Tsunami Followed by Hunger and Infection

IT DOESN'T LOOK like a life-threatening wound. The cut on Nurhayati Affan's left foot spans less than three inches from the top of her big toe, and in a town where 90 per cent of the inhabitants were swallowed by the sea, that makes her an enormously lucky woman.

Tsunami Followed by Hunger and Infection

IT DOESN'T LOOK like a life-threatening wound. The cut on Nurhayati Affan's left foot spans less than three inches from the top of her big toe, and in a town where 90 per cent of the inhabitants were swallowed by the sea, that makes her an enormously lucky woman. A polite smile crosses the 24-year-old's face as she recalls clinging to a palm tree while salt water and debris swept up her neighbours - Sumatrans relate even tragedy with a smile. But she darkens as the tale goes on.

Affan's nine-month-old baby girl disappeared in the TSUNAMI, she says, along with most of her family in Malahayati, a seaside town of 5,000 that was obliterated by the waves. She's been camped ever since on a hillside high above the wreckage, mourning the loss of her child and watching the ocean from a safe distance. Now, two weeks after a harried medic bound her cut and thrust a fistful of penicillin tablets into her hand, Affan's wound has taken a turn for the worse. "There's dirty blood coming out," she says, staring at the cut, which she thinks was caused by a strip of roofing metal. The bandage is brown with dirt and seepage, and when asked if she understands the threat of infection, Affan answers with a distant smile. "I hope it gets better," she says, "because I have no way to get to the city for help."

The legendary cheer of Sumatrans is a disarming cultural trait - a poise even this colossal tragedy can't seem to rattle. But in the remote coastal villages of Aceh, where little aid has reached survivors, the smiles stand in disturbing contrast to the surrounding misery. Huddled in ragged camps that line the island's northern shoreline, or stranded hundreds of kilometres from proper medical facilities on the province's west coast, thousands are surviving on sporadic shipments of rice and noodles, ignoring the minor wounds they suffered when the waves crashed through their communities. They are, as a result, stalked by infection and hunger, which makes their small communities a potential second front of the campaign to save lives in the wake of the Dec. 26 tsunami.

It doesn't take an epidemiologist to spot the danger: each day since the disaster, brigades of Acehnese have been trudging through the septic grime where their villages once stood, searching for valuables or the remains of loved ones and oblivious to the health risks. Many work in flip-flops or even bare feet, ankle deep in a soup that can transform the slightest cut into a fatal injury. At the field hospitals in Banda Aceh, where the most seriously injured are taken for treatment, amputations have already become the most common operation. "You've got people who've had festering wounds for up to two weeks now," says Howard Arfin, a Canadian Red Cross worker in Banda Aceh. "Really, these are wounds that shouldn't require such an extreme response."

For a desperate few in outlying communities, airlifts are proving the key to survival. Each morning, United States, Malay, Singaporean and Indonesian military helicopters lift off from Banda Aceh's airport and return with the sick or wounded from remote northwestern communities. The injuries can be deceptively slow to surface: last week in Lam No, a west coast fishing village cut off by the tsunami, a man towed his five-year-old daughter to town on a bicycle trailer because she'd suddenly begun heaving for air. Medics were stumped until they heard she'd inhaled seawater after being engulfed by the mammoth waves. The brine, it turned out, had left a residue of gluey sand in her lungs, which was now clogging her airways. By noon, her prognosis was critical, and as she lay gasping beside the village soccer field, a U.S. Seahawk helicopter swooped in to pick her up and take her away for treatment.

In the area of prevention, though, aid workers can claim some headway. By early last week, soap, clean clothes and antibiotics were reaching the worst-hit towns along the west coast, and a few locations even had clean running water. The Red Cross managed to get four 1.5-tonne water purification units into the hard-hit city of Meulaboh, about 200 kilometres south of Banda Aceh, allowing medical staff to properly bathe wounds for the first time. The tanks arrived thanks to a Lithuanian helicopter company, which used its heavy lifting choppers to move them. "We'd tried to truck them in," says Arfin. "The road was just too muddy."

In some remote areas, survivors have clearly given up hope of aid reaching them. For much of last week, columns of refugees could be seen from the air walking the broken highway along Sumatra's northwest coast. A Maclean's photographer met about 80 as they reached the last broken bridge outside Banda Aceh, having trudged 300 km from their village. "We've been eating coconuts and drinking from streams all the way," said their 40-year-old leader, Kamaruddin Itamyi. "Our village is gone. There's nothing there to eat. There was no reason for us to stay."

