Medicine and life
The Tsunami……half a decade later……..windows of opportunity………..
Due to various reasons, I could not blog at this forum for a period close to a year. During that year, so many things have changed in my personal and professional life and finally my frenetic rate of action has slowed down considerably, much to my benefit. I have finally found some time to go back to my old hobby….writing! So I thought I will get back in to the groove of things with writing a blog at Doc2Doc.
I was dilly dallying with several ideas for some time as to what my topic should be. After considering several ideas, I recently read a blog written on the 5th Anniversary of the Tsunami tragedy by Nalaka Gunawardene. His blog made me think and finally I got my topic.
Many things have been said and written about the 2004 Boxing Day tsunami and there is a wide coverage about its fifth anniversary in the global media. But, since I am from Sri Lanka which was one of the worst affected countries after the tsunami, and I have spent around three years in the post-tsunami Sri Lanka, seeing and experiencing the life-after somewhat from ground zero, this topic has a special meaning for me.
I was somewhere in Eastern Europe in the morning of 26th December 2004. When the news started coming in about the terrible tragedy that was happening back in my country, I went in to a state of shock. I desperately tried to contact my parents and friends wishing that no evil had befallen on my loved ones. I had relatives in the worst hit area of Galle in southern Sri Lanka and friends all over the place. For three days I couldn’t get any news from my parents and I walked around in a numbed state of mind until I finally got news that they had been visiting relatives in a different part of the Island and were safe. Few distant relatives of my family perished from the tidal waves that but no one from the immediate family. I much later learned that a friend from school and a teacher had perished. I was one of the lucky ones.
According to estimates, more than 40,000 people died on that fateful day and thousands in coastal Sri Lanka lost their families and loved ones, including their houses, livelihoods and experienced immeasurable suffering at the hands of nature.
Looking back half a decade later, I dare say that this huge tragedy had opened ‘windows of opportunity’ for the betterment of certain areas in the developing nation of Sri Lanka. The sudden vicious impact of this disaster had exposed weak links in our society, our healthcare and our ability to face a vast disaster. During the past five years, in the rebuilding and reconstruction phase, houses and businesses have been rebuilt, livelihoods have been resurrected, schools and other administrative apparatus have been reestablished. Parallel to these, many developments have taken place in healthcare and disaster mitigation during the time, which did not exist before the tsunami.
A National Mental Health Policy did not exist in Sri Lanka before the tsunami. This gap created many difficulties in the disaster aftermath, in terms of psychosocial services provision to the affected populations. Mental health care were mostly based on institutionalized approach and lacked multidisciplinary, primary care and public health based approach. After the tsunami, many people experienced psychosocial problems and there was an increase in mental health problems. Lack of clear and coherent national policy made it difficult for proper service provision in this backdrop.
However, five years later, we see a marked improvement in the above mentioned situation. A National Mental Health Policy was formed with the support of the World Health organization in 2005, with special attention to providing mental health care in post-disaster situations. This has led to improved service provision to not only those affected from tsunami but to the general population as well.
Sri Lanka, sadly, did not have a National Disaster Management Plan at the time too. It must be said that this was common for most of the worst hit countries in the region. The lack of a plan to counter a natural or manmade disaster of massive proportions had telling effect on the immediate and distant aftermath. It effected coordination between relevant governmental and non-governmental organizations responsible for relief provision, law enforcement agencies, health authorities and other organizations. This led to lack of communication and chaos.
In this backdrop, the Sri Lanka Disaster management Act was enacted, paving the way for establishing a Disaster Management Center. This center now acts as the hub for coordinating early warning systems, pre and post disaster action of various stake holders. A Disaster Management Plan was also formulated. This plan includes important areas such as mobilizing various networks, establishment of forensic services, focus on mental health aspects and others.
After the tsunami, identification of victims became a nightmare as sufficiently developed forensic and genetic services were not available. Also, most victims were unceremoniously dumped into hastily dug mass graves without proper cultural rituals due to the fear of epidemics. The disaster management plan has called in to establishing a comprehensive Disaster Victim Identification (DVI) plan.
Many clinical interventions and research projects were initiated and carried out after the tsunami by local and international researchers. Some of them were required and helped and some of them were not needed and one sided. Also some of the research was carried out adhering to international ethical guidelines while a lot of them were not. Even the ones that were carried out according to international norms were locally inappropriate in certain situations. This led to variable exploitation of the population already made vulnerable by being victims of the tsunami.
These events have led to a close scrutiny and debate about disaster research ethics which is applicable to developing country settings. Academics and researchers from South Asian and South East Asian region affected by big scale natural disasters have gotten together to formulate ethical guidelines with developing country perspective.
These are few developments that had come to fore during the past five years after the great tragedy. They have shown that every cloud has silver lining in a different sense. As every mistake should be used to learn and prepare for the future, and with a uncertain future that may bring even worse natural disaster due to climate change, these little improvements may stand in good deed for the future.
Sri Lanka has fought and overcome major setbacks to its people, economy, culture, health and other areas which happened as a result of the tsunami. Rebuilding and reconstruction has brought unexpected results in many areas which stand to do good for the country and its people for times to come.