Long List of the Ailing Includes the Doctors Themselves

Friday was supposed to be free clinic day at this dirt road community of farmers and fishermen near the coast where the tsunami struck last month. But the first patient for three visiting American physicians turned out to be one of their own.

Neil Jayasekera, a 42-year-old doctor of Sri Lankan ancestry, awoke with a golf-ball-size abscess on his left leg that could have become dangerously infected. Wincing in pain, he sat in a thatched hut at a tsunami-damaged hotel as Mark Stinson lanced the abscess with a scalpel.

Used to running his own emergency room in the San Francisco Bay Area city of Martinez, Jayasekera barked commands to his friend of 11 years like a touchy back-seat driver. “Cut deeper,” he counseled through clenched teeth. “Make that incision longer.”

Stinson, who has worked alongside Jayasekera at their suburban hospital, finished his procedure with some doctorly advice: “I suggest you keep that foot elevated and not work today, but I know you’ll do what you have to do.”

Within an hour, Jayasekera and the rest of the team from Los Angeles-based Relief International (www.ri.org), including Vindi Singh, found itself in a rare situation. In the arena of humanitarian aid, often marked by stiff competition and spy-versus-spy tactics, the Americans were trading reconnaissance and supplies with a team from the French Red Cross that had set up camp just down the road.

Bringing their own box of supplies, Stinson and Singh were allowed to peruse a five-level shelf for medicine that their own arsenal lacked. They scanned the shelves like giddy food shoppers who had gone years without seeing a grocery store.

But in this Third World nation of 20 million residents, few plans go well for very long. The doctors were told that a military jeep supposed to take them the five miles from their hotel to Panama was unavailable.

Samal Gunaratne, the 40-year-old officer in charge of the local Sri Lanka special forces team, raised his hands and said he didn’t have enough jeeps to spare one for the doctors.

Dressed in jungle fatigues, Gunaratne said his ability to cope with the disaster’s aftermath was waning. He had worked largely without sleep since the tsunami struck Dec. 26. He and his men had discovered 200 bodies around the seaside town of Ulle. Most were buried right where they were found, without grave markers.

Many were children, which still grieves Gunaratne, a father of two. “I don’t sleep much these nights,” he said.

A private van was finally located to transport the team of doctors, but another problem arose. Stinson, 46, a veteran of numerous Relief International efforts in half a dozen impoverished nations, said he had suffered chills overnight, which he suspected were due to a contagious virus.

Ten years ago, he contracted a case of cerebral malaria in Africa and spent a week in a coma.

His family later said they had nearly given up hope, because he looked like a “big sickly-white, bloated cadaver.” He recovered, but promised he would never again take such chances with his health.

With the two ailing doctors, the team raced toward Panama, traversing a one-lane road that sliced through rice paddies dotted with loping egrets. They passed groups of fidgety monkeys and trudging water buffalo, the latter unusually thin because the tsunami had flooded their grazing fields with seawater and fouled their grassy diet.

Once in town, the aid workers set up their clinic in an open-air classroom. Jayasekera and Singh treated patients while Stinson handed out medicine with Ruth Zueblin, 28, a Swiss aid worker who had joined the group for a few days after arriving on her own. The group also secured the services of three local interpreters: two schoolteachers who usually taught in that very classroom and a 20-year-old man named Mohammed, whose dream was to one day go surfing in Hawaii.

They set up chairs to accommodate the men and women who began to trickle into the room. At first, the patients sat in the order they had arrived, but Singh suddenly observed, “I think our patients have decided to segregate themselves on the basis of sex.” She motioned to the crowd of mostly Buddhists -- men sitting on one side of the room, women on the other.

Over four hours, the team saw more than 130 patients, wide-eyed children, men wearing saris and Nike baseball caps and women who smiled shyly as they proffered their medical records written on a lined children’s essay tablet. Some wore thongs on their feet; others were barefoot.

For many, their complaints were directly tied to the tsunami. There was the man thrown from his boat onto a nearby beach whose foot was badly gouged; the woman whose hand was broken when a wave-weakened building toppled; the women and children injured as they ran in fear from the giant wave.

Some wounds were psychological, like those suffered by the woman in the bright orange sari who had lost five relatives -- her parents, grandparents and sister. She was living with friends because her house was flooded. Her husband had lost his boat, the couple’s livelihood, in the disaster.

She told the doctor she couldn’t sleep. “All I can say is that it’s going to take time to feel better,” Singh, a Bay Area family physician, told the weeping woman.

“It’s just such a huge loss. You have to spend time with the family you have left, crying and talking about it. But everyone in the world knows what has happened here. The aid will come and hopefully it will help you and your husband build another life,” she said.

In a community of 5,000 people, with one overworked resident doctor who was recently seeing more than 130 patients a day, the tsunami isn’t the only disaster. Many chronic illnesses also go untreated. The American doctors could only sigh as they faced Panama’s long-term needs.

There was the boy with the congenital hole in his heart, the men and women with neck and shoulder pain from stooping in the rice fields. There was the 2-year-old boy with cerebral palsy, held lovingly by his father who looked at Jayasekera with a hope of a cure he knew couldn’t be delivered.

There was the man who complained of a headache he said had lasted five years; the man whose left hand mysteriously became paralyzed two months ago; the teenager with an uncomfortable ear fungus; the woman who coughed uncontrollably from her asthma as she waited in line, gasping for breath.

There was the 12-year-old boy who had recently lost sight in one eye from what the doctors determined was a corneal ulcer. “In the U.S., this boy would be immediately hospitalized and given steroid drops” and antibiotics, Jayasekera said.

He advised that the boy be seen by a specialist the next day, but the child’s mother softly responded that she couldn’t afford the $2 to take the boy to a distant clinic by bus. Jayasekera reached into his pocket and gave her the money. “Otherwise,” he said, “this boy is going to go blind” in one eye.

The doctors ended their day visiting the local Panama dispensary, where they promised to send drugs to a medical outpost that had already run dangerously low on supplies and would wait another two months to have its stocks refilled.

On the way home, they stopped at a refugee camp outside the town of Ulle where 3,000 people had crammed into dirt-floored, aluminum-walled huts after their homes were destroyed by the tsunami.

The doctors planned to return to the camp the next day. But for now, they posed for pictures with the crush of curious children. Then, exhausted, they retuned to their base camp to meet with French officials and plan their next aid efforts.

The work was taking an emotional toll. Early Friday, as she walked down a dirt road paced by dogs that were once family pets but whose owners were now dead or missing, Singh talked about the weight of what she was seeing.

“Someone should publish a book or a report with the names and a short biography of every person killed or missing in this disaster,” she said, her eyes cast downward. “These people were important to those who loved them. They deserve to be recognized.”