Relief workers cope with fatigue, stress, and cultural gaps

BATTICALOA, Sri Lanka — Dead tired, Northwest Medical Teams workers were eating noodles near their destination Monday when a stress-induced tiff broke out, soon to be repaired.

Lorie Baker, a nurse who heads the team responding to the tsunami devastation on Sri Lanka’s east coast, felt that a colleague was trying to override her decision to talk with a local expert privately and to relay the advice to the other three team members.

“Whoa, you just had a really peculiar reaction to what I said,” said Tom Hoggard, a Portland doctor who maintained the foursome should hear out the expert together right away.

The details of their misunderstanding, which came near the end of a grueling 16-hour day, weren’t important. But the frayed tempers and the subsequent briefing taught at least two lessons about challenges facing the team and other relief workers rushing to respond to the tsunami that has killed at least 139,000 people and displaced millions in southeastern Asia.

First, good people can disagree amid trying circumstances. Baker and her volunteer team of two doctors and another nurse were dispatched by Portland-based Northwest Medical Teams last week on hours’ notice. Two 10-hour flights carried them halfway around the world, where they then ran a gantlet of vexing logistics in Colombo, Sri Lanka’s capital. On Monday they survived a harrowing nine-hour drive to the east coast. There, late at night, they rented and furnished a house.

Second, difficult conditions can complicate aid distribution in a developing country already suffering from civil war, corruption and economic woes. Eve Ekanayake, a Sri Lankan mental health expert and relief volunteer, used her impromptu dinner briefing to explain that politics has already overtaken relief efforts.

“That is why we refused the police escort when we arrived just now,” said Ekanayake, who had guided the team and its mounds of medicine and gear in two trucks from Colombo, the country’s largest city. An escort by authorities, in an area where anti-government feelings among Tamil minority members can run high, would immediately compromise perceptions of Northwest Medical Teams as a neutral humanitarian organization.

Likewise, Ekanayake said, team members — who urgently want to begin treating tsunami victims — could jeopardize their mission, even before getting started, by forming the wrong alliances. “You need to be sensitive about who you select for translation,” for example, she said, “and what kind of agenda they’re pushing.”

How are we supposed to know? Baker asked.

“I have no answer for that at the moment,” Ekanayake said.

And then there are cultural considerations as the team begins offering treatment and medicine in camps for desperate, displaced people. “In many of the camps,” Ekanayake said, “only the men come forward to receive stuff. So if there’s a household that doesn’t have a man in it, they probably won’t get anything.”

Baker, a seasoned humanitarian worker with experience coordinating aid, said Northwest Medical Teams has solved that problem elsewhere by announcing that during morning hours, team members would see only women and children patients.

Ekanayake said the city of Batticaloa, once a stronghold of the Tamil rebels fighting the government in Sri Lanka’s civil war, is in what is probably the third most devastated area hit by the tsunami. The area around Ampara, to the south, is apparently the worst-hit region, she said. The second worst is likely the northern coastal area held by the Tamils’ shadow government, which insists on controlling aid distribution there.

Ending the hurried briefing, the team pressed on to the house that Leads, a Sri Lankan development organization, had located for them to rent. In stifling late-night humidity, rummy humor took over as Hoggard, nurse Lisa Ripps and Dr. Bill Springer fumbled to erect a mosquito-net tent that would protect Baker from disease-carrying mosquitoes during her brief night’s sleep. “How many Northwest Medical Teams workers does it take … ?” quipped Baker, dissolving into laughter.

As team members met to outline Tuesday’s strategy, Hoggard took care to praise Baker in the presence of all for keeping the tired team on track all day.

“You’re doing a great job, and I know the stress,” Hoggard said. “So thanks.”