humanitarian charity called Mercy Relief—they united on arrival to share expertise and resources.

Some international aid had reached the people of Twan Te, many of whom are living in tented refugee camps with access to water filtration systems donated from overseas. Other residents had taken shelter in the town’s monasteries.

Rebuilding of damaged houses has already begun, the Singaporean team says. Many homes had lost their roofs and provided no shelter.

The team was restricted to the local province, which has a population of around 250 000, but were free to roam within it. They later set up mobile clinics and travelled by boat to some of the region’s more remote villages.

"These areas had no medical facilities, no doctors, and no nurses," said Arif Tyebally, leader of the health ministry’s team. "Some of them had health centres, but they were badly damaged by the cyclone, and there had been no medical help since then."

Access to clean water was also limited in the more isolated areas, and many villagers were drinking from contaminated wells.

At the peak of their operations the Singaporeans treated up to 600 patients each day. Gastroenteritis, chest infections, and skin infections were the most common ailments—typically resulting from the contaminated water in the villages or the poor sanitation and crowded living conditions in the township’s refugee camps.

The team also encountered mosquito-borne diseases such as malaria as well as fractures, burns, and abrasions that had remained untreated since Cyclone Nargis struck on 3 May.

Fatimah Lateef, a senior consultant from Singapore General Hospital who was working with Mercy Relief, reported that signs of post-traumatic stress disorder were common and were evident in children as young as 3 years old.

Even people who were not victims of the cyclone sought attention from the team, and patients with untreated chronic diseases such as diabetes and hypertension were often found in the queue at the clinics.

As they were limited to Twan Te province, the members of the Singapore team were unable to reach the worst affected areas in the Irrawaddy delta, where eyewitness reports have emerged of bodies trapped in trees. Closer to Rangoon the dead had been removed before the team from Singapore arrived.

"It probably was a problem closer into the delta, but we were not there, so I can’t speak at first hand. But from what we’ve heard some may have been left to decompose, and some may have been cleared," said Dr Tyebally, who previously took part in relief missions to Aceh in Indonesia after the tsunami in 2004 and Muzzaffarabad, Pakistan, after the earthquake in 2005.

Dr Lateef, also a veteran of relief missions in Asia, denied that the lack of access to the delta region was a source of frustration to the team. Preferring to focus on the coverage they provided in their allotted area, she said, "When we mount a humanitarian mission we have to respect the sovereignty and the rights of the country."

She reported that the Burmese officials were cooperative, particularly in providing translators and assisting the team in their travel around the region.

The Singapore team arrived in Burma on 22 May, three days after an agreement was reached at a meeting of the Association of Southeast Asian Nations to allow aid in from neighbouring countries.

The Red Cross team brought more than $S20 000 (£7400; 9400; $14 600) worth of medical supplies on their relief mission, including drugs, surgical equipment, intravenous infusion sets, syringes, thermometers, and bandages. The delegation from the health ministry flew out with 250 kg of supplies and was reinforced with a further 730 kg three days later.

As supplies ran low the team began to seek out further stocks in Rangoon, where much of the aid from other countries has ended up, and typically received a new delivery every two or three days.