Those who have stayed behind in refugee camps, meanwhile, are getting increasingly restive. Several of the roughly 300 bivouacked at a high school in Lam No say their group is receiving only two boxes, or 80 packets, of instant noodles per day - while up to a dozen helicopters laden with food, water and medical supplies land daily in the village. Their patience snapped last week when Gen. Bambang Purnomo, Indonesia's commander of operations in Aceh, strode through their camp, boasting to reporters that Jakarta was managing the crisis well. Stunned by the general's bravura, refugees pointed out that government troops are the ones who unload and distribute the aid - a not-so-subtle suggestion that soldiers are diverting it to the black market. "I don't trust anything the government tells us," says Armia Sulaiman, a 50-year-old tailor acting as a spokesman for the refugees. "The best way to ensure help reaches us is for the foreign aid groups to bring it directly to our door."

Relief groups, of course, would be happy to oblige. But it's become increasingly clear they're less than entirely welcome in Aceh. Last week, Indonesian President Susilo Bambang Yudhoyono announced that international aid workers must wrap up their efforts within three months and get out of the country - a timeline that defies logic to anyone who has seen the scale of destruction along the coastline. In the meantime, all foreigners - journalists, soldiers and relief staff alike - must now register with local police before travelling outside Banda Aceh or Meulaboh, a restriction ostensibly meant to protect them from separatist rebels in the area.

For those stranded in outlying towns and villages, the time limit is bad news indeed. While it's generally accepted Banda Aceh will rebuild (it's the closest centre to Indonesia's oil and gas reserves), there are no such guarantees for remote communities, many of which saw more than half their buildings washed away when the tsunamis swept through. Without the outside lifeline of foreign military helicopters, and international oversight of the aid on its way here, they'll be at the mercy of a government with which they've been at odds since the 1950s, and which was initially reluctant to even acknowledge the scale of destruction caused by the waves. Will Jakarta send helicopters to transport them in medical emergencies? Will the government open its vaults to help rebuild their homes?

The need is great. Hamidah Razali, a 45-year-old widow from a village near the west coast city of Calang, is now in that city's military hospital. Propping herself by a window, she issues the obligatory smile when introduced to a visitor, recalling how she was airlifted to Banda Aceh with a pus-filled gash on her forearm. But her face crumples when asked when she plans to return to her hometown. "I'd rather go to a refugee camp," she says through tears. "My husband, my son, my son-in-law, my two grandsons - they're all gone. I'd like to stay in my village, but I have no house to go to. Why would anyone go back?"

It's hard to think of a response, beyond the obvious point that refugee camps tend to be sad, unhygienic places prone to rapidly spreading illness. When the idea of living in such circumstances is more appealing than going home, it's testimony to a level of misery few with a roof and a family can fathom. For now, Sumatrans may smile in the face of this disaster - just as they do with any misfortune. How long they'll be able to maintain their outward cheer in the face of such tragedy is another question.

No Cure for Misery

IT'S NOT A PLACE for the faint of heart. The southwest ward of Banda Aceh's military hospital has a few more patients than corpses, but the international team running this place - mainly Indonesians, with support from the Australian military - wage a daily battle to keep death at bay. Success can be as depressing as failure: more than two weeks after the tsunami wiped out many of the surrounding homes, the hospital is full of amputees - victims of injuries or, more recently, the infections that ravage the cuts and abrasions many suffered.

For days after the disaster, this was the only place to turn for people like Bactiar Hasan, whose seven-year-old daughter, Dalysah, had her knee crushed by a log after being carried an astonishing eight kilometres from her home. Hasan figures the tree saved Dalysah's life because it protected her from a falling bus. But the price was high, and today she rests on a cot in the hospital's breezeway, swatting away flies and silently studying the bandaged stump where her leg used to be. It's a heart-wrenching scene, but preferable to the alternative hospital staff face more and more. As many as 20 per cent of the patients needing surgery are simply refusing treatment, says Capt. Greg Brown, an Australian army nurse in charge of emergency services at the hospital; that leaves doctors and medical staff with little alternative but to provide palliative care as the patients slide toward death.

Watching them do so offends the humanitarian spirit, he admits. But after two weeks of trying to manage the physical and mental trauma that the tsunamis unleashed on northern Sumatrans, Brown has become philosophical. "If I'd lost my wife, my kids, and my means of making a living," he says, "and then someone said they wanted to take off one of my arms and one of my legs, I think I just might take my chances."

Maclean's January 24, 2005